Births by caesarian section: Reasons behind the rising trend

The number caesarian sections carried out in Mauritius has nearly doubled over the past fifteen years. In 2000, 26.8 per cent of births were by caesarian sections while the figure reached 47.3 per cent in 2015. What explains this situation?

In a statement issued in 2015, the World Health Organisation took a firm stand against the rising recourse to caesarian section (C-section) for birth deliveries. “Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons.” The Organisation is worried about an indiscriminate recourse to this method of delivery and the lack of a proper mechanism to assess need.

Couples often blame the medical staff for the increasing recourse to this delivery method while healthcare professionals put forward hospitals and doctors for this rise but doctors advocate various reasons and causes for this increase. The World Health Organisation recalled that since 1985, the international healthcare community is of the opinion that the ideal rate for caesarean sections to be between 10-15%. However, the figures are much higher for high-income and medium-income economies.

In the year 2000, out of a total of 16,834 births in Mauritius, 4,508 that is 26.8% were done by caesarian section, at the same time, 382 instrumental births were carried out. By the year 2015, out of a total of 8,727 births recorded in the country, the number of caesarian sections carried out stood at 4,125 that is 47.3% while the number of instrumental deliveries dropped to 155.

Consultant in charge Obstetrics and gynaecologist Dr Toolseeram Rugbursing reveals that the rise depends of various factors. There are four main reasons why C-section is performed:

• history of previous caesarean section
• fatal distress 
• abnormal labour 
• breach position 
• HIV positive

However, the medical practitioner advocates that a patient can undergo an emergency c-section in some life threatening circumstances such as: when the cervix stops dilating or the baby stops moving down the birth canal, and attempts to stimulate contractions to get things moving again haven’t worked; when the baby’s heart rate poses concern; or when the umbilical cord slips through the cervix.

What explains the rising trend

Dr Rugbursingh reveals that there are various factors for the increased rate of caesarian section in Mauritius such as: teenage pregnancy, first pregnancy above 35 years, diabetes or hypertension and pre-mature births.

The consultant explains that teenage pregnancy is on the rise and this is one of the causes why the rate of c-section is increasing. “Girls in the age range of 15-16 are getting pregnant. We had even one case where a girl of 12 was pregnant. In most of the cases, being a young girl, the body is well not developed. The cervix is not strong enough to deliver. For such cases, the risk of abnormal labour is higher. Moreover, another trend is many women are having their first child at the age of 35. In such cases, there are often complications that increase the likelihood of having recourse to a c-section. Similarly, many pregnant women suffer from gestational diabetes which leads to various complications and they cannot end their terms.”

Measures to be taken 

Dr Rugbursingh lists three main measures pregnant women should take and follow:

• Nutrition
• Physical activity
• monthly check up

The gynaecologist reveals that often women neglect their health and misses their monthly check ups. “Ante natal check up is very much important and cannot be ignored. It is a way for doctors to monitor the health of pregnant women through tests that are done. Many women are ignorant about the importance of ante natal visits. During the visits, doctors prescribe necessary vitamins that the women lack, for example, iron for anaemia and calcium for bone growth. It is essential for pregnant ladies to undergo tests like electronic cardio and topographic monitoring.” 

Similarly, the gynaecologist stresses on good nutrition and physical activity. “Pregnant women should eat healthy. They should imperatively eat protein food and vitamins and avoid fatty food. Physical activity is important for a normal delivery. It is during ante visits that doctors and nurses explain to women what kind of exercises they can perform. If a woman keeps on resting or sleeping, she is harming itself. Moving is very important.”

Exercises to do when pregnant 

Plié

Stand parallel to the back of a sturdy chair with the hand closest to the chair resting on it, feet parallel and hip-distance apart. With your toes and knees turned out to 45 degrees, pull your belly button up and in. Bend your knees, lowering your torso as low as possible while keeping your back straight. Straighten your legs to return to starting position. 

Side-lying inner and outer thigh

Lie on your right side, head supported by your forearm, right leg bent at a 45-degree angle and left leg straight. Place your opposite arm on the floor for stability. Lift left leg to about hip height and repeat for reps. Then, bend your left knee and rest it on top of pillows for support. Straighten your right leg and lift it as high as possible for reps. Switch sides and repeat for reps.

Curl and lift

Sit on the edge of a sturdy chair with your back straight, feet on the floor, arms at your sides. Hold a 5- to 8-pound weight in each hand, palms facing your body. Bend your elbows so your arms form a 90-degree angle. Then, keeping your elbows bent, lift the weights to shoulder height. Lower your arms to your sides, then straighten to return to starting position. Repeat for reps.

One-arm row

Using a sturdy chair, place your right knee on the seat, left foot on the floor. Bend for- ward, back parallel to the floor and place your right hand on the seat. Hold a 5- to 8-pound weight in your left hand, arm extended down and in line with your shoulder, palm facing in. Bend your left elbow up so that your arm forms a 90-degree angle. Hold, then return to starting position. Repeat for reps, then switch sides.