Thursday, 18 April 2013

Cape Town & Obstetrics

So..... we have arrived in beautiful South Africa and received into the waiting arms of our loving family. There is nothing quite as special as returning home!

What I have learnt so far from maternity statistics in South Africa has made me incredibly sad when I am not just hopping angry. 

There is a 90% cesarean section rate in Cape Town within the private sector (can anyone say obstetric malpractice). I refuse to belive that all these women choose major adbominal surgery and accept all asociated risks with complete and ethical informed choice.

Within the public sector there is a 20% cesarean section rate wich is concidered normal in Europe, although the maternal and infant mortality rate is sky high. 

In Africa: 
280 000 women die annually during birth! 
10 million die due to pregnancy, or due to post partum complications. 
3 million newborns die annually, many from infections.
2.6 million stillborns annually. 

So these issues flag up two huge healthcare needs in South Africa both envolving EDUCATION, EDUCATION, EDUCATION and RE-EDUCATION. Being just one intrepid midwife in a land as vast and diverse as you can imagine, I feel this not a burden but an opportunity to engineer change, to be part of progress and a future with better maternal and neonatal outcomes. 

No-one disputes a woman's right to choose how to deliver her baby. However, making an informed choice regarding an elective cesarean section means taking an objective look at the risks. According to a study led by Alan T.N. Tita, assistant professor in the UAB Department of Obstetrics and Gynecology, "Women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child." 

 Cesarean Section Neonatal Complications &  Risks include: 
 Premature birth when the delivery date is not accurately calculated. 
 According to a recent study, cesarean section neonates may not have the same beneficial gut bacteria at birth as babies delivered naturally. This may cause immune related troubles to develop later in life. 
 Babies born by cesarean section are more likely to develop breathing problems like asthma and allergies later in life. 
Cesarean section is known to raise a child's risk of diabetes by 20 percent. 
Lower Apgar scores at birth. 

Cesarean Section Maternal Complications &  Risks include: 
Major abdominal surgery. 
Surgical wound complications such as adhesions that can cause bowel obstruction and chronic pain. 
Resultant placenta accreta or percreta in subsequent pregnancies. This can result in complete hysterectomy to treat major haemorrhage after delivery of the placenta.
High risk of DVT - anti-thromboric medication should be prescribed, this is in the form of subcutaneous injections which sting and depending on risk may be required everyday for up to six weeks.
Loss of sensation at incision site.
Six weeks of no driving or lifting any weight heavier than the baby. In South Africa where nothing is accessible without a car this may lead to isolation and/or dpression. 
May affect breastfeeding success. 
May contribute to postnatal depression
May affect maternal-neonate bonding
Dramatically reduced incidence of skin to skin resulting in system and hormonal consequences both for the mother and neonate.

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