Cutting it out: monitoring C-section deliveries


Doctors say there ought to be an audit of C-section deliveries in private and public health facilities

In its new guidelines, the World Health Organization (WHO) has called for the elimination of the so-called ‘one-centimetre-per-hour’ benchmark — a rule of thumb that obstetricians use to determine whether a delivery requires surgical intervention. This is to counter what the body calls a “surge” in interventions such as caesarean sections that could be “unnecessary”.

A caesarean section (CS or C-section) is a surgical intervention carried out to ensure the safety of mother and child when vaginal delivery is not possible. Across the world, CS rates are on the rise and India is no exception.

Data shows an increase

CS rates and trends over the last 23 years in India were analysed from four consecutive National Family Health Surveys (NFHS) in research papers published in the Journal of Medical Science and Clinical Research. The authors reported that the CS rate increased from 2.9% of childbirth in 1992-93 to 17.2% in 2015-16, at an average annual rate of 8%.

In particular, seven States had a CS rate greater than 30%, eight with rates between 10% and 20% and nine States less than 10%, as per one of the papers, “Increasing Trend of Caesarean Rates in India: Evidence from NFHS-4”.

Since 1985, the international health-care community has considered the ideal rate for C-sections to be between 10-15%. Also, since the 1950s, a woman progressing through labour at a rate slower than one centimetre of cervical dilation per hour has been considered “abnormal” by the WHO.

“The tendency is to act, either with a caesarean section or with the use of drugs such as oxytocin that speed up labour, leading to the increased medicalisation of childbirth,” the organisation notes.

However, doctors say that these recommendations have already been internalised within standard obstetric practice.

“We can’t accept that doctors would deliberately hike the C-section rates. These are done only in cases that are absolutely necessary. Patients are given an explanation about the need for it,” says Dr. Archana Dhawan Bajaj, consultant obstetrician, gynaecologist, fertility and IVF expert at The Nurture, a Delhi-based clinic.

Birthing trends

She says that while the WHO guidelines didn’t suggest anything radically new, policymakers in India also have to appreciate that India is witnessing a shift in birthing trends. “Today we have older women with more medical complications giving birth and these have to be taken into consideration,” she says.

Dr. K.K. Aggarwal of the Indian Medical Association seconds this. “C-sections should be done only when vaginal delivery poses a risk to the mother or baby. This mode of delivery can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications. Natural birth may seem like a waiting game but in the absence of any potential complications due to which a C-section may be needed, it is advisable to let nature take its course,” he explains.

Dr. Anita Kant, senior gynaecologist at Asian Institute of Medical Sciences, Faridabad, adds it is vital that patients understand that even elective CS are not always risk-free. Moreover, C-section rates can be higher in tertiary institutes or super-specialty hospitals as they are more than likely to get “complicated” cases.

Doctors, however, say that there ought to be an audit of deliveries done through C-sections, in private as well as in public health facilities.

“This is to ensure that economics do not influence the doctor’s and a hospital’s decision to conduct a C-section delivery,” says Dr. Aggarwal.

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Printable version | Jan 30, 2020 3:17:12 AM |

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