Caesarian births in Uganda go back to pre-colonial days...

Saturday June 18 2011


By Halima Abdallah

Not too long ago, the Bunyoro of north-western Uganda fed expectant women intensively in preparation for childbirth, says Mastura Wamara.

“Women in the community used to cook groundnut soup, beans and millet bread,” says the experienced traditional birth attendant.
“They also used to steam sweet potatoes, cassava, green bananas and dark green vegetables. Mothers ate these foods before and after conception to reduce pregnancy-related complications like anaemia and malnutrition.”

Mastura says traditional birth attendants gave antenatal care to expectant women and could detect complications well in advance.
“We never used to go to hospital. If the woman’s passage was too small for the baby to pass through, for instance, an episiotomy would be performed using the sharp edge of a reed. The mother would bleed, but she would eventually be fine. We used herbs to help heal the wounds,” she said.

Sometimes, however, the delivery got more complicated and the birth attendant recommended the Caesarean section. This is a life saving emergency obstetric care performed only on a doctor’s recommendation.

It was being performed more than 100 years in Uganda by Banyoro surgeons in pre-hospital days. In 1879, Catholic missionary Robert Felkin witnessed a Caesarean section being performed on a young woman in Bunyoro.

Felkin’s testimony is documented in the book The Development of Scientific Medicine in the African Kingdom of Bunyoro Kitara.

“... The patient was intoxicated with banana wine. The surgeon made a quick cut upwards from just above the pubis to below the umbilicus, severing the whole abdomen wall and uterus so that the amniotic fluid escaped. Bleeding points were torched with red hot irons.

“The surgeon completed the uterine incision, with the assistant holding up the sides of the abdomen wall with his hands and hooking two fingers into the uterus. The child was removed, the cord cut and the child handed to an assistant...

“The peritoneum, the abdominal wall, and the skin were secured with seven sharp spikes. A root paste was applied over the wound and a bandage of bark cloth was wrapped around it. Within six days, all the spikes were removed.”

What Felkin saw is essentially what happens today in C-section surgery rooms, but with vastly advanced technology. For example, there are trained gynaecologists, well equipped theatres, anaesthesia and drugs to help the wounds heal.

The clinical head of gynaecology and obstetrics at Mulago hospital in Uganda, Samuel Kalisoke, says: “Caesarean section is done only if the baby’s head cannot pass through the available space, the placenta blocks the way, or there are other life threatening conditions like eclampsia (high blood pressure in pregnancy.”

However, the seriousness with which doctors view the surgery is gradually diminishing as many women from across the region view it as a social trend.

“Some women think that vaginal birth will make them age faster, but this is not true. Women are back to their former selves a few weeks after delivery,” said Projestine Muganyizi, head of obstetrics and gynaecology at Muhimbili hospital, Tanzania.

George Karanja, an associate professor from the Department of Obstetrics and Gynaecology, University of Nairobi, concurs.

“There is an increasing number of mainly young women who say normal births will overstretch their organs. This is not true.”

The preference for the C-section is also growing among economically independent women in East Africa as they can meet the high surgery costs required.

At Uganda’s national hospital general ward, the surgery costs between $150 and $200, which many women with genuine emergency needs struggle to pay. It costs slightly more in the private wings of national hospitals — about $500 in Kenya, Tanzania and Uganda.

The cost in private hospitals in the three countries is about $2,000.