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Archive for the ‘Reproductive Health’ Category

By Kingsley Obom-Egbulem

A couple of weeks ago, Ted Turner-the founder of CNN and some of his colleagues in the United Nations Foundation visited Nigeria. The main objective of their visit was to evaluate how the nation is responding to polio and other deadly childhood diseases affecting children mostly in northern Nigeria.

As Turner and his team were deliberating with some of our leaders , I wondered to myself, “where are our Turners and what are they doing about the problems of childhood diseases in Nigeria?”, “where are the big boys  and big girls of northern Nigeria; and what have they done about ending child marriages and maternal mortality?”

Do they even know that these problems exist right in their domain?

Now, just in case you are not aware, northern Nigeria is among the very few parts of the world where polio have not been eradicated. The sad side of the story of polio in the north is that its eradication have been given several religious albeit political colouration yet the facts are there to be seen.

With the help of nothern elites Nigerians will stop being the image of polio in Africa

Imagine these scenarios: an illiterate peasant farmer and his wife are stuck with 5 children-all of them crippled by polio with its attendant consequences. And on the other side of the divide, we have the home of an influential northern politician; he is pictured with his 5 children playing football and cycling around the garden ;all five children purportedly born in high brow hospitals and immunized against the childhood deadly diseases including polio.

Just for the records, Bill Gates have spent no less than N114billion in eradicating Polio in Nigeria. (Gates have spent N1.2 Trillion Naira on polio eradication globally. This amount is 1/3 of Nigeria’s 2010 budget of 4.079 Trillion Naira).

And you ask, what are the Bill Gates of northern Nigeria doing about childhood diseases? What are they doing about child marriages and its consequences such as vesico virginal fistula(VVF),obstetrics complication and even death? How are the Bill Gates of northern Nigeria responding to the rate of infant and maternal mortality which appears to be the highest in northern Nigeria?

What about cholera-a disease that broke out this year in most part of northern Nigeria and claimed about 1,550 lives? So, what did the Bill Gates of northern Nigeria do about cholera-a disease that even some poorer countries only read about in newspapers or see on CNN?

The power brokers:These men would live a more fulfilling life eradicating childhood diseases

It is imperative to state that this discourse is not about polio, cholera or the north-south dichotomy. It is actually a lamentation about how we leave undone the little but fundamental things that makes all the difference and pursue bigger things which we end up making nonsense of ;it is a reflection on the current campaign for the presidency of Nigeria vis a vis the burden of the north and what ought to be the primary concern of some of those dying to rule this country albeit by force.

This discourse is borne out of what could be described as an urgent need to redirect the thinking and wisdom of the northern elders forum such that they can truly become the much needed oasis  in northern Nigeria’s desert of underdevelopment and vane quest.

I have always bothered about the irony that  northern Nigeria represents. Northern Nigeria remains the most backward by every standard yet Nigeria have been ruled mostly by presidents from this part.

It won’t be out of place to ask how these men have helped the fate of  northern Nigeria-a region that continues to wallow under the burden of diseases ,mass illiteracy as personified by the ubiquitous almajiris(street urchins) who are all over the place and making nonsense of whatever achievements made by northern political leaders in the name of governance.

And while I was still bemoaning the way mothers(especially teenage girls) are dying in the north, the children that died of lead poisoning early this year, the cholera outbreak, the embarrassing impact of river blindness, diarrhea, guinea worm, vesico virginal fistula, poor enrolment of children in schools, the existence of a northern elders forum brought smiles to my face. I was shocked to know about these “wise” old men and how influential they are even to extent to deciding who becomes the president of Nigeria-the world’s most populous black nation.

Gates:demonstrating the difference between being wealthy and being "possessed by wealth

I am still wondering where these elders stand in the face of the worrisome under development in the north. Im really troubled why these men have not met and arrived at a consensus on how to confront the problems of street urchins in the north.

These elders must be next to Elohim if they can ask Babangida, Gusua and Saraki  to step down for Atiku. And  I said to myself, how come these same elders have not been moved to the point of asking their subjects to award special scholarships to medical students of northern origin so as to strengthen the quality and quantity of  manpower rendering healthcare services in the north.

Perhaps, you would expect these men to speak up against the devastating impact of polio on the future of children. You would expect these men to become icons and advocates against child marriages and regularly engage their brothers and sisters about the need to protect their children from possible disability in the future if they don’t respond positively to polio eradication.

