In those days of Roman civilization, a baby would be cut out to protect its unborn child. After finding the way of possibility, the thought of cutting the stomach of the living mother and taking out the baby started. But he did not have the wisdom to sew the cut place. So the death rate was one hundred percent. Bleeding and infection were the leading causes of death. How to stop bleeding? The inner part of the bark of the banana tree is slightly spongy. Since it is like a yard when dried, it was dried and wrapped around the cut area with them and kept lying down. Some of the bleeding would stop under pressure, some of the bleeding would be absorbed by the dry bark of the tree.
The first recorded surviving woman had a caesarean section in her husband's hands in 1560 when nothing was being delivered. The first use of chloroform was in 1853. In 18 Carbolic spray was used to disinfect the operation site.
Since the uterus is a place of bleeding, an obstetrician in 18 recommended abortion after a caesarean section to stop the bleeding. Until 181, there was no way to sew the cut. Finally, in 182, two German obstetricians stopped bleeding with the first stitches. Later, through various researches, simple methods and safe ways can be found. Gradually the hole changes and expands a lot.
Today, in the 21st century, a surgeon will take a baby out of the womb in 15 to 20 minutes and sew it on the abdomen in such a way that no one will realize that there is a cut in the abdomen. It's like comparing a rocket to a friend's walk. Who would not like the system? The germ-free environment, the use of antibiotics, the easy availability of blood have made this method safe.
But no. No matter how safe and easy this method is, we will not make it public. Because childbirth is a natural process. It has been around since ancient times. It is the same as other biological processes. Just as we do not eat in a healthy state without a mouth and a tube in the nose, so we do not give birth to a snake in a different way without a reason.
I don't know about normal or normal delivery.
At "36 to 40 weeks" the "labor pains" arise on their own, with the baby's "head down" and "within 12-18 hours" maintaining the "mother's health", without any "cuts" and "with little assistance" If the infant "cries" when it is conceived, it is known as an ordinary birth. Each of the captive words in the comma is a normal delivery parameter. Vaginal delivery is called vaginal delivery, but it is not called normal delivery.
Deviations from this can lead to many problems and even death for both the mother and the baby. Morbidity like VVF (mother) and cerebral palsy (disabled child) remains even if death is prevented. Therefore, the role of Caesar in preventing maternal death, infant death and various morbidities in any abnormal situation is undeniable in the modern world.
Caesar is usually of two types. Elective and Emergency. An elective caesarean section is performed if the pregnancy risk can be identified during pregnancy care and normal delivery deviations can be estimated. That is the predestined Caesar. And if there is a sudden difficulty in the delivery process, then the caesarean section is called emergency caesarean section. Notable among these sudden difficulties is hollow fetal distress or lack of oxygen in the baby's mother's womb. If the baby's brain does not receive oxygen for a long time, the baby may die in the womb or the delivery may take place in such a way that the baby does not cry. That is, breathing is not started. The result can be death or resuscitation through resuscitation through various means.
Maternal mortality and infant mortality rates were much higher in Bangladesh at one time due to lack of facilities. One mother dies every twenty minutes and 26,000 mothers die every year. Is it conceivable that a girl would die for a physiological reason? There was a morbidity like VVF that crippled a girl's life. Makes the mother's life even more miserable if the baby is a birth defect.
Professor Abdul Bayesh Bhuiyan introduced Emergency Obstetric Care in the nineties of the last century to prevent this extra maternal mortality. As a result, village midwives can get the necessary health care on an emergency basis at the nearest health complex.
Caesar is one of these emergency obstetric services. Attempts at home delivery have failed, with the baby's arms and legs hanging, the mother's uterus ruptured, the flowers removed and bleeding, foaming at the mouth due to convulsions. Significant causes of maternal death began to be obtained through abstract labor. As a result, not only maternal mortality, but also infant mortality and VVF began to decrease. Maternal mortality ratio decreased from 574/100000 in 1990 to 194/100000 in 2010 and 18/100000 in 2015. And the global rate has come down from 365/100000 in 1990 to 218/100000 in 2015.
