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Caesarean is safe delivery method

NOMSA NKANA, Lusaka
THE University Teaching Hospital (UTH) conducts 20,000 deliveries yearly out of which 4,000 are Caesarean Operations also known as C-Sections.
There are many contradictory theories about where the term C-Section comes from.
Some argue that it is named after Julius Caesar, a Roman statesman, who is alleged to have been so born.
This theory, however, has been shot down because although caesarean births have been carried out since ancient times, in Rome it was usually only performed once the mother was dead. Caesar’s mother lived for many years after his birth, hence the unlikelihood.
Another theory from the Encyclopaedia Britannica Online states: “According to ancient sources, the procedure takes its name from a branch of the ancient Roman family of the Julii, whose cognomen Caesar [Latin caedere, “to cut”] originated from a birth by this means; some modern historians doubt that this is true.”
However, putting the origin of the term aside, Caesarean section is a surgical procedure (operation) in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterectomy) to deliver one or more babies.
In a caesarean delivery, an incision (cut) is made in the skin and into the uterus at the lower part of the mother’s abdomen.
The incision in the skin may be vertical (longitudinal) or transverse (horizontal), and the incision in the uterus may be vertical or transverse.
The C-section procedure is done when it is determined to be a safer method than a vaginal delivery for the mother, baby, or both.
UTH consultant of Obstetrics and Gynaecology Dr Belington Vwalika says the hospital performs 8-13 C-sections every day.
Dr Vwalika explains that there are two types of C-sections that are performed namely transverse and longitudinal.
According to Dr Vwalika, a transverse incision extends across the pubic hairline, whereas, vertical (longitudinal) caesarean incisions extend from the belly button or naval down to the pubic hairline.
He said a transverse uterine is the most common type of caesarean section because it heals well and there is less bleeding.
According to him, transverse uterine incisions also increase the chance for vaginal birth in a future pregnancy.
However, the type of incision depends on the conditions of the mother and the foetus, Dr Vwalika said.
CONDITIONS FOR C-SECTION
There are several conditions which may make a caesarean delivery likely to be conducted.
• If the baby is not breathing well, this could be a good cause for a C-section.
• When the baby is too large to be delivered vaginally.
• If a woman has a small pelvis.
• If a mother has had two or more previous caesarean operations.
• When a mother has certain medical conditions such as severely raised blood pressure (BP)
• If labour fails to progress or does not progress normally.
Dr Vwalika said there may be other reasons for a doctor to recommend a caesarean delivery adding that reasons for this procedure may vary from mother to mother depending on the symptoms they present.
BEFORE PROCEDURE
The doctor will explain the procedure to the mother and give her the chance to ask any questions that she might have about the procedure.
She will also be asked to sign a consent form that gives the doctor permission to do the procedure.
The doctor will ask when the mother last had anything to eat or drink.
If the caesarean delivery is a planned procedure and requires general, spinal, or epidural anaesthesia, the mother will be asked to not eat or drink anything for eight hours before the procedure, generally after midnight.
The mother must notify the doctor of all medications (prescription and over-the-counter) and herbal supplements that she may be taking.
She must plan to have someone stay with her after the procedure.
For the first few days, she may have pain and will need help with the baby.
Based upon the medical condition, the doctor may need her to do other things to be ready for this surgery.
When ready for the operation and also before the procedure is done, the mother will be given prophylactic antibiotics.
Dr Vwalika said a caesarean delivery is done in an operating room or a designated delivery room.
“For this procedure, there are two anaesthetics that are used, these being regional anaesthesia and general anaesthesia,” he said.
Regional anaesthesia is also known as a nerve block, epidural, or spinal anaesthesia.
It involves injecting an anaesthetic medication around certain nerves in the spine so the mother does not feel anything below the waist.
According to Dr Vwalika, this is the most common form of anaesthesia for non-emergency caesarean sections because it allows the individual to remain awake to experience the delivery.
General anaesthesia is a combination of intravenous (IV) medications and gases that put the mother in a deep sleep.
She is unaware of the procedure and will not feel any pain.  The mother may also receive an injection or continuous drip of liquid anaesthetic, which will flow through a tiny tube inserted near the surgical site to control pain during and after surgery.
WOUND CARE
The muscle, skin incision, and tissue layers will be closed with sutures.
Dr Vwalika said no foreign bodies such as methylated or surgical spirits or any other should be applied to the wound as it is able to heal on its own.
He also said depending on the material used to stitch the wound, the stiches can absorb themselves or they can come off after five days.
He said when wounds are taking long to heal, it may mean an infection has set in.
Dr Vwalika has also dismissed theories that C-sections have the tendency to pain in cold weather.
“After the wound heals, there should be no pain unless the mother has a medical condition,” he added.
He has also dismissed the myth that children born through C- section have a high Intelligence Quotient (IQ).
Having a caesarean section does not necessarily prevent one from having vaginal deliveries with future pregnancies.
However, vaginal birth after caesarean (VBAC) does carry a small risk of uterine rupture.
This is a serious complication that can endanger both the mother and baby.
A healthcare provider is best able to guide a mother’s delivery choices based on her circumstances.

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