These men(and even women) would rather fly around the country campaigning for the presidential ticket, when there are more than enough work to do in their home state. It took a young man from far away America; a man who had no business doing what he is doing in the north to fight the polio epidemic.

I want to see a Babangida campaigning for an end to maternal mortality and offering to grant women free access to cervical and ovarian cancer screening and treatment, a Gusau advocating for prevention of  mother to child transmission of HIV and access to quality HIV education among young girls and women. I want to see a Bukola Saraki, an Abdul Ogbe, an Adamu Chiroma spend the rest of their lives advocating and pushing for bills that will guarantee access to affordable(if not free)quality health care service for everyone, particularly women and children in the north.

Ciroma:Leader of the "wise men" from the north

All these are  worthy causes any man can spend the rest of his life working for and the good thing about such causes if that you don’t need to rent a crowd to achieve them; you don’t have to pay Nollywood actors, footballers or musicians to sing your praise and you can’t heat up the polity trying to achieve them; it has nothing to do with a zoning formula either.

It is simply about doing things that would make the next generation believe that the word elder is not about senile dementia but about the sanctity and sanity of our redemptive decisions and consensus.

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As we conclude our discussion on the role infertility is playing in swelling cases of violence against women and the attendant health implication especially the spread of sexually transmitted infection, perhaps it won’t be out of place to ponder on the words of Dr. Oliver Ezechi.

In a recent interview with NIGERIAN HEALTH JOURNAL, Ezechi who is consultant Obstetrician & Gynaecologist and Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos said:

“The pressure from society forces men infertile relationships to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. This is so that the woman can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.”

This is puzzling, to say the least. To think that there is a married woman somewhere, currently having affairs with other men(with the approval of her husband; by the way) so she can get pregnant and protect him from society’s ridicule is  one of the weirdest thing to imagine let alone do.

It doesn’t make sense to any observer who is not too conversant with the African society and how it is dealing with

African women:when will your jubilee come?

issues of infertility. But these stories are real and like some public health physicians and epidemiologists may have realized, have added to the list of harmful cultural practices believed to be driving the HIV/AIDS epidemic in most African societies.

Part of what this reality suggests is that  perhaps, marriage is becoming particular risky and dangerous for an average African woman as it appears that she is even more exposed to HIV in marriage than as a single woman.

Doesn’t this provide the basis for interrogating some of the cases of HIV sero-discordance we’ve had to deal with in Africa?

Dr. Ebun Adejuyigbe, consultant pediatrician and associate professor, Obafemi Awolowo University, (OAU) Ile Ife, Osun State would rather say an emphatic yes to that poser and she has a strong case to support her stand.

Just  in case you are wondering “HIV discordance refers to a pair of Sexual partners in which one is HIV positive and the other is HIV negative.”

After studying several cases of pediatric HIV infection she and her colleagues have had to deal with over a period of time  and the fact that only the mothers of the children were the ones with HIV, Adejuyigbe soon discovered that sterility or sexual impotency and infertility were all at the root of the whole problem.

“We discovered that these women  with HIV positive babies apparently were encouraged by their husbands to go out and be impregnated by another man. The choice of man the woman decides to opt for would be determined by the possession of certain physical features that could clear any possible doubts about the child’s paternity. No one would ever imagine that a man irrespective of his medical condition would allow his wife to go out and get pregnant by another man and pose as the father when the child is born”, said Adejuyigbe.

That is the norm in some parts of Nigeria and the women in a bid to shield their husbands from social stigma that comes with sterility or impotence would actually go and have sex with another man and come back pregnant for her husband. But these days, the women are not only coming back pregnant. They are also coming back infected with HIV. And their husbands may  never get infected especially for those whose husbands are sexually impotent.

“I never knew this was happening until we started noticing an unusual trend at the pediatric ward in OAU. We were seeing several sick children, infected with HIV and expectedly ,you will have to talk to the parents of such kids and after encouraging the mothers to go for HIV counseling and testing; the result is usually positive”.

That is often the beginning of several revelations according to Adejuyigbe, especially if the clinician insists that the father of the child should also be tested for HIV.

“The women involved would wonder at our display of naivety if we conclude that the man probably would also be infected with HIV. But they will tell us emphatically that their husbands cannot be HIV positive. Of course, you want to ask is he not infected and the women would tell you their husbands can never get infected because “he doesn’t, and can’t have sex with them. If you probe further they will tell you because he is impotent”.