The Millennium Development Goal 5 (MDG 5) aims to reduce global maternal mortality by 75% by 2015, with only 9 of the world's 75 countries achieving the target. Bangladesh is one of them. Similarly, the target of MDG 4 was 48/1000 child mortality under 5 years by 2015 which has come down to 44/1000 by 2011. Newborns account for 61% of all children under the age of five, down from 52/1000 in 1993 to 26/1000 in 2014. The contribution of good maternity management in reducing the infant mortality rate is immense. Caesar is one of them. And Bangladesh was rewarded for its success in reducing the maternal and child mortality and reaching the goals of MDG 4 and 5.
No one but an obstetrician understands what an obstetrician sacrifices to provide an emergency maternity service. Not even the physician husband or wife who has been lying side by side for years as a part of it.
What is the best way to keep the delivery safe?
Certainly not. Caesarean section is not the best way to keep the baby and the newborn safe. What is undeniable for safe delivery, healthy babies and safe motherhood is wholehearted care. This gestational care is an indicator of a country’s safe motherhood. Second, high-risk pregnancies must be hospitalized. Delayed or prolonged labor in the hospital is performed by caesarean section before the baby is removed. In Bangladesh, the maternity care rate is still 56%, mostly in cities. Then the rate of gestational care of village girls will be much less. As a result, many pregnant women come to the hospital in an emergency.
What should be the rate of Caesar?
According to the World Health Organization, a community should have 10-15% caesarean section for this safe delivery, which applies to those at-risk pregnancies. And that requires 100% pregnancy care. But do all countries around the world have that opportunity? We see a little bit about Caesar's rate despite the social and economic differences in different countries.
The rate of caesarean section is increasing all over the world. In the United States, the rate of caesarean section was 23% in 2000, which increased to 32% in 2015. Similarly in the UK it was 19.6% in 2000 which increased to 26.2% in 2015. Growth rate in different countries from 2000 to 2015
Global. 12.1% to 21.1%
Middle East and North Africa 19% to 29.7%
South Asia 8.2% to 16.1%
East Asia and Pacific 13.4% to 26.7%
Latin America and the Caribbean 32.3% to 44.4%
Eastern Europe and Central Asia 11.9% to 26.3%
North America 24.3% to 32%
Western Europe 19.7% to 26.9%
Bangladesh 3% to 24%
The countries with the highest rates of caesarean section are Holes
Dominican Republic 57.1
Brazil 55.5%
Egypt 55.5%
Turkey 53.1%
Venezuela 52.4%
Chile 48%
Paraguay 45.9%
Iran. 45.6%
Ecuador 45.5%
Mauritius 44.6%
Maldives 41.1%
Mexico 40.6%
Cuba 40.40%
India 40%
Bulgaria 39.1%
Korea 36%
Hungary 38.2%
Georgia 36.5%
Poland 36.2%
Italy 35.3%
Sri Lanka 35.5%
China 34.95%
Bangladesh 31%
In Bangladesh, the caesarean section rate was 12% in 2010 which was 31% in 2016. Compared to other countries, it is still much less than many countries. Especially less than in India with almost the same culture. The World Health Organization recommends 10-15% and states that "Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate." Which is applicable for Bangladesh. The World Health Organization has not taken into account the terrible level of illiteracy, unawareness, malnutrition, anemia and neglect of maternity in our community. So it's time to think anew. If you want to stay with our current socioeconomic infrastructure, Caesar's rate tied to this organization, there is no problem, the death rate will increase again.
The question may be why the mother's death is static even after Caesar's rate hike? Maybe this is our bottom line in the current socio-economic context. Since there is still a significant maternity hospital "point of no return." From where the doctor can not afford to return. Deaths come from that group. However, with the further development of rural Bengal in the future, people's awareness may increase and maternal mortality may decrease further.
