A caesarean, commonly known as a “c-section”, is a procedure that’s done to deliver a baby surgically when the mum or baby is at risk at birth. The month of April is International Caesarean Awareness Month and we wanted to hear the experiences of women in Botswana. We had a chat with Medical Doctor at Princess Marina Hospital, Dr. Tumie Mphusu, and a few wonder mums who shared their experiences with us.
What are the statistics in Botswana?
It’s a little hard to quantify. Generally, the number of c-section births in government hospitals is lower than in private hospitals. In government, a c-section is only done when it’s absolutely necessary and natural birth isn’t possible. This is because c-sections are expensive and the government healthcare system can’t afford to have mums give birth through c-section when natural birth is an option. This is different for private hospitals as parents have more flexibility in choosing to give birth by c-section.
What’s the good and the bad about c-sections?
Natural birth safer and easier.
As with any surgery, caesarean sections are associated with short and long term risk . Which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies… Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.World Health Organisation (WHO) Statement on Caesarean Section Rates
When is a c-section necessary?
An elective c-section is planned when there are medical conditions for high-risk pregnancies that could hinder the birth of a baby. This includes mums who’ve had operations previously, or when there are complications or no progression during labour contractions.
Emergency c-section is done when there’s foetal distress. This can be due to the baby not breathing well, decreased or increased heartbeat, the umbilical cord tied around the neck, or umbilical cord prolapse. Another reason could be placental abruption where the placenta separates from the inner wall of the uterus before birth. Or placenta previa which can cause severe bleeding during pregnancy and delivery. The most common cause in Botswana is pregnancy-induced hypertension known as preeclampsia.
What are the pros and cons of having a c-section?
One of the biggest disadvantages of a c-section is the scar tissue building because of the surgery. This can affect other internal organs. The second is in the event of general anaesthesia the mum could go to sleep and not wake up, and there wouldn’t be a specific reason. It’s generally hard to tell how people will respond to the medicine and no one can anticipate some of the deaths. There are also higher risks as with any surgery because of human error and there’s a risk of bleeding out due to internal organ damage. Post-operation pain can be difficult to deal with and recovery takes longer compared to natural birth.
Having said that c-sections do have their advantages as mum doesn’t have to go through hours of labour contractions. Generally, delivery is complete within an hour, and compared to other surgeries, a c-section is one of the easier operations. Now with modern medicine, you leave with a cute small scar as if nothing ever happened, and mum’s vagina doesn’t go through as much trauma as it would with natural birth.
How many children can one have with c-section?
The Botswana healthcare system allows up to three births after which they then close your tubes. The reason being that with every operation the uterus is not the same as before and mum is more prone to having complications because of the scar tissue, or in some cases a hysterectomy if the uterus is damaged. From the second surgery onwards, there has to be a specialist nearby in case there’s damage to a nerve or artery during the operation.
Who decides on the c-section
Experiences differ between government and private hospitals. Government hospitals encourage natural birth as it’s cheaper, easier, and safer. In private healthcare, there’s more freedom to opt for a c-section.
If I’ve had a c-section before, does it mean my next birth will also be a c-section?
This is not necessarily the case, natural birth is still possible depending on the health and well-being of mum and baby.
What emotions do mums go through before, during and after surgery?
As with any operation anyone can be scared before surgery because they don’t know if they’ll wake up or not.
During surgery mums can be anxious if they are feeling tugs if it’s a hard extraction. The upside of this is they get to ask questions and converse with the doctor and nurses during surgery and they get to see the birth and baby immediately.
Post surgery mums will experience pain as we have to force a walk on the same day, which is not easy. The operations also takes 4-8 weeks to heal.
What’s the difference between general and local anaesthesia?
Spinal anaesthesia is preferred as mum is awake and this helps both doctors and mum see how mum is doing. General anaesthesia is where mum is asleep and this is the least preferred as anaesthesia is a muscle relaxant and there will be no contractions in the uterus. Also anaesthesia can wear out during the operation and we wouldn’t know as doctors. Lastly, some mums struggle to accept the baby as they did not see the birthing process or the baby after birth, but this is not always the case..
What’s your favourite story from c-section?
There are so many! All mums and babies are warriors, especially during covid times.