This development was confirmed following further survey and interview of several women visiting the pediatric ward with children infected with HIV. The women are counseled to go for HIV test and if the result turns out positive, they are usually not in doubt as to the source of the infection.

It all started as a problem of infertility and the need to shield themselves from the social stigma that  infertility attracts. One partner decides to cover the shame of infertility they both will have to live with and it turns out that she is actually laying down her life.

Again, the question many would want to ask is ‘how can men protect their wives from society’s ridicule if indeed she is medically confirmed to be the one with the problem that has caused the couples infertility?’

Marrying a second wife or even divorcing the woman has been the norm for most men. If a woman could decide to get pregnant by another man just to protect her husband from the shame of sterility(and eventually get infected with HIV)then men should start thinking of a better sacrifice to make when the table is against their partners.

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In continuation of our series on Women, infertility and the price for saying ‘I do’, Kingsley Obom-Egbulem spoke with Dr. Oliver Ezechi who is consultant Obstetrician & Gynaecologist as well as a Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos, Nigeria. Ezechi in this revealing interview shares his perspective of infertility as one of the causes of domestic violence  and sheds some light on what society can do to reduce the pressure felt by women whenever a couple is faced with infertility.  Excepts.

Is it true that infertility is not defined within the context of individuals…and that there cannot be an infertile man or woman. Can you clarify this?

Yes. Infertility is a couples thing as it takes two to make a baby. Infertility is defined as the inability of a couple to achieve pregnancy after regular and unprotected intercourse for a full one year. One partner may not be a able to achieve conception in one union but can succeed in another union. So it takes two for pregnancy to occur  and it takes two also in the case of infertility.

Given this definition why is it that men, especially in Africa don’t identify with sterility or infertility. Where is the origin of this norm?

It is purely a cultural thing. In patriarchal societies like most African setting, men never do wrong. In this setting, they have traditional ways of handling infertility when it is confirmed that the man has a medical issue. A brother or relation may be arranged to impregnate the wife and the child bears the name of the husband. But if the problem is with the woman, it is very obvious as she will not be able to get pregnant. The man just remarries. But if it’s the man, nobody

Dr.Oliver Ezechi

will ever know. Some women even protect their husbands and suffer the ridicule.

What is the implication of our perception of masculinity and infertility?

Because in our setting, we believe that infertility is always the fault of the women, a lot of women are violated even when it is not there their fault. We need to re-educate the populace that either party could be the cause of infertility in a relationship. Men and women contribute equally to infertility. Male – 30%, Female – 30%, Combined – 30% and unknown -10%. We have been wrongly socialized to accept  that men are superior to women and as such cannot be the cause of infertility in any union. Hence the man would not even want to see a doctor because he has been absolved of any problem by society in the first place. So, it is the woman that should ‘go and find out what is wrong with her.’

A lot of women have suffered various forms of violence perpetrated by their husbands due to infertility. Can you identify with this?

Yes. Because of the perception , even when the man is the cause he will except his wife to go out there and get pregnant. And when she refuses both him and his family will continue to inflict both psychological and physical violence on the woman.

What would push a man to this point?

To prove that he is a man after all. The male ego is at play here and the need to meet society’s expectation even if it means hurting your wife.

How can such domestic violence hinder a woman’s chances of conception?

With the psychological trauma the woman is very unlikely to ovulate as this affects the higher centres that regulate the reproductive hormones and signals. Also abusive men are more likely to engage in extramarital affairs with associated sexual infections. When he infects his wife, it leads to damage of the reproductive tract and infertility. Even in non abusive men , the pressure of the society forces them to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. So, she can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.

How can one address cases of domestic violence apparently resulting from infertility?

We need cultural reorientation and education of the populace on the causes and contribution of partners to infertility.

A black eye;a broken arm:the price to pay sometimes for saying I do?

We also need to address issues of assisted reproductive treatment and making adoption culturally acceptable as an alternative to having a biological child. In the case of assisted reproductive treatment, it should be made affordable for families given the implication of divorce and multiple relationships in a bid for couples to prove they are fertile.

Some men see it as a sign of weaknesses to go for fertility checks especially before marriage…can this be encouraged so as to prevent the pressure on their would be wives?

This should be encourage but we need  a reorientation before this happens.

