Giving birth through Caesarean Section has been demonised by society over the years. This has cost many women their lives, thus, contributing to Nigeria’s ranking as the second country with the highest maternal, neonatal and child mortality figure globally, AMARACHI OKEH writes
When Toluwani Esho was informed by her doctor that she would birth her baby through a Caesarean Section due to safety concerns, disappointment set in, especially as she had anticipated and keenly looked forward to vaginal delivery.
For her, the biblical Hebrew women’s experience had been prophesied as her lot by many pastors, and the new verdict by the doctor seems to contradict her belief.
Going against the doctor’s recommendation, after being in labour for 48 hours, she knew if she didn’t accept CS, she could lose her baby or her own life.
When she eventually agreed after the dangers of going against the doctor’s advice were laid bare, getting the approval of her husband became another hurdle to cross.
He would not hear anything of it and vehemently kicked against the CS option by holding on to what his pastor, especially, said.
Moreover, not having the sum needed for the procedure made it a difficult choice.
When Toluwani eventually went into labour weeks later, for hours, she writhed in pain as dilation of the cervix progressed slowly.
At a point, family and friends begged and appealed to her husband to sign the approval form authorising the operation to avert the loss of both mother and child.
Recounting her experience, she said, “My husband was the only one that wasn’t in support of me undergoing the surgery. It was after he saw how much pain I was in during labour, coupled with my mother’s begging that his heart softened.”
According to her, after the delivery, life has not been easy as the experience left her depressed and sad.
“I usually have suicidal thoughts,” she told our correspondent with a sad expression.
While Toluwani was lucky, some women were not, and one of them was Nneoma Ogadi.
The desire of this young woman to one day hold her baby after two painful miscarriages, was killed when her husband dragged her from the hospital while in labour to a run-down maternity ward in the neighbourhood.
Nneoma’s husband, it was learnt, thought the hospital was trying to fleece him of his hard-earned money when his wife was scheduled for a CS.
A friend of the deceased, Rose, while recalling what transpired and which led to Nneoma’s death in Enugu said, “The doctors said she would have to undergo CS as the labour was taking long, but her husband refused, saying the hospital wanted to ‘eat’ his money.
“He took her to one maternity clinic and after being in labour for several hours, she and the baby died. The CS could have saved her life. She had looked forward to carrying that baby after having two miscarriages. She lost her life because her husband thought she should be given enough time to give birth as a Hebrew woman.”
Horrifying numbers
A 2023 report by the World Health Organisation titled ‘Improving maternal and newborn health and survival and reducing stillbirth: Progress Report 2023,’ revealed that Nigeria took second place after India in the latest ranking of countries with the highest number of maternal and child mortality.
According to the report, in 2020, about 540 women and children per thousand died in Nigeria, while 788 women and children died per thousand in India.
Nigeria was also noted to account for 12 per cent of global maternal, and neonatal deaths and stillbirths, and India was pegged at 17 per cent.
Similarly, the United Nations Economic Commission for Africa also revealed that one in seven global maternal deaths occur in Nigeria, which is more than 50,000 women dying per year in Nigeria
CS, a lifesaving cut
A caesarean section is a surgical procedure for delivering a baby when vaginal delivery can’t be done safely, experts explain.
The medical procedure can be planned ahead of time or performed in an emergency. However, it carries more risk than a vaginal delivery, with a slightly longer recovery period.
Caesarean Section is generally divided into two, elective and emergency.
A Consultant gynaecologist and obstetrician, Samuel Illikannu, explained that even under emergency there are two types, urgent and scheduled.
He added that emergency CS must be carried out within 30 minutes as any delay might cost the life of the mother and child.
Illikannu further explained that there is what is known as urgent CS, and its time frame is between 60 and 75 minutes, while that of scheduled, can take up to a day as well, just like that of the pre-planned/elective CS which can be fixed at the convenience of the mother and doctor.
According to the World Health Organisation, a CS can be an essential and lifesaving surgery but can still put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need.
WHO, however, noted that the procedure must account for only 10 – 15 per cent of births.
“Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed,” said WHO’s Department of Sexual and Reproductive Health Director, Dr Ian Askew.
Furthermore, the agency explained that caesarean sections are essential in situations such as prolonged or obstructed labour, fetal distress, or because the baby is presenting in an abnormal position.
As with all surgeries, there are risks with CS, WHO noted, adding that they include the potential for heavy bleeding or infection, slower recovery times after childbirth, delays in establishing breastfeeding and skin-to-skin contact, and increased likelihood of complications in future pregnancies.
Not woman enough?
In as much as CS has been described as a lifesaver for women who are unable to give birth naturally, in Nigeria, there are still barriers that prevent women from accessing this service when needed.
In April 2022, Halima Nwankaego, the daughter-in-law of former Kaduna Governor, Nasir El-Rufai, issued a stern warning to her Instagram followers to desist from making derogatory comments after they touted her for ‘not giving birth to her twin boys’ because she had a CS.
