It’s almost the new normal: the C-sec or Caesarean section, the surgical method for delivering babies through incisions in the abdomen and uterus. It’s supposed to happen only in the case of certain medical complications that make vaginal delivery unsafe for the mother and/or the baby. Some of these include obstructed labour, foetal distress, or multiple deliveries.
What are the stats?
The World Health Organisation stipulates that C-section rates in the 10-15% range are normal and are associated with lower mother and baby mortality. Rates above 15% are associated with an increase in childbirth deaths. The National Family Health Survey-4 showed a doubling of the rate of C-sections in the past decade. While the overall rate is at 20.6%, the real picture emerges when you disaggregate the percentages into public versus private, urban versus rural, rich versus poor. For example, rates for C-section in urban areas were 28.3% versus 12.9% in rural areas. Analysis by wealth index reveals C-section rates of almost 26% among the rich versus only 1.5% in the poorest women. These numbers are alarming and reveal a trend towards unnecessary C-sections, says Dr Puneet Bedi, Consultant obstetrician-gynaecologist, Indraprastha Apollo Hospital, Delhi.
What is being done?
When Subarna Ghosh filed a petition in February 2017 asking for doctors and hospitals to display C-section rates, it didn’t take time for over 3,00,000 like-minded people to declare support. The petition was addressed to Union Minister for Women and Child Development Maneka Gandhi and Health Minister J P Nadda. Only Gandhi responded and appealed to the Ministry to direct hospitals to be more transparent about the percentage of C-sections they conduct. “It is time to make doctors/hospitals more accountable for their actions, it is a patient’s right,” says Ghosh. In September this year, the Central Government Health Scheme or CGHS norms initiated a policy-level change, making it mandatory for all hospitals seeking empanelment under CGHS to display their C-section numbers. So a pregnant woman and her family can have access to this information now.
Why the rise?
Multiple reasons, says Dr Kedar Padte, infertility specialist and founder of the Goa IVF Center.
These include busier doctors who want a quick delivery so they can move on to the next patient, choosing an auspicious time for the birth, fear of labour and of affecting future intimacy, and the fact that women are having children in their late 30s and 40s these days. “When women don’t conceive till late, or undergo fertility treatments, they prefer to have a C-section as they don’t want to risk a normal birth. As doctors, we discuss the risks and benefits, but ultimately we comply with the patient’s wishes.”
Not all high-risk deliveries (for example, where the woman has gestational diabetes, or has had a previous C-section) require a C-section, says Dr Bedi. The requirement for a C-section is decided on a case-by-case basis. Bedi adds, “The propaganda has been: doctors are always right. So if your doctor says C-section, you are not going to argue. But ask questions if you have a doubt.”
First look after Cesarean Section C-Section Birth. Mother smiling at view with her Newborn following surgery.
Dr Ritu Nath Deokota, obstetrician-gynaecologist and HOD at the STNM Hospital, Gangtok and Sub-committee member of Medical Council of India (MCI), believes that counselling the patient on the risks of an unnecessary C-section is the job of an obstetrician-gynaecologist and depends on an open and trusting relationship between the patient and the doctor. As far as the reason for the increase in C-sections goes, Deokota strongly believes that the shortage of doctors in hospitals and the high doctor-to-patient ratio is a major contributor, as it demands faster processing of deliveries. “We need the right infrastructure and adequate manpower,” he adds.
So what can you do?
Choose the right obstetrician-gynaecologist (and by extension, the right hospital)
The best way to ensure a normal delivery is to have an honest dialogue with your obstetrician-gynaecologist. Ask about C-section rates in the hospital and her own rates. Also ask about her philosophy on natural childbirth. Ask family and friends for recommendations. If you do not feel comfortable with your doctor, you could change, even if it is close to your delivery date, says Padte.
Educate yourself on pregnancy and childbirth
There are important advantages to having a vaginal delivery. For your baby it means a decreased risk of some types of immune system disorders due to exposure to bacteria in the birth canal, and getting immediate access to you and your breast milk. For you, it means a shorter hospital stay and recovery time, and avoidance of the scarring, potential infection/bleeding and pain associated with surgery. Take a birthing or Lamaze class. It will prepare you (and your partner) for what is to come and you won’t be taken by surprise (well, not totally).
Stay home until active labour
Go to the hospital when your contractions are strong, less than 1 minute in duration and less than 5 minutes apart. Chances of having an intervention, including a C-section, rise the longer you labour at the hospital, says Bedi. Last year, a study published in Frontiers in Medicine said,“Early admission to labour was associated with a significantly higher risk of delivery by caesarean section during the first and second stages.”
Enlist support
Get your spouse and family involved and hire help before the delivery rather than after.
Prepare, mentally and physically
Remain physically active during pregnancy and labour to hasten birth. Research findings published in the Journal of Perinatal Education have shown that women who are mobile during labour have shorter labour, report less pain and require less medical interventions. Trust your body, it knows what to do, says Padte.
