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After nine exciting months, the anticipation is tangible. Be sure that you understand all the choices when it comes to giving birth and that the decision you make is what’s best for you and baby at this most exciting time.
By Keri Harvey
Childbirth options fall into two broad categories: Caesarian and natural birth in hospital or at home. While there are pros and cons for both options, moms-to-be need to make informed decisions when choosing how to give birth because her own and her baby’s wellbeing depend on it.
The famous Roman, Julius Caesar, gave his name to this medical birthing option, which has steadily gained popularity in recent years. Ironically, in the dark old days Caesars were usually a post mortem procedure in a bid to save baby when mom had succumbed. Today, Caesars are common practice – be they elective or for medical reasons – and they are seldom performed under general anaesthetic; spinal blocks are the preferred choice.
Johannesburg gynaecologist Dr Sumayya Ebrahim says after 37 completed weeks the foetus is mature, so most elective Caesars are performed between 38 and 39 weeks. “However,” she says, “elective Caesars are sometimes not a choice but a necessity for mothers giving birth. This is the case if the baby is breech or in any other position except head down. Elective Caesars are also done when it’s a multiple pregnancy or where there’s a low-lying placenta. Of course there are cases too where parents simply want their baby born on a certain date.”
Dr Ebrahim says that in South Africa Caesarian section intervention is taken sooner than in many other countries such as the UK, where natural birth is promoted. Cost may be an influence in some countries, since it’s much more expensive to have a Caesar than to give birth naturally. She says that in South Africa, some areas report an increase in requests for elective Caesars, while in other areas natural birthing options are gaining popularity – it all depends on area, cultural group, religion, lifestyle, peer pressure and the availability of information on different birthing options.
Pros and Cons
“As far as we know there are no adverse effects on babies born by elective Caesar,” says Dr Ebrahim, “except for a condition called Transient Tachypnoea.” She explains that in a natural birth the baby is squeezed through the birth canal and the 30-40ml of amniotic fluid in the baby’s lungs is forced out of the baby’s nose and mouth during the final stages of birth. With a Caesar being a more rapid delivery, this doesn’t happen. “So when the baby is born this fluid needs to be absorbed. Some of the fluid will come out spontaneously from the baby’s mouth and nose, and some will be suctioned out and the baby will absorb the rest. Most babies do this within five minutes, some take an hour but some really unlucky babies have to go to high care for a few hours to have oxygen support until they have cleared this fluid from their lungs. Until the fluid is cleared, the baby will not be able to breathe properly and so won’t be able to feed either. But there are very few long-term implications.”
Expectant moms can have a natural birth either assisted by a gynaecologist or a midwife with a gynaecologist as backup. Epidurals may be given as pain relief during Caesarian and natural birthing options.Dr Ebrahim says that many women are choosing the natural childbirth route and there are clinics that specialise in natural birthing options because of this demand. “Many women embrace the natural birth method because they don’t want the birth to be a medically-driven experience. They want to work with their bodies and take themselves through the whole experience, as it’s simply the end result of procreation which is a perfectly natural experience.”Cape Town midwife and paediatric nurse Sr Fiona Ho-Tong believes natural birth is best for mothers and babies, since the body was designed to give birth naturally. She says it’s a healthy and empowering experience, which keeps both mom and baby alert, aware and ready to communicate with each other. Still, she says there are times when medical intervention is necessary and in the best interest of mother and child. Dr Ebrahim confirms that should a mom change her mind halfway through a natural birth experience and request a Caesar, or should circumstances change during natural birth, performing a Caesar is common practice. “The only consideration always is what is in the best interest for mother and baby and that there are no medical disadvantages for either.”
Natural home births are usually performed by midwives and very rarely by a doctor, unless living in the rural areas. For low-risk pregnancies, a number of studies have shown that planned, assisted home births are at least as safe as hospital births, but home birthing is not advised for first pregnancies.While in many Western countries, home birthing declined over the 20th century due to the development of hospitals supervised by obstetricians, there has since been a revival of the practice in most European countries, the United States and now also in South Africa. Dr Ebrahim advises that “for home births you have to be completely careful, have a very experienced midwife, and a proper backup system. For example, have petrol in the car, know the route to the hospital, have a gynaecologist on call who is available at short notice – because if something goes wrong sometimes you only have minutes to intervene. However, a good midwife will be able to make the call early if something is amiss and head for the clinic rather than wait until disaster strikes. Sometimes unpredictable things happen too, but this is the risk you take with home births.”
Dr Ebrahim confirms that water births are neither more safe nor more dangerous than births out of water, “but the conditions have to be checked before you get into the birthing tank. Importantly, there must be no prematurity, no foetal distress and no intrauterine infections. There are also certain techniques that are safer, but it’s a misconception that the baby swims in water after it’s born. Babies are simply born from water to water and then removed from the water.”Sr Ho-Tong explains that water birthing can benefit both mother and child and that some hospitals and birth centres in South Africa offer this option to parents-to-be. For home water births, birthing tanks need to be hired.“Properly heated water helps to ease the transition from the birth canal to the outside world because the warm liquid resembles the familiar intra-uterine environment, and softens light, colours and noises,” says Sr Ho-Tong. “Water is relaxing and soothing and gives relief from the pain of labour, the weight of pregnancy, and allows babies to be born gently and naturally. During a water birth you move as you wish. You can change positions, allowing the water to support you, and you can easily squat – which is a natural position for labouring and giving birth.” She says that water birth is natural for babies, as they have been in water for nine months. So instead of being jarred immediately into cold air, you can bring your baby’s head out of the water and then ease his body out slowly. . Water birthed babies are often also more peaceful and alert after having been gently born into the water and pulled up to their mother.
General risk factors
Dr Ebrahim says that complications with natural births that result in catastrophe are relatively unusual. However, moms do still die in childbirth occasionally, particularly when other medical conditions exist. Hypertension and post partum haemorrhage are still risk factors.Teenage moms and moms over 35 years old may also be at higher risk of complications during childbirth, while underweight moms often deliver smaller babies and obese moms risk hypertension, gestational diabetes and thrombosis during surgery.Dr Ebrahim says that premature births are also on the increase as assisted pregnancies and multiple births become more prevalent. But medical technology has advanced considerably over the years to assist moms who don’t carry to term – more so than ever before.
“Most important,” says Dr Ebrahim, “is to be informed, discuss everything with your gynaecologist, read about all the different options and choices, and discuss them with your care giver. There are many things to consider when deciding which is the best birthing option for the patient. The patient’s wishes are important and I inform them of the pros and cons of every option, but ultimately they decide unless there are medical reasons to suggest otherwise. Both natural vaginal birth and Caesarian section have advantages and disadvantages, neither is necessarily better than the other. The most important question you always have to ask is: Which options offers the greatest benefit with the least risk?”
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