Why CS delivery is increasing in Nigeria –NMA

 …Dismisses claims of increase in deaths from CS complications

Angela Onwuzoo

The President of the Nigerian Medical Association, Prof. Innocent Ujah says the number of pregnant women delivering their babies through cesarean section is increasing in Nigeria.

The NMA boss, however, dismissed claims that deaths from the surgical procedure are on the rise.

Ujah, who is a professor of obstetrics and gynecology, said the increase is due to repeat procedures.

Speaking with PUNCH HealthWise in an exclusive interview, the consultant obstetrician and gynecological surgeon said claims that more pregnant women are dying from complications during and after CS are completely off the mark.

Ujah was reacting to a recent claim by a member of the House of Representatives, SergiusOgun, that no less than 300,000 women die annually in Nigeria as a result of CS procedures, citing a medical survey.

Ogun had, in a motion titled: “Need to Stop the Spate of Maternal Mortality

Resulting from Caesarian Operations in Nigeria”, which was adopted by the House, said the country was witnessing a rise in the rate of maternal mortality caused by CS.

“The House is concerned that the incidences of maternal mortality occasioned by caesarean operations are on the rise, with the latest medical survey revealing that no less than 300,000 women die annually in Nigeria as a result of the procedure.

“The House is also concerned that there is no vigorous effort on the part of the government to stem the tide of maternal mortality through provision of quality healthcare facilities.

“The House is worried that if the situation is left unattended to, the country may end up losing an alarming number of mothers in the process of childbirth”, Ogun had said.

But the NMA president told PUNCH Healthwise that although the lawmaker failed to disclose the source of the medical survey, it is untrue that over 300,000 women die from CS in Nigeria annually.

Ujah said, “What he said is not true. What is the total number of maternal deaths in Nigeria that you will have over 300,000 deaths from CS? I don’t agree with that figure.

“He needed to have quoted his source but I know that it is not true. Maternal deaths from CS in Nigeria are not significant at all.

“If he says the number of CS is increasing, yes, I will all agree, but I can’t agree to the claim that death from CS was increasing. To say that 300,000 maternal deaths occur from CS annually is a lie. Our total maternal mortality rate is not up to 300,000.”

Nigeria’s maternal mortality rate is 512 per 100,000 live births, according to the 2018 Nigeria Demographic and Health Survey.

In 2015, Nigeria’s estimated maternal mortality ratio was over 800 per 100,000 live births, with approximately 58,000 maternal deaths during that year.

In comparison, the total number of maternal deaths in 2015 in the 46 most developed countries was 1,700, resulting in a maternal mortality ratio of 12 maternal deaths per 100,000 live births.

The World Health Organisation says a Nigerian woman has a one-in-22 lifetime risk of dying during pregnancy, childbirth, or postpartum/post-abortion; whereas in developed countries, the lifetime risk is one in 4,900.

On why many Nigerian women are delivering their babies through CS, the professor explained, “The reason for the increase in CS is because of repeat CS.

“There are some women who after the first and second CS, depending on the cause, will have a repeat CS.

“Once a woman has a second CS, she will also most likely have a repeat CS because if we don’t do that, when next she is trying to deliver, the uterus may rupture and she may bleed to death.

Now, the reasons for doing the first CS are many.

“If the baby is breached, particularly if it is a first-time mother, the delivery will definitely be by CS.

“Also, if the baby is lying transverse, it has to be delivered by CS. If there is a foetal distress and if the woman has placenta previa, the baby will be delivered by CS.

“If the birth canal is small, a CS has to be performed. If a woman delivers by CS twice, it means that the rest of her delivery will be by CS.”

The gynaecologist noted that CS is an acceptable mode of delivery.

He called on the government to make antenatal care, delivery and CS free for all pregnant women.

This, he noted, would greatly reduce maternal and infant deaths in the country.

Ujah recommended the empowerment of women, while stressing the need for girl child education, adding that educated women are more likely to have hospital delivery where there are skilled birth attendants than uneducated women who most times patronise traditional homes or give birth at home.

According to him, in hospitals, delivery and labour are supervised by skilled birth attendants, such as gynaecologists and midwives.

Also speaking, a Consultant Obstetrician and Gynaecologist at the Family Health Department, Federal Ministry of Health, Abuja, Dr. KamilShoretire, said he was not aware of the 300,000 figure quoted by the lawmaker.

The gynaecologist urged pregnant women to always use hospitals for their antenatal care where he said they can be well educated on their delivery status.

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