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By Kingsley Obom-Egbulem

The burden of infertility, especially in Africa is borne by women. This is not arguable. Aside being the one to carry the pregnancy(whenever it occurs) ,she is also the evidence of  infertility in the relationship. Even in churches,what you  hear most times is “sisters trusting God for the fruit of the womb”.But  it takes someone to plant the seed that bears the fruit there. How about “brothers also trusting God for a seed for the womb” for a change?.

So, whenever a woman’s tummy is not protruding, she is infertile irrespective of the fact that she needs someone(yes a man) to get her pregnant. And it doesn’t matter if that man in question has impediments that  appears to have limited his reproductive capacity.

Now, when the man is apparently the  source of infertility in a relationship, the African society tends to cover it up and protect him from the  ridicule that most women  suffer even when it has not been medically proven that she has problems conceiving.

The sad side of the story is when  the woman is subjected to all forms of physical and emotional abuses- a problem she is not  even responsible for.

In my interactions with organizations dealing with issues of domestic and gender-based-violence  not a few of them confirmed that infertility among couples have contributed to cases of battery and physical abuse in some homes. Leading eventual to divorce.

I was told the story of a woman whose husband was  diagnosed with aspermia (a medical condition in which no spermatozoa are present in the seminal fluid). For years, this woman suffered dehumanization from her in-laws because she couldn’t conceive. Of course she couldn’t have been able to conceive given the problem with her husband. She wasn’t too sure whether her husband knew he had this problem before they got married but what was clear was that the man was always brandishing his clean bill of health whenever she demands that they both see her doctor.

She was always doing one medical tests after the other just to be sure she wasn’t the problem. During some of her appointments her doctor will tell her “your eggs are ok and would be released between now and mid-day tomorrow; please make sure you have sex with your husband during this period”.

Unfortunately for her, this is the period the man chooses to “travel” for one business engagement or the other just to conceal his problem.

After several of such suspicious strips which often coincides with her ovulation period, the woman insisted on eithertravelling with him or stopping him from travelling. That was when the man restored to violence and physical abuses.

Sometimes he will beat her to pulp, lock her up in the house for days and “travel”.

But there was this trend that made her suspect that either there was something fundamentally wrong with her husband

Women:always at the receiving end of every infertility-related humiliations:But would our patraichal society turn the table in her favour?

or that she was in for a nightmarish relationship. She noticed that whenever her husband goes for these phony trips, his younger brother will visit the house.

He comes in close to midnight; feigning ignorance of his brothers purported trip. Since it is too late to go back home, he would opt to pass the night and throughout the night he would make passes at her, hoping that it will culminate in sex.

Her husband’s younger brother is apparently aware her husband is suffering from aspermia and his regularly visits especially when she’s ovulating (and the brother is “away”) is an orchestrated move to get her pregnant and save the husband the shame of being seen as sterile or not being man enough.

Being her ovulation period, the thinking is that her chances of accepting her brother in-laws overtures will be higher and her chances of getting pregnant will be  higher too. Ultimately ,the baby that would come out of this arrangement may have some resemblance with her husband since he looks so much like his younger brother.

The plan never worked. The woman didn’t fall for it. At a point the brother in-law almost raped her. That was when she reported to her husband what has been happening each time he “traveled”.

The husband’s remark was a frightening wake up call albeit a critical flash point .

“So what, if my brother decides to sleep with you? What is the problem with that? Don’t you know that what belongs to me belongs to my brother too and when Im not around it is his duty based on tradition to “take care” of you?”.

That was all she needed to decide whether or not to remain in the marriage. And the fact that the beaten from her husband had assumed a rather brutal and senseless dimension at this stage was  also a deciding factor. For him, not accepting to sleep with his brother frustrated his game plan and continues to expose him to ridicule. So the beating was an expression of his frustration and a way of making her pay for her stupidity.

Eventually, she escaped from the house-back to her family house and never went back till date.

Why should society continue to torment a woman for a problem she is not responsible for? Even if she responsible for the problem there are some that she couldn’t have done anything about especially if it is congenital. Why should couples live in hatred and violence or be torn apart  due to cases of infertility that can be medically resolved?

The answer to  any of these posers is definitely anybody’s guess.

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Ibrahim Umoru

At the early years of the HIV and AIDS epidemic when treatment was a mirage, a woman testing positive to HIV gives up hope of bearing a child for the fear of having HIV+ children.

