Posted on October 13, 2018

An obstetrics specialist at Hamad Medical Corporation (HMC) says most women will not require a C-section, but she notes it is important that expectant mothers prepare themselves, particularly emotionally, should their doctor advise that a surgical birth is necessary.

She says a caesarean section is recommended in around 30 percent of deliveries across HMC's maternity hospitals. "Sometimes there are medical reasons that make a C-section the best option for a woman and her baby. In many cases, we know in advance that a C-section will be required and the woman is able to prepare herself. However, there are times when an emergency C-section is necessary and knowing what to expect can help make the situation less stressful for a woman and her family," says Dr Najat Khenyab, senior consultant and head of the Feto-Maternal Medicine Unit at the Obstetrics and Gynecology Department at HMC's Women's Wellness and Research Center (WWRC).

A caesarean, or C-section, is the surgical delivery of a baby and involves making incisions in the mother's abdominal wall and uterus. While many C-sections are planned in advance due to a woman developing pregnancy complications or having had a previous C-section, Dr Khenyab says in some cases it doesn't become obvious until labour is well underway that a caesarean is required. "It is important to note that a C-section is a major surgery and is not necessary, nor recommended, in most pregnancies. There are a number of reasons why a woman may need an emergency C-section, including fetal or maternal distress, maternal hemorrhage, placental abruption, or a prolapsed umbilical cord, but this is not an elective procedure. Being advised she will require a C-section can be a very emotional and traumatic event for many women so it is important that pregnant women and their families are prepared in the event a C-section is recommended," Dr Khenyab notes. 

A caesarean is generally a safe procedure, but like any type of surgery, it carries a certain amount of risk. Dr Sawsan al Obaidly, consultant, Maternal-Fetal Medicine in the Obstetrics and Gynecology Department, says possible complications of a caesarean delivery include blood clots, excessive bleeding and the potential for damage to internal organs.  "Major complications relating to caesarean delivery are wound infections, post-partum hemorrhage, blood clots, reaction to anesthesia, injury to pelvic organs and increased risks during future pregnancies," she highlights.

She adds that pregnant women who have delivered a baby through a caesarean section are generally at a higher risk of potential complications, noting that health risks increase with each subsequent C-section. "The risk of placenta previa (when a baby's placenta partially or totally covers the mother's cervix the outlet for the uterus) in women who have had one C-section is 10 in 1,000 cases, compared to 28 in 1,000 cases for women who have had three cesarean deliveries. Placenta previa can cause severe bleeding during pregnancy and delivery," she states.

According to Dr al Obaidly, the risk of placenta accreta (a serious pregnancy condition that occurs when the placenta grows too deeply into the uterine wall) in women with placenta previa and no caesarean deliveries is three to four percent, compared to 50 to 67 percent in women who have had more than four caesarean deliveries. She says both of these placental disorders increase the risk of hemorrhage and the need for a blood transfusion and hysterectomy (operation to remove a woman's uterus).

Overcoming these pregnancy challenges and labour conditions and related issues were highlights of the 'First Qatar Challenges of Cesarean Births Symposium,' which was recently hosted by the Feto-Maternal Medicine Unit. The workshop shed light on some of the important challenges related to cesarean births and gave obstetric care providers a better understanding of the process and the various available management approaches. Over 300 participants, including obstetricians, anesthetists, family physicians, midwives and obstetric nurses from across Qatar attended the symposium.

source: Qatar Tribune