Speaking against this backdrop, Adaobi Okolo, a nurse with the Nnamdi Azikiwe University said, “It is not surprising that some women are still being shamed for not being ‘woman enough’ to deliver through the vagina by women, husbands, mothers, and family members for giving birth through CS and as a result, some have sworn never to disclose that they birthed their child through CS.”
Taboo
Having run a CS awareness and advocacy organisation known as CS Mums Initiative, for five years, Oluwajerimi Adewale said she has seen her fair share of bizarre cultural reasons why women are not supported to undergo the procedure, but acknowledged that the situation has improved in the last 10 years.
She noted that the most shocking cultural reason why some women reject CS is that their relatives would tag them as being promiscuous.
“They believe that maybe while pregnant, the woman had an affair with another man, which is why she has to go under the knife to deliver. To them, it is taboo to go under the knife.
“While cultures and traditions keep pregnant women in bondage, older women and mothers-in-law have also been known to forbid their sons from supporting their wives to undergo the procedure,” she added.
HMOs’ complicity
While Nigerians are urged to subscribe to a health insurance plan, it appears that some Health Management Organisations are determined to undermine the health of subscribers as their interest is to maximise profit at the expense of lives.
A mother that insisted on being identified only as Adaobi, who recently had her son through CS, told our correspondent that barely two hours before her elective surgery, she got a call from her health insurance manager suggesting she opt for vaginal birth.
This HMO manager didn’t ask why she was recommended for a C-section.
She said, “I was scheduled to give birth between 12 and 3 am on May 4, but around 11 pm, I got a call from my HMO that they would like to discuss something with me.
“At that time, my hospital was seeking approval from my HMO before proceeding. My HMO manager called me to say he noticed that the hospital wanted me to give birth through CS but that hospitals try to schedule CS for pregnant women even when it is not necessary. He then told me that he could suggest two hospitals where I could give birth through the vagina.
“I was shocked because this was just less than an hour before the operation. I told the manager I opted for elective CS because of my medical history.”
Unsafe maternity clinics, TBAs
For most women who cannot afford to give birth in well-equipped hospitals that handle CS, the alternative is typically maternity clinics and traditional birthing home attendants, and in worse cases, their homes.
But with the proliferation of quack maternity clinics and birth attendant centres, the life or death of a woman in labour swings on a pendulum in the hands of those operating such centres.
According to a Consultant Gynaecologist and Obstetrician, Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Stanley Egbogu, there are more maternity homes in Nigeria than there are specialist hospitals, and most of the operators are not trained.
“They are just parading themselves as delivery homes and they sometimes cause a lot of problems because they are the first persons these women get in contact with,” he added.
Recalling an experience etched in her memory, Nwokolo recounted the ordeal of a woman who lost her baby and womb due to insisting on a stubborn choice to deliver at a maternity clinic.
TBA speaks
However, speaking with our correspondent, a Lagos-based Traditional birth attendant, Ramota Osho, said people who prefer to give birth using a TBA must be mindful of the type of TBAs they use.
This is because certified TBAs conduct tests to ensure that health indicators truly show that the woman can give birth through the vagina.
“We also examine the mothers for seven to eight days before the due date of delivery to take note of any change before labour begins
“Whenever women have labour pains, we observe them too to ensure they can handle it as there’s no fixed duration of labour for women. Some women would have laboured for four hours but when we observe that there are changes in their blood pressure, dilation of their eyes or they look exhausted, the first thing we do is contact their family members,” she said.
‘Awareness must be intensified’
In Nigeria, the positive awareness of C-sections is still very low, hence the prevalence of negative beliefs and stereotypes of the procedure. A bottom-up approach is crucial as cultures and traditions are strongholds that imprison women, said Nwokolo.
On why there needs to be more positive awareness of CS, Adewale noted that if a woman refuses CS and is in labour till the baby dies, the CS would still be done to evacuate the dead baby from the womb.
“Why not do a CS to have a living baby rather than not having a child to show for the scar you end up having,” she quipped.
According to her, the government’s intervention in reducing maternal and child mortality has to be a multipronged approach.
She said there is a need to create and ramp up multi-level awareness programmes to educate mothers, and families about CS.
With the majority of Nigerians below the poverty line, another is to offer free medical services and provide free CS and vaginal delivery for mothers.
According to Illikannu, in Delta State, women eagerly come to the general hospitals as the services are free but when they are referred to federal medical centres for surgery, they get agitated and panic due to the cost.
Egbogu added, “likewise, good roads make it easy for pregnant women who are in dire need of emergency CS to access medical care where such women are referred from lower hospitals or TBAs
“Another is stamping our quack maternity clinics to reduce incidents of maternal and child mortality.
“Also, the importance of HMO cannot be overemphasised as it helps families to spend less on delivery,” he said.
