In obstetric, there aren’t many big questions around.
Mainly, at the end of the 40weeks or shorter journey, the big question is “How to deliver.” and this question, believed me as open-ended as it used to be.
There are just two choices, either through the natural vaginal delivery or abdominal route through the popular lower segment Caesarean Section.
More mothers are currently proud owner of the Pfannenstiel scar, a souvenir commemorating the grand alternative pathway, which is operative C-Section that brings the baby into the world.
It is in our current trend that this path was being treaded for subtle reasons, rather than clear-cut indications.
Clinically, those may be subtle reasons, but for the patient, as an individual, those reasons are seriously crystal-clear reasons.
I came in clinic few days ago, faced with an elderly mother at the age, which probably, wouldn’t have been expecting a pregnancy. She had lived more than 4 decades, and got married just last year. From the probability of conception point of view, she was truly, seriously, without a single doubt, blessed.
With blessings, her pregnancy came with obstacles, having to bear mild gestational diabetics and pregnancy-induced hypertension along the way.
Her first child.
She was obviously anxious.
She had her doubt.
Probably her imagination ran wild from time to time, about how her pregnancy going to end.
Probably she was hoping I could give him an ultimatum for her wandering mind.
Maybe I can. Or maybe I can’t.
She: So, do I have to go for Caesar?
Me: So far, your pregnancy despite mild medical illnesses is progressing very well. Is there any reason you wanted to go for Caesarean section?
She: well, you see, there’s this Kuan Yin Ma (Goddess of Mercy) that I pray to, and when I asked Kuan Yin Ma about how to deliver, Kuan Yin Ma told me to go for C-Section.
Me: Well… Err… How Kuan Yin Ma tell you? By fortune-telling sticks? How?
She: Well, the temple owner went into trance and through her, Kuan Yin Ma told to go for C-Section.
Me: Oh… I will need to discuss with my specialist first.
Although there was no clear cut indication, but there are subtle reasons how the decision for elective C-Section should pull through, mainly because she was an elderly primid coupled with multiple medical illness. Although she didn’t suffer long period of subfertility, but at 40years old, probably this is the only child she going to get.
At the back of my mind, I was planning for a trial of labor with low threshold for C-Section, but my specialist gave the green light for elective C-Section, justifiable that with a low threshold, an emergency section would prove to be worse than a planned elective op. Plus, my specialist was sadden by the incident of another unfortunate patient in her forties, having to gone through a rather long subfertility period, gone through labor and ended up with a fresh stillbirth. The ill-fated incident was preceded with CTG showing a length of poor variability coupled with a probable indecisive by the medical practitioner of that hospital.
I returned to the patient.
Me: My specialist okayed an elective C-Section, which is probably the best choice for you, after considering various factors and your preference of C-Section as the mode of delivery. However, I need to tell you about the risks and complications involved, ie bla.. bla.. bla…
She: Oh, so when will it be?
Me: I will need to refer to the OT book first.
She: Wait a while, Kuan Yin Ma had given me several choices of date as well.
And my eyes went wide open....