Unnecessary Caesar
I would say Avoid Abel Caesar. Many become maltreated by midwives, sekmods due to not being in maternity care and not coming to the hospital for delivery. Almost all of which require Caesar. Proper labor management from the beginning would have made many vaginal deliveries possible and caesarean section avoided.
On the other hand, in urban areas, the rate of caesarean section is 80%, despite the high rate of maternity care and hospital delivery. Then it is seen that the rate of avoidable Caesar is high from both sides. Caesar has been needed in the village, but the need has been created without proper management. Unnecessary caesarean section is also done in the city due to lack of proper management. Patient choice is also a significant factor.
And if an obstetrician is having a caesarean section just for business reasons, it is definitely an abomination and I don't know if there is any way to change their character. But in numbers it is negligible.
What to do?
1 | Inclusion of 100% of patients in antenatal care. As long as that doesn't happen, the WHO's recommendation doesn't apply.
2 | A low-risk patient will be able to have a home delivery only if he or she is under the care of a birth attendant. If there is a problem, he will send it to the nearest facility immediately.
3. Applying oxytocin or misoprostol to a sexo and birth attendant to induce and expedite labor would be a punishable offense. Many patients bring emergency, uterine rupture for this maltreatment.
3. High risk patients must be admitted to the hospital for delivery.
Many times you have to be admitted long before the date. Significant maternal deaths occur from this group of people who come to the hospital in a dying condition. Even if a caesarean section is performed, not everyone can be saved. Eclampsia, obstructed labor is significant. Caesar's rate is also higher. Postpartum hemorrhage is the number 1 cause of maternal death. Hospital delivery can prevent death due to postpartum hemorrhage.
4. Preparation of trained midwives: One / one means one midwife for one mother. (To get WHO rating). Whatever the hospital delivery. From hospitals in remote areas to corporate hospitals in the capital.
5. Formulate an up-to-date labor management protocol including partography and external monitoring. The same protocol will work all over Bangladesh. Accidents can sometimes occur even after proper management from within the protocol. As a result, there will be a provision to punish the culprits if any attack is vandalized by blaming the doctor for any inconvenience to the mother or child.
6. Introduction of epidural anesthesia. Achieving tolerance of the patient and the patient's parents in non-epidural space.
A significant number of girls in the city have Caesar because they cannot bear the pain. Many caesareans are caused by intolerant patients and patients' parents.
Motivational counseling in favor of vaginal delivery. Patient choice is a significant cause of unnecessary caesarean section.
Patients should not put pressure on the consultant as to who will be in charge of vaginal delivery.
Preference must be there. However, the delivery is in the hands of the midwife
In order for this to be possible, the consultant is forced to terminate beforehand if the consultant is repeatedly in pain. Traffic jam in Dhaka city is also a significant issue.
7. Introduce sharing system without consulting the consultants alone.
There will be a group of three or four people who will be able to attend any need of the patient round the clock. There is a possibility of Caesar to avoid it.
8. Recruitment of trained assistant doctors.
Do not put anyone in charge of monitoring without at least six months of training in labor management.
9. Formulation of physician insurance policy.
10. Implementation of Physician Protection Act.
11. Bringing the private clinic closer to the charge of Caesarean and normal delivery.
12. Further increase in all types of facilities for availing services in government institutions.
Conclusion
A physician's meditative ideas are always patient-centered. There is no one more compassionate for his patient than he is. O GSB has always been working tirelessly to improve the health of mothers in this country. But the country's socio-economic structure and policy formulation for overall development is a big limitation. We are working with our conscience. We should vow to show the greater interest of our patients. So in the interest of the patient, we do and will do whatever is good for him according to the situation at that moment. However the request of those who are accustomed to operating the clinic owner’s sorted patients, do not give him the opportunity to make his pockets heavier in return for your labor. The clinician will decide for you, not the owner of the clinic. In the end, our slogan is one: "We want a healthy baby from a healthy mother."
Respected Professor Dr. Rashida Begum Madam's writing about Caesar.