Cry Baby Cry…

Until early 20th century CS was never undertaken unless the mother was dead or moribund.

In the shared responsibility of our railway hospital half way through the CS,when the baby takes a gasp, my Gynecologist friend lets out a sigh, and merrily hands over the baby to me. Good riddance.
9 months job over.

As a pediatrician though, I have some reservations about this skewed CDMR- Cesarean Delivery on Maternal/ even Doctor’s Request.

-1-

CS was introduced to salvage a live fetus from the womb of  a dead mother.

In ancient Rome it was a religious necessity to remove the baby from the womb of a dead mother( caedar in latin means to cut ) for a separate burial. Until early 20th century CS was never undertaken unless the mother was dead or moribund.

Even CS has been done 30 min after the death in a mother who committed suicide & a healthy baby weighing 3037 gm was delivered. (Am J Obst. Gyn. 2008;198(1)

Till 20th century, CS was supposed to be baby friendly at the cost of Mother but not any more.

With the improved NICU facility now a CS is ordered as early as the fetal lung can be permitted by the local hospital set up to breathe independently . Even the immature lungs can be coaxed to maturity by steroid mimicking the labour stress.

While ACOG recommends that 39 weeks is ideal for deliveries, 37 weeks is technically considered full term.

From a Pediatrician’s view 37 weeks is full term only for a normal labor as long as the maternal stressed hormones of labor season the fetal lung into maturity.Yes, 37 weeker is full term for normal labor not for an elective CS just because others are in a hurry.

For the baby, the last 3 weeks are invaluable for that extra development of Eyes, Ears, Brain and the extra ration of placental antibodies. Unfortunately they don’t matter much in the OT as long as the baby gives a luscious cry. With that melodious sound, surgeon’s scalpel moves faster to cut the cord. All concerned are anxiously waiting for this. Cry baby cry. Sweet melodious cry.

The parents run for the astrologer for the Panchanga shravanam. Everybody is happy except me.

• Is fetal lung maturity is the only limiting factor in CS ?
• Is breathing easy the only criteria of quality of life?
• What about hearing, vision and other higher functions of the brain?
• How is he going to fight the big, bad world ?
• How can he enjoy life without those fine senses ?

It is too late now. The cord has been clamped. Baby has been handed over to me. I have no other option but to join the chorus with my team,” cry baby cry.”

The full OT joins the chorus,” Cry.. Baby..Cry….”

Our existence depends upon your lungs only.

-2-

Only the pediatrician in me knows about all the learning disability, hyperactivity, minimal hearing & vision deficit that the baby has to overcome 5 years after. And that is the most crucial period in growing up, the Learning window, the Preschool period. That is the time this baby has to muster all his resources to perform against other  Arjunas of his class in the vicious peer pressure of modern education system. Like the proverbial king ‘Karna‘ of the Mahabharat this baby has unsuspectingly  given away his god given ‘Kabacha Kundala‘ on the OT table to some unknown Indra. His day in the Mahabharat war is yet to come.

Pediatricians call it MBD. Nice abbreviation for ‘Minimal Brain Damage‘. Incidentally MBD in our country is an established book seller for study help for such weak students.

What a coincidence.