With the advent of robust treatment, care and support; our women folks taking advantage of Prevention of Mother to Child Transmission(PMTCT) services smile with relief for the ability to have babies who are HIV+. What a wonderful world!

However, as a father, a husband and somebody living positively and constructively with HIV, I sure do have a role, in fact a bold and big one at that, in my wife’s effort at accessing PMTCT. I play strong roles in supporting my wife on treatment to attain a robust CD4 count and undetectable level of HIV in her blood. It is my responsibility to make her have a good nutrition and maintain a good health as well as encouraging safer sex to the time of peak ovulation. This is to reduce re-infection.

One of the ways to prevent mother-to-child transmission of HIV involves a long course of antiretroviral drugs and

Make sure she sees a midwife:Living up to his responsibility beyond just getting her pregnant:source:africanfathers.org

avoidance of breastfeeding, which reduces the risk to below 2%. In developed countries ,the number of infant infections has plummeted since this option became available in the mid-1990s.

Since 1999, it has been known that much simpler, inexpensive courses of drugs can also cut mother-to-child transmission rates by at least a half. The most basic of these comprises just two doses of a drug called nevirapine – one given to the mother during labour and the other given to her baby soon after birth. These short-course treatments, combined with safer infant feeding, have the potential to save many tens of thousands of children from HIV infection each year.

However, for the whole robust course of a full ARV regime, opting for elective CS, alternative infant feeding; men’s roles are obviously essential and we MUST be there for our female partners.

It is important to note that as husbands we have a role to play to make the period of pregnancy less stressful for wives and always be there for them and for the union too. In encouraging my wife to consent to elective caesarian section, I continued with such support and was in the theatre by her side when she had her baby.

This is my opinion about men being part of the solution rather than the problem. We played a role in the pregnancy and since we cannot carry it (the pregnancy) we should be responsible enough to support and  encourage the woman till she enters the labour room.

If we all agree with this summation, then we can collectively agree that the term PMTCT which is Prevention of Mother To Child Transmission of HIV  should  be broadened to  read PREVENTION OF PARENT TO CHILD TRANSMISSION OF HIV (PPTCT). We all should work for that success as I and  my darling wife continues to celebrate the birth of our latest baby born HIV free baby.

Have a pleasant day!

Ibrahim Umoru

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Ibrahim Umoru

When HIV is in the family, divorce comes knocking, love flies out of the window. This seems the story of most homes affected by HIV. And Im really hoping we can stop this trend..and that is why I appreciate the opportunity offered by Nigerian Health Journal to educate subscribers to this blog on HIV sero-discordance and how we can protect ourselves and our families against HIV infection. And just in case we are already infected or affected by the virus, how to live a happily and fulfilled life.

Like the Moderator hinted earlier I will be sharing mostly my experience on this blog how I have been able to live with HIV for the past 10 years and counting as well as experiencing gained form helping families affected by HIV stay together and strong

It won’t be out of place to set this discourse rolling by providing some background information to help us understand what sero-discordance is all about.

HIV discordance refers to a pair of Sexual partners in which one is HIV positive and the other is  HIV negative. This condition has caused several painful, dreadful experiences in once beautiful marriage. When HIV infection enters the family, it heads straight to the root of the relationship and starts breeding discords, suspicion and worst still dissolution of the relationship. All thanks to the high rate of stigma and discrimination encapsulated in the robust level of ignorance in the society.

Whenever a married man or woman gets infected with HIV something else very precious to that individual also gets infected. Suffice to say that the first target of attack as soon as HIV infects a married person is his/her marriage. It is no longer news that many marriages are daily lost to HIV infection in Nigeria. The once loving husband or wife suddenly becomes a foe the moment their spouse comes home with a HIV positive test result.

Divorce seems the next destination and before you know it both partners are heading their separate ways. This would have been less worrisome if they remain lonely. But they are soon involved in fresh relationships thus increasing their chances of either getting infected, re-infected or infecting someone else. But a simple, yet fundamental support by way of education and counseling could help address these anomalies.

No doubt a wide gap exists as far as AIDS response in Nigeria is concerned. This gap includes the need to strategically reduce the number of AIDS related divorces. Marriages must be preserved. Homes need not break or disintegrate with HIV infection. There can be much love after HIV infection. This is why I would rather invest so much in building

Can your marriage withstand it when the HIV test says "positive"? source:blackchristiannews.com

HOMES than just building Houses!

