Tuesday, 8 March 2016

CAESAREAN SECTION AND THE SIEGE OF IGNORANCE



Eloho is a booked 33 year old primigravida and staff of a hospital who presented at a gestational age of 39weeks+2days on account of drainage of liquor five hours prior to presentation. Her labour was augmented. However, following an assessment of prolonged second stage of labour secondary to cephalopelvic disproportion, she was counseled on the
need for an emergency caesarean section (C/S) which she declined.
At the 8th and 16th hour reviews, with obvious fetal distress, she was offered caesarean
section. Again,she bluntly turned it down. Eighteen hours post presentation, she had assisted vacuum delivery of a male neonate that weighed 3.97Kg with an Apgar score of 2 in 1minute and 3 in 5minutes. Attempts at resuscitation failed.
She had postpartum hemorrhage with third degree laceration that was repaired under anaesthesia in the theatre.  

Rita is a booked 31 year old G2P1+0 A1 Nurse who presented in active phase of labour at a gestational age of 40weeks +1day. Labour was augmented due to poor progress. An assessment of prolonged second stage of labour secondary to persistent Occipitoposterior position was made and she was counseled on the need for an emergency caesarean section.
One would have expected that being a nurse, she would have appreciated the untoward consequences of the assessment made and wouldn't hesitate to give an informed consent. Alas... She declined.
Later, her husband came around and muttered something about Hebrew women delivery in her ears.
At the 12th hour review, with obvious fetal distress and chorioamnionitis, she was again counseled for  C/S which she refused.
Eventually, with much scolding and admonition from her fellow nurses, she reluctantly agreed to the operation and signed the informed consent form. 
She was quite lucky as she was delivered of a live female neonate that weighed 3.15Kg with an Apgar score of 7 in 1minute and 10 in 5minutes.
Laughably, on her husband's return(the consent form was signed in his absence), rather than being thankful to God and appreciative of the effort of the doctors, he kept threatening to sue the medical team for operating on his spouse.
Anyway, I wouldn't blame him much. I would rather blame the nurse who placed such decision bordering on her reproductive right and life in the hands of a lay and misinformed husband.  (Oh oh!!! I expect a tidal burst here).

The above real life instances highlight the widely held misconception about caesarean section (C/S) amongst women in general and women of southeastern extraction in particular who view anything short of a vaginal delivery as a failure of maternal achievement. This misconception is further compounded by the widely held and taught, but misinformed and misunderstood concept of the 'Hebrew Women Delivery' amongst Christian faithfuls.
Whereas the traditional Igbo woman who goes under the knife to have her baby is dismissed by her family (particularly her mother in-law) and scorned at by the Umuada as being weak and unworthy of womanhood, the Christian woman's case is further compounded by her pastor and brethren who think her deficient in the faith due to her perceived failure in 'claiming' the promise of the 'Hebrew Woman Delivery" protocol.
On the flipside, In the western world, about 37.9% of women willingly book for elective caesarean section as their preferred mode of delivery. Therefore, that a woman undergoes a C/S to have her baby does not make her any less a woman, it equally does not make her any less a believer of God's promise of a safe delivery for His daughters. For indeed an uneventful Caesarean Section with good fetomaternal outcome is equally synonymous to a 'Hebrew Woman Delivery'. (Agreed?)
With respect to Caesarean section, the depth of ignorance is so deep and it's grip so firm that even health workers are not spared its siege and spell.
For if the average 21st century registered practising health worker in a Federal Teaching Hospital has such a skewed perception of Caesarean Section, one can only but wonder at the burden of ignorance on the streets.
Ignorance can be bliss, but certainly not in matters of health.
Dr Ogbu Nathaniel
07039040488
Enugu, Nigeria. 
Article written by Dr Ogbu Nathaniel and edited by Dr Orabueze Ibuchukwu.

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