A story that comes to mind is mum had to do an emergency c-section as the baby was showing signs of distress but it was hard to tell why. When we were able to get into the uterus we noticed that the baby’s umbilical cord was wrapped around the neck twice but there were signs of life. The resuscitation team helped and the baby survived with no complications from lack of oxygen.
This was during the time when the blood reserves in the country were running low and mums uterus needed blood to help it contract, which wasn’t available.Hours later there was still bleeding from the uterus and we had to do a hysterectomy. Once the uterus was extracted she was fine and both mum and baby were on their way to good health.
All mums and babies are warriors, especially during covid times.
Here Are Some Personal Stories From Some Strong Mamas
I had a c-section with my firstborn. I had a normal pregnancy without much difficulty until the last week before giving birth. For the duration of the pregnancy, I’d been preparing for a natural birth with my gynaecologist and that’s what I was expecting, the conversation about a planned c-section only came up a few days prior to my due date when the doctor noticed that the baby was not in cephalic position. We then discussed and finalised to go through with surgery. It was scary because I was expecting a natural birth and had budgeted for it. My husband and I had decided that I would give birth in a private hospital and the charges for surgery are a little steep.
An appointment was set up with my anaesthesiologist, who briefed me on what was going to happen and what I could expect. We also sat down with my gynaecologist who walked me through the process. The choice of whether I wanted to sleep through the delivery or to be awake was ultimately mine. I chose to be awake.
On the set date, I arrived at the hospital and went straight through the first procedure to get ready and was taken to the theater. I was expecting something different, especially since this was a first-time experience for me, but the process was easy without pain. It was also an easy experience because the nurses around me would chat with me. At some point, I closed my eyes just to rest and think through the process, the nurses tapped my face to check if I was still alive. Which i thought was thoughtful.
The first thing to note is to trust your doctor when they recommend the c-section. They know best. Research more on whether to do spinal or general anaesthesia, get the information from your doctor on which one they prefer and why. In the lead up to surgery make sure to stay calm, a high blood pressure complicates things. Make sure to shave completely the day before the procedure.
There will be pain after the surgery, especially when you get off the bed post-surgery. Walk as much as possible after the procedure, but be careful not to overdo it, lying down slows down healing. Use surgical spirit to clean the would and keep it dry.
You will need to use a catheter to wee, it’s uncomfortable but not painful. Don’t lift anything heavier than baby the first two weeks after birth.
The best part was there were no painful stitches or stretching in my vagina, you stay intact down there.
So mine was an emergency. I started off with labor which didn’t progress well of which in the process the baby ended up in distress and we had to go for an emergency c-section. I just remember being given something to drink which completely knocked me out, next thing I woke up in theatre feeling tired and groggy, everything was done, the baby was out, safe and sound. Stitching was all done and I was taken back to my room where I found my baby waiting. My husband brought the baby to me to see but unfortunately I couldn’t hold her at the time as I was still feeling tired, dizzy and a bit confused.
I only started feeling a lot of pain after midnight when the effects of the anaesthesia were starting to wear off. I spent two days in the hospital and once I was back home I just took it easy and followed the doctor’s directions of the do’s and don’ts. In less than 2 weeks I was starting to feel normal again, I can’t really say I have had any major side effects from it up to today (almost 2 years now).
I went in for induction at 8 am, which didn’t take. I got induced again 12 hours later, still nothing. Past midnight decision was made to do an emergency c-section. I was caught off guard but trusted our ob-gyn completely. He was friendly, point-blank, and relatable. The anesthesiologist was terrible and cold, but our Dr was there with us so that helped.
I came out of the surgery, freezing, I couldn’t move, talk and was so cold. At last I was wheeled back to my room where my husband was waiting, excited and nervous. He asked me my name and our first-born’s name.
I was was on a morphine drip for a few days. Enjoyed that, might have abused it a little. Healing was painful, but I’m a warrior woman. I did what was necessary.
I got my husband to insert my bum pills. He must be a part of the whole experience, right? He also helped daily with cleaning the c-section. All-in-all it wasn’t terrible. I just wasn’t ready for it. It was never an option we looked into or read up on.
It’s always important to remember that every birth is amazing, no matter how it happens. We’re not medical professionals but are passionate about sharing personal experiences. Always consult with your ob-gyn for all your pregnancy and childbirth questions.
We celebrate all Mamas who’ve had a c-section and natural birth, enjoy the journey as you build your nest.