IMPACT OF INCREASING C-SECTION DELIVERY ON SOCIETY AND WOMEN HEALTH

WHAT IS C- SECTION DELIVERY?
C- section or caesarean section or caesarean delivery is surgical procedure of baby delivery via incision into mother abdomen and uterus. It is major surgical procedure. It is safe and sound for those  women who has different medical complications.

REASONS FOR C-SECTION TO BE PERFORMED
• Due to different medical complications like diabetes, hypertension, infection and placenta previa (when placenta completely or partially covered placenta opening cervix).
• When fetus is under stress due to hypoxia or abnormal heart rate.
• If previous delivery is through c- section in order to avoid uterine rupture.
• If pregnancy having twins or triplets
• If baby position is breech or transverse
• Prolong labor or obstructed labor
• Failure of labor induction
• When vaginal birth is not safe for mothers or babies.

WHO RECOMMENDATION FOR C-SECTION
WHO recommends the c-section when it is medically necessary to avoid unnecessary risk associated with it. Optimal c- section rate should ideally be 10 -15% in a population level.

C- SECTION RATE IN PAKISTAN
Pakistan is surpassing global recommendations of C-section which is visible through its upward trend. Let’s check out, what the various studies of the country indicating,
• According to Federal Government Polyclinic of Islamabad study findings, the c-section rate between September 2022 and August 2023 is 53.16% in which 77.89% cases are of emergency c-section. Previous c-section is also a major contributing factor of rise in c-section delivery in Pakistan.
• According to tertiary care hospital in Karachi, from January 2020 to  July 2021 54.4% births are via C-section .

Let’s explore the factors responsible for this substantial rise of emergency c-section deliveries in Pakistan according to study,
• Younger maternal age
• Fetal distress
• Primigravida (first time pregnancy)
BUT, ground reality is seems to be different where you can observed the irrational c-section deliveries become a fashion
1. Due to gynecologist will to charge heavy fees per birth which also save their time (45 minutes required for caesarean delivery) in contrast to vaginal birth which may take some time 1to 2 days. They declare most of the cases as emergency cases especially in primigravida women which initiate the cycle of c section deliveries for future pregnancies.
2. Secondly, Pakistan is facing a serious issue of rise in population growth. To overcome this issue, it has been observed that hospital’s management prefer c-section births over vaginal births to control population growth rate because there will be the gap of 3-4 years between the two pregnancies in order avoid medical complications secondary to c-section.
3. Sometimes, it is patient’s demand especially in urban areas or in higher educated women.
However, it is inappropriate to neglect potential medical complications associated with higher c-section rate which may not only negatively affect the physical and mental health of mother and new born but also show its negative impact on society and family system.

DRAW BACKS OF IRRATIONAL C-SECTION
Irrational c-section has many draw backs which are as follows,
• Longer recovery time and longer stay in hospital in contrast to vaginal births.
• Higher risk of getting infection
• Risk of blood clot formation is increased.
• Adhesion and scaring at incision site and more pain after birth .
Despise the above mentioned draw back, according to me  some prominent draw backs are as follows,

RISK OF DIABETES
Woman who undergoes C-section are more obese than vaginal births woman. Obesity is itself a key factor of diabetes and gateway of many others health complications. Research shows that the despite of controlling body mass index woman who have surgical birth are more prone to get diabetes. Altered gut microbes in c-section delivered baby may become the risk factors of insulin resistance, obesity and diabetes later in their life. C-section delivery also raises the risk of developing gestational diabetes in subsequent or future pregnancies.

GENDER IMBALANCE
Due to irrational or unnecessary c-section, there will be imbalance between baby girls and baby boys’ population over the period of time. Country like Pakistan, there is strong desire of people for baby boy birth. However, C-section delivery allows only 4-5 births. Then what’s exactly happen? As soon as birth of boy occurred, parents stopped conceiving to protect her partner from surgical complications. On the other hand, some has 4 girls and no boy. Some has only 1 boy and 3 daughters. In short, we are disturbing natural birth ratio of girls and boys. If irrational C-section section does not take place, then hopefully the balance between the boy and girl populations will not be disturb. Decision of delivery via C-section should be taken carefully especially in first pregnancy (keep in consideration the postsurgical delivery medical complications and its negative impact on society) which may initiate the cycle of c-section deliveries for future pregnancies in order to prevent the mothers from uterine rupture consequences. Another aspect is that if someone has 4-5 daughters and no son due to availability of limited option of pregnancies secondary to irrational c- section may lead to the episodes of depression in mothers because of continuous society pressure.

GUT MICROBIOTA LINK WITH DEPRESSION
Surgical stress allows the inflammatory molecules to enter into blood stream, antibiotics use and hormonal changes causes the disruption of gut microbiota (dysbiosis). As we all know, gut microbiota association with brain via production of neurotransmitter (dopamine, serotonin and GABA) which regulates the mood. Low levels of these neurotransmitters may affect the mood and may lead to long term depression.  In short, we can say that there is strong link among gut microbiota, immune system and brain which is mediated through gut-brain axis.

TAKE AWAY NOTE
We can say that over use of c-section deliveries in Pakistan has been negatively impacting our society. It’s not only increasing the metabolic disorder and autoimmune disorder in women but also increasing emotional breakdown consequences if she has no baby boy. Avoid unnecessary c-section through proper medical guidance and reevaluate medical necessity of c-section in Pakistan.