To combat the high number of caesarean sections

With caesarean sections making up more than one-third of the deliveries in the State, much higher than the national average, the State government has decided to enforce the protocols to be followed during labour.

These protocols were spelt out at a State-level advocacy workshop and the launch of a special awareness campaign to promote normal deliveries held here on Sunday. The workshop, organised by the National Rural Health Mission, was inaugurated by Eldose Kunnapillil, district panchayat president. District Collector P. I. Sheikh Pareeth presided over the function.

The World Health Organisation has said that caesarean sections should be just 15 per cent of the total number of deliveries. However, in Ernakulam, Pathanamthitta, Kollam, and Alappuzha districts, more than 50 per cent of the deliveries in private and government institutions are caesarean sections. The first phase of the enforcement of the protocols will hence be in these districts.

One of the protocols makes mandatory the timely and proper recording of the progress of labour, including partogram, a measurement to assess the progress of labour, which includes checking the health parameters of the woman and the child in the womb. The attending doctor needs to write on the case sheet the indication for induction and caesarean section.

A monthly clinical audit of complicated cases of pregnancy and delivery, including caesarean section, should be done at the institutional level and a report of the audit and corrective steps should be sent to the District Medical Officer (DMO) on the first working day of the following month.

At the district level, a committee comprising the DMO, the additional DMO, the senior-most gynaecologist in the district, and the Reproductive and Child Health Officer (convener) will be constituted for the monthly evaluation of delivery cases. Major issues, if any, will be brought to the notice of the Director, Health Services.

Risk assessment

The protocols include risk assessment steps during routine antenatal checkups and early referral of high-risk cases to institutions with facilities to manage them; providing health education to antenatal women and their family members to prepare them mentally for labour; and taking the second opinion of a gynaecologist before going for C-section.

More than 65 per cent of the deliveries in government hospitals in Ernakulam district were caesarean sections in 2009-10 and 2010-11. In private institutions, these made up more than 55 per cent. In Pathanamthitta, government and private institutions averaged between 50-55 per cent caesarean deliveries in those years.

However, the number was down in government hospitals in that district between April and June this year, touching 46 per cent. However, the rate continues to be 53 per cent in private hospitals.

V.P. Paily, president, Kerala Federation of Obstetrics and Gynaecological Society, delivered the keynote address at the workshop.

K.V. Beena, District Programme Manager, NRHM, introduced the project and action plan.

Safiya Beevi, Additional DMO, welcomed the gathering. S. Sachithananda Kamath, Indian Medical Association, Kochi, Sherly John, president, Cochin Obstetrics and gynaecological Society, and Chitrathara, secretary, participated. R. Santhakumari, District RCH Officer, proposed a vote of thanks.