Two types of HIV discordance have been identified in the course of our work.

Soft Discordance or Discordance Simplex: This is a condition where the woman is HIV positive and the man is negative. This classification is done based on the need for child bearing. In Nigeria and indeed Africa, childbirth is the icing on the relationship of any couple. In this condition the woman needs to have a relatively high CD4 cells, very low viral load or preferably undetectable and with the support of the medical team and the counselor, the woman  can collect the sperm of the male partner during her ovulation period in a sterile syringe without the needle and introduce it to her vagina. She can get pregnant with this simple method and continue with other Prevention of Mother to Child Transmission (PMTCT) practices as may be prescribed by the medical team. In our environment, the financial cost implication of this practice is very minimal hence I ascribe the terms   ‘Soft’ or ‘simplex’.

Hard Discordance or Discordance Complex: This is a condition where the male is HIV positive and the female is negative. Getting the female pregnant with minimal chance of infection can be very complex. This happens to be so as the sperm of the male which though is HIV free is in the medium of the semen that carries HIV, hence would have to be separated from the HIV carrying semen before introducing it into the woman. The financial cost implication of this procedure, sperm washing and artificial insemination is outrageously high. Most fertility facilities in Nigeria shy away from this practice and rather would refer couple in this condition to facilities in South Africa and Europe. This is most regrettable and frustrating to the couples and even the supporting counselors too.

With robust counseling support over time, it has been prove couples could live happily. Hence, our national response to HIV need to bridge the gap that exist in the peculiar need of this group by increasing the services of the tertiary HIV care centers  to include sperm washing facilities and expertise while enhancing couple communication and disclosure.

Ibrahim Umoru

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A Caesarean section is a form of surgery in which one or more incisions are made through a mother’s abdomen and uterus(womb) to deliver her baby(ies).It is usually performed when a vaginal delivery would put the baby’s or mother’s life or health at risk, although in recent times it has been also performed upon request for childbirths that could otherwise have been natural.

While this life saving innovation is helping to save the lives of women and contribute to reducing maternal mortality, it is often a source of stigma especially in Nigeria where some women are sometimes “ashamed” to say they were delivered by CS. Kingsley Obom-Egbulem engaged an expert on this issue . The interview featured questions you’ve always wanted to ask about Cesarean Section with answers presented in a down to earth manner by Oliver Ezechi, Consultant  Obstetrician and Gynecologist and Chief Research Fellow at the Nigerian Institute of Medical Research(NIMR),Lagos.

What are we not doing right with respect to CS in Nigeria and what are your recommendations in addressing these ills?

Presently there are lot of negative perception about CS, with local myth that only weak women deliver by CS. CS is also termed as unnatural. There is also the believe that CS limits the number of children you want to have. With special reasons and in the hand of a qualified obstetrician  4th and 5th CS can be done. The cost of CS is also a major barrier to acceptance of CS. My recommendation is that we need to intensify public enlightenment  on dangers of having children too early, too close and too many children. We need to educate the public on the reasons for embarking on CS. Maternal health services should be free including CS.

What specific  gynecological or obstetrical problems was CS invented to solve and what is the state of this problem before the advent of CS?

Caesarean section was originally invented to save the life of the mother from dying or sustaining injuries from prolonged labour. Later, it was extended to save the baby too.

The Caesarean operation was thought to have originated in Roman times. It is known that Caesar had made a decree under Roman laws that all women who were dying in childbirth should have their baby delivered by cutting open their belly. This was meant as an attempt to save the child and increase the low population at the time. Hence the word ‘Caesarean’ was derived. In the 1500’s a French midwifery text referred to the operation as a ‘section’, making common the term ‘Caesarean section’. Later it became a tool not only to save the life of the  baby but that of the mother too.

Some women by their physical make up  and based on some medical reasons are supposed to have their babies through CS. Could you shed some light on this?

Oliver Ezechi:We must embark on constant education of women and their families what CS really does for them and their babies

The reasons for carrying out CS could be maternal or fetal or both.  For the baby to pass through the birth canal , there needs to be enough power to push it down- uterine contraction, baby small enough (passenger) to pass through the birth canal (passage).

