If you already had a caesarean birth, you can still deliver your second baby vaginally, a leading reproductive health expert in Nairobi says.
Prof Marleen Temmerman, who leads the Centre of Excellence in Women and Child Health at Aga Khan University Hospital, says the catchphrase “once a C-section, always a C-section”, is not true.
“Many doctors consider a first C-section as a reason to have subsequent deliveries done via C-section again, but the saying ‘ once a CS always a CS’ is not correct,” she said.
Temmerman spoke after many Kenyans raised concerns over the rising C-section rates in the country.
The Kenya Demographic and Health Survey 2022 results showed rates in some counties approaching 40 per cent.
Nationally, the CS rate is 17 per cent, but the World Health Organisation says there is no evidence of added benefits when population rates surpass 15 per cent. A C-section carries more risk than a vaginal delivery, with a slightly longer recovery period.
Prof Temmerman told the Star that Caesarean section without valid medical reason should be avoided, especially in young women in first pregnancy as they will be at higher risk during their next pregnancy.
“Women should be educated about the mode of delivery, and be informed that in most cases, they can still have a safe vaginal delivery after a CS. Important is to ask your doctor/hospital about their policy on VBAC (Vaginal Birth After Caesarean), so that you are assured there is a team that will support you,” she said.
This helps mothers avoid certain health problems linked to multiple caesarean deliveries. These problems can include bowel or bladder injury, womb removal, and problems with the placenta in future pregnancies.
Prof Temmerman also chairs the Aga Khan-Unesco Youth Leadership Science, Health, Gender and Education and is a board member of the Partnership Maternal, Newborn Child Health (PMNCH), the world's largest alliance for women's, children's and Adolescents' health.
According to the KDHS report, women delivering through cesarean sections in Kenya rose from nine per cent in 2014 to 17 per cent in 2022.
The Aga Khan don said more women could be asking for CS for various reasons such as better planning, fear of natural birth and fear of pain during childbirth.
“However, they often do not realise that a CS is still a surgical intervention with more complications than a natural birth, and in addition, once a CS, always a scar with higher risks for the next pregnancies. Information and education are important as well as better pain management during childbirth,” Prof Temmerman said.
Kirinyaga county leads with a rate of 40 per cent followed by Kiambu at 33 per cent, Tharaka Nithi at 30 per cent, Nairobi 28 per cent and Taita Taveta 30 per cent.
The AKU don said high rates at the county level could also indicate that gynaecologists are using this method of delivery for non-medical reasons, including planning of work, monetary incentives and fear of litigation.
“Counties could have an audit, and understand why they have such a high rate. Counties with CS below 5 per cent should invest in maternal-child health and health systems,” she said.
Dr Simon Kigondu, a gynaecologist and President of the Kenya Medical Association, said many C-sections are necessitated by poor primary healthcare infrastructure.
“Mothers are thus advised to attend antenatal care and the government is advised to invest in the infrastructure and, more importantly, well-trained and motivated human resources to ensure safe delivery of mother and baby,” he said.
Kigondu said doctors should not be blamed because women cannot be denied the procedure when they demand it.
However, he said the first CS should be avoided because it increases the possibility of a second one.
The KDHS 2022 report showed 10 per cent of all adolescent births were via CS.
“A cesarean section rate will be higher in an area where the mothers have had previous operations in their previous pregnancies,” Kigondu said.