December 29, 2005

Hail Caesarean

**Got this from msn.com. It's really worth a while to read**

I've wanted to tell this story for a long time. However, it makes me to be this ignorant fool that I am embarrassed (and reluctant) to admit I am. Like a friend of mine said, even some of the most educated people on earth can make some stupid mistakes. I guess I'm not as informed as I thought I was after all.

On 6th June 2002, I had a Caesarean birth for my first child, a girl, two weeks shy of my actual delivery date.

The day before, I had gone for my routine checkup and my doctor (now my ex-gynae) told me that I was dilating and wanted to check me in. Putting my full trust in her, I checked into Pantai on 5th June 2002 at about 11pm.

At about 1pm, my gynecologist came and checked me again. She said my cervix was only two to three centimeters open, and had to wait further. At 3pm, when nothing seemed to be happening, she burst my water bag to see if that would help things. Note that during all this time, I felt no labour pains and even wondered arrogantly then what the fuss was all about.

I was only six centimeters at about 7pm, which was more or less when they decided to induce me, but not before I had my epidural. The contractions started coming at about 8pm and the epidural did not work properly as I still felt the pain. The anesthesiologist re-administered the drug and half my body was numb while the other could still feel the pain from the contractions. And YET, I was not dilating fast enough.

At about 9pm, my gynae informed my husband and I that progress was slow and if I did not reach ten centimeters by tonight, she will perform an emergency C-section for the safety of our child. At 11.00pm, we made the call as Raeven was not crowning at all despite having reached ten centimeters dilation. I was rolled from the labour ward into the cold operating theatre at 12 midnight and gave birth to my daughter at 12.35pm under general anesthetic.

Suffice to say, this was an expensive experience. In total, we paid over RM10,000 in medical fees to Pantai, comprising the food and accommodation for four days and three nights, the doctor's fees, the anesthesiologist fees (he charged us twice for the re-administration of the epidural!) and the full suite of painkillers used, the paedetrician's fees (the only thing I was happy to pay), the nursery, UV light fees for the baby et al. After addressing this unhappy issue to our gynae, she managed to negotiate a refund of RM400 or so, off the price of the second epidural administration.

Still, it was over RM10k. And this isn't including my confinement lady fees of RM2, 500.

Fast forward two years later to May 2004, and my friend Mae in Singapore is having her second child. She emails me from her office.


"I am only three cms so my doctor told me to stay at home first. I was bored and decided to go to work."

Imagine my surprise. No, imagine my shock. Three cms and she got to go to work? I was in the hospital BEFORE I was three cms! What on earth?

As I had already changed my gynae for my second pregnancy (am six months along now) due to the fact that I did not want to go to Pantai anymore due to its exorbitant fees, I decided to ask my present doctor some questions. He listened to my grim tale patiently and when I'd finished, asked me only one question.

"Was your ex-gynae going on holiday the week after?"

And that was when it struck me. She had told me that she was going on her vacation around the same time. It just did not occur to me the significance of it because hell, she's my doctor. She should be able to manage her schedule and not only because I am paying her to be around when I'm ready to pop.

Of course I was outraged. I began to see why I was rushed to the hospital before my labour pains started, two weeks ahead of my due date, before I was even dilating properly! And to realise I should have known about this dilating thing - but then again, how many first time mothers do?

According to my present gynae, depending on the health of the pregnancy after months of monitoring, the practice is to admit a patient only when their contractions are minutes apart, or when the water bag has broken, or if the husband is around to check, if the cervix is about 5cm dilated. Anything earlier is just a waste of time and money, UNLESS complications are expected to arise.

That said, my gynae confesses that he is pro-Caesarean himself. Why? Because it is safer for the mother and the child. However, for first time births, he usually discourages it unless the baby is breach (positioned wrongly) et al. For mothers who have gone under the knife, such as myself, he recommends another Caesarean simply because of safety.


"Honestly speaking, it poses less stress for the doctor as well because we are worried for you, if your wound might rupture, which is very messy. The decision is ultimately still up to you to go elective or vaginal," he told me.