If there is a problem with either the power, the passenger or passage, the baby will not be able to be delivered vaginal. In some women, because of their small size, or injury to the passage ( fracture of the pelvic bone during accidents), deformity from e.g. polio or congenital abnormality of the pelvic bone, the passage is small, a normal sized baby will not be able to pass through. The labour is stalled. Unless  CS is performed to remove the baby, the mother or baby  may die from injury or exhaustion. Also if the baby is too big, or presenting in an abnormal way  it will not be able to pass through a normal passage. Also some women for medical reasons in may not tolerate labour and delivery e.g. hypertension in pregnancy, previous injury to the womb will not be allowed to labour and push as this may cause severe morbidity and mortality.

Within the religious parlance delivery through CS attracts some form of stigma and you hear some women say “when the Doctor told me I am going to have my baby through CS,I rejected it and we started praying and the next thing the baby came out”. What’s behind this  perception of CS?.

In Nigeria some pregnant women will not mind losing a baby than having a CS. If the baby is not doing well during labour, a doctor will recommend CS for the woman to be able to have quality baby . A lot of babies are born compromised. The effects are not manifest until years later when the child starts having problems with learning . At that time it will not be attributed to the difficult delivery.

Do you have a personal experience in this regard?

Sometime ago, I had advised a couple about having a CS because the baby’s heart rate was not doing well during labour. The labour got prolonged as she had a borderline pelvis. They rejected it and discharged themselves against medical advice. Days later the couple came back to the clinic and boldly told me that God did it for them despite my recommendation. She proudly said ‘I had a normal delivery’. They were making mockery of me but  I professionally told them that  if  I have a situation again like theirs, I will do the same thing. As they were leaving I noticed that they did not come in with their baby and I innocently asked ,’were is the baby?’They shamelessly answered that they believed that the baby was not their own as they lost the baby soon after birth. That God will give them their own. The couple lost two other babies in quick succession. They later came to their senses and now have three kids from CS.

There is also the cultural dimension to this CS issue, where women who didn’t  go through vaginal delivery often hide the truth about how their baby was born some even lie and we are told they are said not to have the normal experience of child bearing? What’s your take on that and how can we deconstruct this mindset?.

We need to step up public enlightenment campaigns on the reasons for CS. Empowerment of women to be able to take decisions and free maternal health care. People need to know that CS is life saving option aside helping you have your baby safely and we should not be clapping for people who were told to go CS and they eventually had vaginal delivery, we are sending wrong signals about CS and women who opt for it.

How many times can a woman go for CS?

There is no fixed number. However, for every one after three deliveries ( whether vaginal or CS)  the risk of maternal morbidity and mortality increases. The ideal family size scientifically is two. The safest pregnancy is the second one. However, we generally advise women not have more than 3 CS but in the hands of  qualified obstetrician you can go as high as 5 or 6. I have done a 7th CS. The woman came to me after 5th CS and she had no child and she been advised not  have any more pregnancy. When she came to us we knew if we ask her to go, she may end up in the hands of unqualified persons and get killed. We counseled her on the dangers and agreed with her that she will be admitted in the hospital at  28weeks and delivered at 36weeks instead of 38weeks. We didn’t want her to contract at all because she may rupture her uterus and bleed to death. She has two kids now. After the 7th CS we tied her tubes.

How can we make CS safe or safer given our setting where unsafe surgery is contributing  to medical accidents and swelling the rate of needless deaths?

All maternal deaths in the country should be reported and inquiries made about how the woman died. We should insist that CS is not be performed by people not qualified to do so. Government should improve the capacity (human and infrastructure) of our hospitals to deliver quality services.

How do you prepare a woman who might require CS for surgery?

The woman should be counseled and educated on the reasons for the surgery. She need assurance and support. To increase acceptance, they do not need to be kept in the hospital for 7 days. After CS, I discharge the woman on the third day like any other woman. They come back on the 7th day for me to review the site of operation. This will reduce cost as well as prevent the relations from knowing she had a CS. We did a study in Ile-Ife which showed that our women prefer it and will accept CS in such situation.

The issue of cost  and affordability verses the need to save a woman’s life and that of her child will always pop up whenever we discuss CS in context of reducing maternal mortality. If a doctor knows quite well a woman will require CS and the husband obviously  can’t afford it, where is the fair point to stand?

Government should declare free maternal health  and improve public hospitals. Women who cannot afford the bills of the private hospitals will have a choice. If you go to a private hospital you will have to pay your bill because they receive no subvention from government.

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