Nigerian women are increasingly taking advantage of great improvements in caesarean delivery to have their babies on the exact days they choose, primarily to mark specific milestones in their lives or the birthdays of their husbands.

This new fad is quickly taking root among young upwardly-mobile corporate or professional women for whom time is an ever scarce resource they could hardly waste, sluggishly carrying a protruding tummy around, waiting for the natural process to run its course.

Caesarean section is a medical procedure done to deliver a baby when a normal delivery looks risky to the baby and/or mother, explains Dr. Olayiwola Mudashiru Bello, Medical Director, Subol Hospitals, Idimu. He adds, “as much as possible doctors try to avoid caesarean section (CS) and only resort to it as a life-saving procedure either to save the life of the baby or that of the mother if either of them is in danger and the need to act fast becomes imperative.”

The feeling and the thinking among women who opt for elective caesarean delivery, Daily Sun found out, can be summed up this way: “If I can safely have my baby through caesarean section, why not?”
Even some government hospitals, just to meet its self-imposed need to have a Baby of the Year on January I, has joined the bandwagon, tacitly endorsing the fad.

Daily Sun’s investigations revealed that at Island Maternity Hospital, popularly referred to as ‘baby factory’, and Lagos State University Teaching Hospital’s ‘Ayinke House’, the first babies of the year for 2004, 2006, 2007 and 2008, born to Mrs. Babington, Mrs. Rukayat Adejumo, Mrs. Oyebola Fashina, and Mrs. Iyaniwura Aramide, respectively, were delivered through caesarean section.

“The hospital has to produce the First Baby of the Year. The cost of CS is not more than N30,000 for public hospitals,” a doctor revealed, explaining why the government ‘encourages’ women whose EDD (expected date of delivery) is close to New Year to opt for caesarean section.
However, Lagos State Commissioner for Health, Dr. Jide Idris stoutly debunks this view, saying: “It is not true that most first babies of the year are born through CS. In fact, it is wrong to say many women prefer to go through CS instead of normal delivery.”

“The first baby of the year is a programme that we started during the Asiwaju Bola Tinubu administration to bring smiles to the faces of those, who for the reasons of health, are in the hospital, rather than their homes, during the festive season. It is just a way of cheering up these people and adding excitement to the Yuletide period.

“As far as I know, as a medical practitioner, the reason for CS to be indicated must be something necessary because it is a surgical procedure that can come with complications, sometimes dastard ones, if not properly done. Doctors only decide to perform CS when they feel it is necessary, especially if the baby is in jeopardy or perhaps there is prolonged labour, they will quickly deliver the baby to save the lives of both mother and baby.”

Commenting on the insinuation that some women sometimes prefer the CS, in order to be the mothers of first Babies of the Year, Idris disagrees, saying: “I don’t want to believe that in order to produce the first baby of the year, anyone will subject herself to a needless surgery.”
He stresses that no doctor would ask his female patient to have a caesarean surgery except it was absolutely necessary.

Although many doctors insist that caesarean section is usually the last alternative in saving either baby or mother and at other times both of them, they concede that a good number of their obstetric patients are now electing to have their babies delivered by caesarean section for a variety of reasons.
The cases of some women, who spoke on condition that their real names would not be disclosed, give clear indication that elective caesarean delivery is bound to increase in popularity among women in the years ahead. The only hindrance for now may be the cost of the surgery rather than the fear of dying during the process.
Here is a sampling of the views of some women who opted for elective caesarean delivery to have their babies.

I was in UK when I had my first baby
While she was overseas, where the procedure is much simpler, Nkechi Nwadibia didn’t consider having her baby through CS a big deal as it is here. She said: “I was in UK (United Kingdom) when I had my first baby. I went for ante-natal class and it was during that time that I got to know that you could, on your own, decide to have your baby on any date as long as the pregnancy is over six months. I remembered that there was this particular lady, she came in for ante-natal class and told the doctor that she was tired of carrying the pregnancy and wanted to have her baby delivered.

