Monday 20 November 2017

To section?

Having a baby by Caesarean section brings increased risks and longer recovery, but in some cases it is simply the best option. We ask Dr Sharon Cooley of the Institute of Obstetricians and Gynaecologists about the pros and cons

WITH at least one in four babies born in Irish hospitals delivered by Caesarean section (C section) - some planned, some emergency - it's something every expectant woman considers at some point during her pregnancy.

The reasons for planned C sections are many and varied, as Dr Sharon Cooley of the Institute of Obstetricians and Gynaecologists, a consultant at the Rotunda in Dublin, explains.

"For example, there could be a bottom-first/breech presentation, which suggests the safest mode of delivery would be planned C section. For some it's the placenta; if it is overlying the neck of the womb [placenta praevia], ideally there would be a C section because of the risk of major haemorrhage."

She says another reason would be concerns about the mother's health in cases where there is a pre-existing condition (an example would be a heart complaint). "Also, where there is pre-eclampsia [pregnancy-related high blood pressure], a planned C section will minimise the risk to the mother's life."

Of course, not all C sections are planned. According to Cooley, the most typical reason for an emergency C section is where a woman's labour is failing to advance despite the usual steps being taken. At that point, concerns for the well-being of both the mother and the baby would indicate delivery by C section.

Risks and recovery

It may be quite a common procedure, but a C section constitutes major abdominal surgery, and brings with it all the attendant complication risks. While most women and their babies come through it perfectly well, complications arise in some cases. For the mother, this can include a negative reaction to the anaesthetic, haemorrhage, damage to adjacent organs, or thrombosis. Complications for the baby are rare; the most common would be breathing difficulties.

"The risks with C section are higher than a normal delivery, possibly two or threefold," says Cooley. "However, from a mother's perspective, having it means you avoid labour and therefore your baby undergoes less stress."

Recovering from a C section takes a bit longer than recovering from a vaginal delivery, with most mothers staying in hospital between three and five days. "Most women would be mobile within 24 hours, however, which is important to reduce the risk of clotting," says Cooley. "They would usually be off painkillers within a week."

Women are then recommended to take just very light exercise for six weeks, and nothing high impact for three months. "It does limit your life, particularly if you already have young kids at home," says Cooley.

After a C section, many women will not feel fit to drive for several weeks, and most avoid it until after their six-week check. If you do want to resume driving, make sure your insurance policy will cover you.

Maternal request

Sometimes, a C section will be performed purely because the mother has requested it in advance. There may be various reasons for this, but it is often because of a fear of labour. "You go through their reasons with them, as it's not a decision any woman should take lightly," says Cooley. "Most women are very frank and tell you what their concerns are. Most are also very well informed. Once you've gone through the risks with them, it is their right to choose."

It is not recommended that a woman have more than three C sections, however. "After that, the risk of placenta praevia or other placental abnormalities, such as where the placenta invades the womb muscle, rises significantly," says Cooley.

Having an emergency C section on one baby doesn't preclude you from giving birth vaginally on a subsequent baby. "It just depends on the indications of the C section, so for example if you had one because of foetal distress in labour, and you go into labour on another baby, the chances of your having a normal delivery are 70pc."

Rate

Ireland has a relatively high C section rate, well in excess of that recommended by the World Health Organisation (WHO), and considerably higher than it was in the Nineties.

"It has certainly gone up," says Cooley. "In 1990 it was close to 11pc, while OECD data from 2009 put it at 26pc."

However, Cooley says the 10-15pc rate recommended by the WHO makes for a very narrow window. "If the rate is less than 10pc that suggests the C section is under-used. It should very much come down to managing each woman as an individual. Every baby and every mother is different. Whatever affords a mother the best chance of taking her baby home should be the mode of delivery decided on. There should be less focus on the rate."

Irish Independent

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