Over the years, the number of expecting women who opt for a caesarean section has increased. Why is C-section a seemingly preferred method of child birth in Rwanda? 

"The rates of births by caesarean in Rwanda have gone up significantly compared to recent years. Although there is no specific figure to back this up considering there hasn’t been any research done on the subject,” says Dr. John Muganda, the Head of Gynecology Department at King Faisal Hospital.

A caesarean section (C-section) is a type of birth done by surgical incision in the abdomen and uterus to deliver a baby safely when normal birth is not considered safe for either the mother or the unborn baby.

According to Dr. Muganda, caesarean section should be done on recommendation of a doctor. In most cases, the decision is made when the option of normal birth has failed.

However, many women today prefer the c-section even when they are able to deliver naturally.

Vivian Mukamusoni is expecting her first baby and she has made up her mind to deliver by a caesarean section.

"I have weighed the advantages and risks of both and feel that a C-section is much safer, in my opinion. I think there are too many risks associated with a natural birth. I have no assurance that natural birth will be a hundred per cent safe, my baby would get tired or I would become weak in the process of pushing, I cannot bear that risk.

I’d rather be operated on instead of tearing as it is with natural birth,” Mukamusoni says.

She says that she understands that there are also risks with a cesarean section, but to her, they are much lower, especially when the operation is by choice and not an emergency.

According to medical experts, more first-time mothers are opting to have their babies delivered by C-section even when there’s no clear medical reason to do so. However, doctors advise that unnecessary C-sections should be avoided.

Dr. Teckle G. Egiziabher, a gynecologist at Rwanda Military Hospital Kanombe, says that a C-section should be done when the natural delivery is a risk to the mother, to the baby or both. Sometimes it’s done upon request of the mother.

There are conditions which require a woman to undergo a C-section, for example, when labour is prolonged beyond twenty four hours, when there is a condition of Ante-Partum Hemorrhage (APH) or when the woman has severe genital infections which can infect the baby. Plus, a situation when the baby is excessively big or when not getting enough oxygen, Dr. Egiziabher explains.

He adds: "There are women who come and decide to be operated on though they are not that many.We accept as long as they sign to approve their consent. However I wouldn’t advise a woman to take such a decision because a C-section involves a lot of risks such as excessive bleeding, infections, prolonged time for healing and others.”

Dr. Muganda echoes the same advice. "I wouldn’t advise a woman to have a C-section when there is no medical complication; the C-section involves a lot of risks. C-section is an operation and hence there has to be risks during and after the procedure, there could be excessive bleeding, one can get an infection, it can also create chronic pain in the abdomen.”

He adds that there are women who decide to have a C-section but it’s the duty of medical practitioners to teach them the dangers associated with it.

"Unless we see that there is need to. Sometimes they fear pain; and some just want to do what is done in European countries.”

According to Dr. Alphonse Butoyi, a gynecologist at Hopital le Croix, some women prefer a C-section even though there is no obstetric indication or reason; this is mainly due to fear of pain.

" A C-section has a lot of risks like increased risk of morbidity and mortality because a woman can get haemorrhage, genital track lacerations( uterine lacerations, uterine vessels rupture), bladder and bowel accidental wounds , wound infection, sometimes deep vein thrombophlebitis, which can lead to death; and at a social level, contact between mother and baby is delayed. A C-section would be recommended under difficult circumstances but a natural birth would be the best option,” Dr. Butoyi says.

Some women are tokophobic (fear of pregnancy and child birth); they are traumatised by the horrific stories from the labour ward. Women with tokophobia can have increased psychological morbidity during both antepartum as well as postpartum period. Increased incidence of caesarean sections is found in this group of women.

Lillian Akaliza says she might choose a C-section when she decides to have a child in future. She is terrified about the pain mothers go through while in labour.

She says: "The thought of that labour pain really makes me shudder, at least every mother has a terrifying story and this scares the hell out of me. I haven’t made up my mind on whether I will have children but when I do, I think I will definitely go for a caesarian section because to be honest I don’t think I can go through with the whole process.”

Some women, however, regardless of the pain, prefer it the natural way.

Julian Uwitonze has just had her baby and though she was operated, it wasn’t her choice but rather something that had to be done because of medical reasons. "I had a C-section because the doctors told me my baby was big and I wouldn’t be able to push. The C-section wasn’t bad, neither was the recovery plus I also managed to deal with the pain. But I wouldn’t advise anyone to voluntarily request for a C-section since it is riskier than having a natural birth.Besides, I think one being able to push their baby into the world brings an awesome feeling, therefore women should always do it the natural way,” Uwitonze says.

It is safe to say that there should be choice when it comes to child birth because when all factors are put into consideration, the safety of the mother and baby should come first. Birth is a deeply personal experience that varies from person to person; expectant mothers should talk it over with healthcare professionals and come up with a plan that takes all risks and benefits into account.

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Natural birth or C-section: What’s your preference?

Majorine Ndagire

I prefer natural birth because it doesn’t have a lot of risks, even the doctors recommend it. A woman can lose her life in an operation. I would rather push my baby than be cut.

Phionah K

After the terrifying story my friend told me on how the midwives let her rip when pushing, and watching her walk in pain because of threads ‘down there’, it is safe to say that when I have a baby, it will be through a C-section.

Victoria Kasoma

As far as I know, very few doctors recommend C-sections unless it’s an emergency. There are risks, and many women get infected, that’s not something I would want. Therefore I wouldn’t go for a C-section; I would be strong and face the pain like a woman.

Aisha Klein

Most women just do it out of selfishness, not considering the risks involved with the operation. I myself wouldn’t go for surgery unless it was recommended by a doctor.

Stacey Kainerugaba

I prefer a C-section because I won’t have to feel the labour pain plus, the baby, or myself, won’t have to get tired in the process of pushing. There won’t be tearing and my body will remain its normal size.

Online research on why women prefer a C- Section

Most women fear the pain associated with labour.

Also, there is fear of the risks associated with the natural delivery like urinary incontinence which increases the risk of leaking.

Some feel that scheduling delivery is more convenient than waiting for labour and childbirth, allowing them to more easily arrange for maternity leave and extra help at home.

Others believe that a C-section might help them minimise the pain or certain complications such as tearing, incontinence, or sexual dysfunction that is associated with a vaginal delivery.

Scheduling a C-section may give some women a feeling of control over an inherently unpredictable experience.

After all, if you knew the date your baby would be born, you could plan more easily for family help, work leave, and other post-baby needs. Some women feel it would be better to relax and enjoy those last few weeks instead of waiting anxiously for contractions to kick in at any moment.

editorial@newtimes.co.rw