“Some of us Nigerians who overheard the discussion felt that she didn’t know what she was saying. But before we were through with our class that day, she had a baby boy through CS. It was strange, but it was what prompted me to have my baby at seven and half weeks of my husband’s birthday. And he is a big boy now. The truth is that technology has improved and you can get away with anything in the best hands.”

I wanted my baby on my birthday
Kemi Abatan, a lady from the southwest of Nigeria, also shares a similar experience thus: “I told my doctor that I wanted my baby on my birthday, which was on Christmas day. After the necessary medical precautions here and there, he told me there was no medical reason restraining me from having the baby. Then my pregnancy was just eight months. By 10 a.m on Christmas day, I was already cuddling my baby boy. I was fully awake when the operation was being done. I communicated with the doctors, we shared jokes and laughed. So, the myth about CS should be erased from people’s mind, it’s no big deal,” she declared with a smile.

With CS, the baby comes out in a jiffy
Ndidi Nkama, who hails from the eastern part of the country, and is a banker, also had no qualms about caesarean delivery, given that medical technology had improved over the years to make CS a less risky intervention.
She recalled the experience this way: “Before I got pregnant, I had fibroid and before I fell into labour, my doctor advised me to opt for CS, which I did. Both baby and fibroid were brought out same day, though it was tough, I learnt later. My doctor wanted me to try normal delivery the second time, but I was afraid, so I opted for CS. For my third child, I had to go through it because I felt there was no point in endangering my life if I attempt to ‘push’ and in the process, got my stitches open. CS is no big deal. Before you know it, your baby is out in a jiffy.”

Baby had to be delivered to prevent harm
However, the story of Mrs. Bola Onuoha, a lawyer is quite different. She told Daily Sun: “My first and second babies, who were twins came through the normal delivery but because the amniotic fluid drained quickly and easily during my third baby, I was advised to do CS. When my doctor asked me to wait so that he could place me on bed rest, I ran away, because I could not afford that luxury due to some of the cases I was handling at the time. But when the movement I felt within me became weaker, I had to run back to seek medical advice.

“It was there that I was told that the fluid that aids the baby’s movement had drained and the baby had to be delivered to prevent harm. They advised me to have a CS. Though I prayed for divine intervention, my husband at that time had been involved and I had no choice but to consent to having CS, so that the baby could be brought out. Even the baby had to be revived with oxygen because his colour was blue black by the time they brought him out. But luckily, he survived the ordeal.”

I was the one shouting for it
Though she has had five healthy children through caesarean delivery, Mrs. Josephine Ojo, a journalist, never really set out to have her babies that way. Fate, more or less, made the decision for her.
Ojo had a prolonged labour during her first pregnancy. The baby became distressed in the process and there was no other option than to have the CS.

“In fact, I was the one shouting for it because it was as if my life was ebbing away. Initially, my doctor wanted me to try some more but when the monitor indicated that my baby was distressed, I had to be wheeled into theatre for surgery immediately,” she recalled.
“Subsequently, my other four babies also came through CS. I have five healthy children through CS. Technology has improved tremendously that in a jiffy, you are out of the theatre with your baby. If a woman is firm and not too fat, there is nothing stopping fast healing of wound. At least, between four or five days, if the woman is healthy, she should be fit to go home,” Ojo adds.

Nothing spectacular about the whole thing
Though, the case of Bukola Martins appears different from the above scenarios, she got married at a late age and by the time she became pregnant, she was over 35 years. From the ouset of the pregnancy, the doctor advised her to opt for CS to ensure that all went well.
“Thank God that I yielded and I have a lovely baby girl now. I was fully awake during the whole procedure. There was nothing spectacular about the whole thing except that after the operation, coming round into consciously, one maybe hit with a bout of pain. But thereafter, all is well,” a very happy Martins says.

It is fast becoming a norm, there is no fear
After Mrs. Ijeoma Ejidike, a medical doctor, had her first child through normal delivery, she revealed that the stress and the pain of labour definitely put her off, and made her opt for caesarean section as the means for delivering her babies.