In considering this (I was very determined to go natural the second time around until his advice), I looked at my friends around me, about nine of them having been pregnant and expecting earlier this year. Out of the nine, eight had Caesareans. Three were emergency while the other five were elective (i.e. voluntary, planned cuts that are grossly cheaper than emergency ones due to hospital protocols).

This was when I decided to do a little sleuthing. I asked all of them why they went for the cut. Three electives quoted that they wanted to be done with it quick and tidily, as advised by their doctors. The other two said that it was because of the money (emergencies cost more than electives, almost a thousand more, give or take, due to hospital protocols and manpower, although natural births cost much less) while one was also afraid of the pain. She obviously did not think of the pain AFTER the drugs taper off.

The three emergencies were due to complications such as breach, placenta previa and a blood clot found in the placenta.

All of them paid no less than RM5k/S$6k for their deliveries (two of these friends delivered in Singapore).


Out of so many of my school friends I still keep in touch with (rough number of 20) who are parents now, only THREE have delivered naturally, and that is only for each of their first children. Two of these ladies went under the knife the second time around
.
This leads me to realise many things. Firstly, for an educated, affluent couple to have a baby today is a truly expensive affair - and this isn't even including the postnatal stuff and the future.


The more you know, the more you seem to want to pay. Take those folks who go to government hospitals (and I know two women who gave birth in Klang GH). They pay RM2 for the urinal cup if they have the good fortune of a natural birth. If there are complications, a week's stay, everything included, is about RM400. Sure, the buildings seem old (for some), the nurses are rude and the doctors don't have a lot of time to spend on you. However, the equipment is top notch and medical care is reasonable.


Still, private hospitals and medical care seems to be THE preferred way to go (and I am guilty as well for holding on to this perception), and as such, one gets the feeling that most gynaes these days seem to be out to literally put you to the slaughter.

Secondly, while safety is always paramount to mother and child, doctors seem to think that a C-section is the panacea for troubled minds (and not blogging!). Do a cut, quick and simple, and mother and baby are safe. According to my gynae, his record is SIX C-sections on a single mother and he knows of a doctor who holds the record of 11 cuts on a single patient.


As such, if one is only planning for two to three kids, C-section is actually quite safe.

With so much for Caesarean, what then is the case for vaginal or natural birth, if one dares to ask? Why was I so adamant?

1. Cheaper fees (which is apparently more of a gamble than Caesarean these days)

2. Less pain and better recovery after (which my doctor insists can be achieved as well in a properly performed C-section these days)

3. Better 'bonding' between mother and child because both are 'alert' at time of delivery (this is very iffy factor to grasp for many simply because it's not exactly proven by science. However, I for some reason believe in it, although my first child and I bonded very well because of co-sleeping and breastfeeding)

4. Easier breastfeeding immediately after (there is no doubt that nursing after a Caesarean is a challenge in itself)

5. The satisfaction after delivery that a Caesarean birth will not be able to replicate (another emotional factor that's hard to push for - pun intended)

6. A friend of mine told me that her paedetrician conducts research on children delivered using Cesarian, who may suffer from a nerve-related growth impediment compared to children delivered vaginally - although none of this is proven yet. This has something to do with the birth canal massaging the nerves as the baby descends.

Last week, after much debate with my husband and discussion with my gynae, coupled with my own research on the Net, I relented to an elective Caesarean on 31st December 2004 for my second child.


Of course, this is just for me as I have a few 'extraordinary issues' to consider, such as my previous C-section, the fact that I was overweight and may have early diabetes.


Still, I cannot help but wonder that with medical advancements having reached its state today where in so many areas, doctors are availed more and more research and methods to help perform their jobs better and easier, that if perhaps they too have forgotten their Hippocratic duty to provide their patients the best possible medical care without conflict of interest - such as to fatten their bank accounts by opting for the easy in the name of safety.

With the dearth of healers in our country, I dare not think about what lies ahead for health care in our country and how high the costs will eventually shoot up if gone unchecked.

It is any wonder that our money-minded mothers wish us to marry doctors these days?

[Copyright Controlled]


[Jennifer Tai writes about Relationships and First-Time Motherhood on msn.com.my Women's Channel every week]

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