Some women choose caesarean section while others find themselves in theatres as circumstances force them.
For instance, Ms Mwende has no regrets about choosing to give birth to her third child by caesarean section.
She opted for elective surgery over natural childbirth just three weeks before her due date because she was suffering from chronic fatigue, something she had not experienced in her two previous pregnancies. She also wanted to undergo tubal ligation immediately after delivery as she did not want more children.
“My doctor told me that it was the only way I could have my tubes tied at the same time. If I opted for a natural birth, I would have to wait for six weeks before undergoing the procedure,” she says. “It would have been inconvenient to return later for the surgery.”
Undergoing tubal ligation during a C-section, is one of the reasons women elect to give birth through surgery, according to a new Lancet series on optimising use of the surgery.
Other common reasons include fear of pain, fear of pelvic damage and involuntary urination as well as negative effects on sexuality and sexual relationships.
“In Kenya there are urban settings where we are doing too many C-sections, yet in the rural areas we don’t have enough to save women’s lives,” says series lead author Marleen Temmerman, professor of obstetrics and gynaecology at Aga Khan University.
Less commonly cited reasons include convenience, perceived advantage of children being born on particular dates considered special or to have religious significance and negative experience with vaginal birth, in which expectant women were neglected or abused.
Mwende’s first pregnancy, eight years earlier, ended up in an emergency C-section following heavy bleeding. Her doctor had earlier diagnosed her with calcification of the placenta, which was affecting the supply of nutrients to her unborn baby, and recommended that she be induced to give birth naturally.
“Before the decision by my doctor to induce delivery, I realised that my baby was not moving regularly,” she recalls.
Even though her second pregnancy was uneventful and labour-quick, she feared that, given her earlier history and age (38), she could end up needing emergency surgery during the birth of her third child, so she figured it was better to plan for it. Her doctor left the decision to her.
Increasingly, more women are delivering through elective surgery, a trend that has alarmed medical experts.