On the experience she passed through during the first birth, Ejidike says: “If you have experienced labour pain, you won’t want to go through it again. I barely managed it the first time. When my second baby was not forthcoming after two hours in labour, I signed the consent form myself and it was all over in a matter of minutes. Now, you can’t even know that I had a baby through CS because it is not visible and I am sure, my third baby would also be through CS. It is fast becoming a norm, there is no fear, other people may prefer to call it a major surgery but to me, it is minor.”

From the records of the Lagos State government, the number of caesarean deliveries has grown geometrically. Awareness has made elective CS acceptable to most people unlike in the past, when people, out of ignorance or religious beliefs, would insist on having vaginal delivery against all odds. Such ignorance or wrong beliefs had often led to maternal death and loss of the baby.

Technology has greatly improved the procedure to the extent that doctors now use a method called cosmetic incision. In the past, the practice was to make the incision at midline, which always left an ugly scar on the tummy. Today, the incision, which is horizontal, is made below what is known as the Bikini Line. It is done in such a way that when the public hair grows, it can conceal it neatly.

Currently, there are many approaches, to making incision for a CS. The cosmetic/plastic approach is considered neater and better than the traditional method of cutting. It takes a little more time compared to the old system, but again in serious emergency, the doctor may opt for the old system because on the average, the cosmetic incision takes a longer time but in the hands of an experienced doctor the time difference is little or nothing.

A senior consultant in obstetric and gynecology at Lagos State University Teaching Hospital, Ayinke House, Dr. Abidoye Gbadegesin, explains that whether in emergency or, otherwise, cosmetic approach can be used.
“Through professional judgment, the doctor would have envisaged a problem and in anticipation deliver the woman before she goes into labour. But when it is done in emergency, it means that CS was not envisaged it came in snap reaction to save either the life of the baby or the mother or in some cases, both.”

However, another doctor hinted that most first babies of the year usually come through CS. Reason? “The hospital has to produce the first baby of the year. The cost of CS is not more than N30,000 for public hospitals. However for private hospitals, it depends on the class of the hospital. There are various classes to private hospital. There is first, second or third class hospital. The classification affects the price for service. Basically, for first class hospital, a patient can pay as much as N400, 000, N200,000, for second class, about N100, 000 or even more for third class”.

When prodded by Daily Sun on the average of CS done on a daily basis, he said: “In a month, we come in contact, conservatively, with an average of four in a week and by 30 days, we talk of 120 CS per month. Actually, because many of these mothers have the option of choosing their baby’s delivery date, most prefer elective CS”.

Another doctor, who spoke on condition of anonymity, at LASUTH, revealed that CS has grown geometrically because many female patients that had contracted the Acquired Immune Deficiency Syndrome (AIDS) virus are delivered through CS, to avoid mother passing the virus to the baby during childbirth.

And records from the Lagos State Ministry of Health, Alausa, made available to Daily Sun for 2005 and 2006 revealed that in 2005, the number of natural births was 7,989 as against 3,504 caesarean deliveries, indicating that 30 per cent of all live births were by CS. Again, in 2006, 9,665 normal deliveries and 3,697 CS deliveries were recorded, that is 27 per cent of live births.
For 2007, Ayinke House and Island Maternity Lagos clocked in thus: At Island Maternity, ND was 1,447, while CS made a close call of 1,017; Ayinke House, recorded 1,950 live births for ND and 1,346 for CS.

However, whether or not CS is on the increase, all the doctors concurred that they don’t encourage CS patients to go beyond four children, because after this, the inherent complications in pregnancy increase.
Dr. Idris notes that the biggest risk associated with women who have their babies by CS is excessive bleeding after delivery because the uterus fails to contract.

In medicine, this condition is known as utero atony. Normally, the uterus or womb has to contract to stop bleeding. Once it fails to do this, the patient can bleed to death. For this reason, Idris says that CS patients are advised to tie their wombs after the fourth child.
“If not, some of them would still go for a fifth one, which carries so much risk,” he added.