Business or freedom driving C-Sec babies growth in India?

By ZRG | Updated: Oct 12, 2012, 18:31 PM IST

Ajay Vaishnav and Ankita Chakrabarty / Zee Research Group / New Delhi

One can easily notice smile and sense of pride on Dulari Devi’s face. After all, her family has been blessed with a new member, a male child. But behind her cheerful face, the 62-year-old harbours a deep grudge against a Delhi-based gynaecologist who gave consultation during the period of pregnancy and later supervised her daughter’s Caesarian section operation.

Even four months after her daughter’s delivery, Dulari thinks that the C-section performed was unnecessary and the lady doctor – currently running her own clinic from Dwarka and also working as a consultant with a private Hospital at Janak Puri where the baby was delivered – didn’t make that extra effort for normal delivery of the child.

While the family has moved on in their daily life, Dulari never misses an opportunity to drive home the point that modern day gynaecologists either lack skills of yesteryears’ midwives who according to her were more efficient in performing normal vaginal delivery or they are increasingly becoming business minded.

“Babies were delivered even during our times. Then doctors use to make extra efforts to ensure that baby is delivered normally. Operation used to be the last resort. But nowadays it has become very common. On slightest pretext, doctors are ready to perform surgery,” stressed Dulari, a Dwarka resident.

Usually, we tend to dismiss such casual observations made during tea-time conversations. However, when one looks at the World Health Statistics (WHS), 2012, then Dulari doesn’t seem to be off the mark. A Zee Research Group analysis of the WHS report reveals that Caesarian operations in India are steadily rising. In fact, 9 per cent of all births in the country were by Caesarian section. What’s more perturbing, the figure has gone up by 5 per cent between 2005 and 2010 raising doubts. Are doctors needlessly exposing women to surgical risks?

While reckoning that c-sections are rising, doctors view it as nothing more than a classic demand-supply situation. According to them, new generation mothers avoid undergoing the pain of childbirth.

Dr Ranjana Sharma, Senior Consultant, Obstetrics and Gynaecology at Indraprastha Apollo Hospital, Delhi observed: “Nowadays most of the women do not want to witness labour pains, they wilfully choose C-section, and also some doctors consider it as an easier and simpler option even though it could have been avoided otherwise. But sometimes genuinely if the patient has difficult labour pains, c-section can’t be avoided.”

But can C-section operations be based on patient’s personal preferences or doctor?
In this regard, it would be better to revisit the World Health Organisation (WHO) guidelines.
The WHO clearly states that C-sections should be done only as a life-saving measure when there is a risk of fetal or maternal death.

Highlighting these risks, Dr Sheetal Aggarawal, Senior gynaecologist at Rockland Hospital, Obstetrics and Gynaecology explained, “Generally under emergency conditions when the baby has passed meconium inside, it might lead to fetal asphyxia and it could be dangerous for the baby, so in such circumstances it is extremely necessary that the baby should be immediately out which is possible through C-section.”

The key question, therefore, is whether doctors comply with the WHO guidelines. More importantly, are there any in-built mechanisms and regulatory measures in place to monitor abnormal rise in C-section cases? The WHO considers any region having C-section rates higher than 10 to 15 percent as unusual. Since India hasn’t crossed the 10 per cent benchmark, one can afford to assume that the current national C-section rates are normal. But, there is a need to monitor states like Kerala which have posted rates as high as 30 per cent.

Besides, periodical WHO and independent surveys conducted by civil society organisations have pointed fingers at hospitals pushing for C-sections for financial gains rather than medical emergency. Even a cursory glance at the admission rates of most private hospitals will reveal the difference in normal and surgical delivery. Hospitals gain financially more from the latter.

Equally important is the need for transparent communication between the family and the doctor. Dr Sheetal Aggarawal at Rockland stressed, “Generally good communication has to be there between the doctor and the patient and her kins, there should be transparency in conducting c-section operation, the doctor should explain the situation to the patient and her attendants and the decision should be taken after their consent.”

Defending the case for C-section operations, Dr Anjali Kumar, Senior Consultant, Obstetrics and Gynaecology, Paras Hospitals, Gurgaon said: “For any Caesarian section operation, there are two basic indications. The first one is elective which is usually decided at 38 weeks of pregnancy if the baby and the mother are not fit. In the other one, if the baby’s heart beat falls or if the mother starts bleeding and despite of the labour pains, the baby is not able to come out, then the doctor takes this step of conducting emergency C-section operation. As a doctor, one has to give options; one can never force a person but should be able to explain the gravity of the situation.”