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It is common knowledge now that an increasing number of Indian women are having C-section deliveries each year. But just how much is this increase, in actual numbers, and what is the problem? A popular news network recently shared the statistics: in recent years, there has been a 70% increase in C-section deliveries in the private sector! It is certainly true that there are situations when a C-section is the only available option for a safe delivery. However, there is a strong reason to believe that many of the C-sections being undertaken in India are actually unnecessary!
In the year 2010, the total percentage of C-section deliveries in India stood at 8.5 %. But this rate has gone up abysmally over recent years. A report published by ICMR School of Public Health gives us clear numbers: Kerala stands at 41%, Tamil Nadu at 58%. Even rural areas are reflecting a similar trend: in just 6 years, the percentage of C-section deliveries has gone from 31% to 51% in rural Haryana!
Now, while C-section by itself is a fairly safe medical procedure, it can pose far greater long-term risks for the mom and the baby as opposed to a normal delivery. It has been seen that babies born via C-section sometimes develop breathing problems, especially if the mother did not labour. This is because the baby’s lungs didn’t get a chance to get fully developed. Some studies have also warned that C-section babies could be more prone to problems such as Asthma, Type 1 Diabetes and Obesity. For the mother too, recovery from a C-section is a much longer procedure. It also predisposes her to the likelihood of having a C-section again, for her next delivery.
A recent tweet by Maneka Gandhi caused quite an uproar and brought the issue into focus once again. Quoting part of her tweet-series, here’s what she had to say –
I’d like to share my concern over alarming percentage of C-Section surgeries being conducted in hospitals these days. /1
— Maneka Gandhi (@Manekagandhibjp) February 22, 2017
I have suggested mandating the hospitals to publicly display the no. of C-Sections vis-a-vis normal deliveries./7
— Maneka Gandhi (@Manekagandhibjp) February 22, 2017
Why Is This Alarming?
The World Health Organization (WHO) has set the recommended level of C-section births for a country to be between 10 and 15%. WHO has arrived at this figure taking into account different factors that affect the decision of going for a C-section delivery – which means, if the percentage of C-sections is lower than the set standard, that is a bad thing too (as it indicates that C-sections are not being done even when necessary).
To bring everything back in perspective, India stood at 8.5% not long back – close to the WHO range of 10-15%. However, this number has skyrocketed over the past decade and this is a big problem.
Who Is To Blame?
Let’s take a look at different people involved in childbirth and understand each perspective.
1. Doctors and Hospitals
Did you know that roughly 70,000 babies are born every single day in our country? That’s close to 50 babies per minute! This puts an insane amount of pressure on hospitals and doctors, in terms of availability of facilities to ensure safe childbirth for each pregnant mom.
C-sections take less time (approximately 10-15 minutes from time of incision to delivery, total 30-45 minutes in all) and are low-stress as compared to normal/vaginal deliveries (which can even last 10 or 12 hours, with constant monitoring of different parameters by the doctor and his/her team). Hence, C-sections should actually cost lesser than (or at least as much as) vaginal deliveries, but definitely not more. However, that is not the case.
The monetary trade-off for vaginal deliveries is far more disproportionate to the amount of time and effort required to be put in. Also, considering the time required for the delivery, more C-section deliveries means a hospital can offer services to a more number of women – an important factor considering the above statistic of number of childbirths per minute.
The prognosis of C-section is lengthier and more complicated than that of vaginal deliveries: this translates as more business for the hospital. Mothers have to stay under observation for longer periods, and have to often be medicated for better prognosis.
2. Family Members
When a pregnant mother is “on the table”, she has little-to-no control over her body. Even if she wishes to make the choice herself, she may not be in a position to do so. And that is where the woman’s family comes into picture.
Family members often seem to be in a greater state of panic than the mother herself. A lot of husbands who ‘want to be involved’ in the process tend to become over-protective and act on impulse rather than logic. Same applies to family members. It is not unheard of family members causing undue stress to the mother and thereby emotionally or mentally coercing her into opting for a planned C-section delivery.
Yes, we ourselves are also to be blamed to an extent. A lot of women tend to think that C-section deliveries are ‘safer’ than vaginal deliveries where ‘anything can go wrong, and nothing is under control’. Some women also opt for planned C-section deliveries because they want to evade the pain of a normal delivery. The pain that they have to deal with for several days after the delivery is another story! Finally, there are women who want to plan their baby’s birth depending on whether it is an auspicious day or not. This might not be so hard to believe, given that we are a country that actively believes in astrology.
Wrong Reasons To Have C-Section
1. Lapse in Estimated Delivery Date (EDD)
A lot of mothers and their family members often panic once the EDD lapses, and coerce the doctors to go for a C-section delivery. Alternatively they may even coerce the doctors to induce a vaginal delivery by inducing labour pains. Both practices are wrong. A baby that is forced out of a mother’s womb before it is ready can suffer from serious respiratory complications and distress. It is normal for a woman to take upto 42 weeks to deliver a baby (9 months and 2 weeks). The EDD is only an estimate, after all!
2. For the Safety
It has been statistically proven that – the risk to a mother is same during both C-section and vaginal deliveries. It is untrue that it will be safer to go in for a C-section. In fact, the complications arising during prognosis of a C-section are far more severe than the prognosis of a vaginal delivery.
3. For the Ease and Convenience
It is important to realise – the pain during labour is far easier to deal with and is short lived, as compared to the long-term and at times irreversible health implications of a C-section.
Right Reasons To Have C-Section
A C-section delivery is recommended in case of high-risk births. A high-risk birth is when a vaginal childbirth poses a fatal risk to the mother or the baby. If and only if it can be said with certainty that the pregnancy and/or the delivery is going to be high-risk is it advisable to go for a C-section.
- If the baby is not in the correct position (head down), or if the baby keeps on turning within the womb (called ‘unstable lie’)
- If the umbilical cord is wrapped around the baby’s neck and there is considerable risk of strangulation during a vaginal delivery
- If the mother is HIV-positive, if she has any severe disease or medical condition (cancer, diabetes, epilepsy, a heart-condition, etc.)
- If the baby has been detected with a congenital defect (Down’s syndrome, Sickle-cell anaemia, etc.)
- If the mother is expecting twins. Twin- or multiple-birth means twice the number of factors that need to be monitored, the biggest factor being position of the babies
- For a mother who has had a C-section delivery before, there is considerable risk of the scar rupturing during the second delivery. However, it is also common for women to have had vaginal deliveries after having a previous C-section delivery
- If the mother is suffering from central placenta praevia, pre-eclampsia or eclampsia
The latest scenario in India leaves no doubt: not every C-section delivery is necessary. So, how can you ensure you do not find yourself in a position where you had to go for a C-section you could have avoided? The best solution is to prepare and educate yourself.
- Do not take the EDD so seriously. There is no scientific way of “predicting” the exact date of delivery… that’s why it is called ‘estimated’ date anyway!
- Even if you earlier pregnancy ended in a C-section delivery, it does NOT mean your second one has to end the same way too. It is possible to have a normal delivery after having a C-section too. Weight the pros and cons carefully before opting for a second C-section. Each pregnancy is different
- Do your homework before choosing a gynaecologist, and hospital. Use your nine months of pregnancy to do complete and comprehensive research
- Obesity, lifestyle, are very big and yet easily avoidable reasons for the increased percentage. Inform yourself better and take care of your health and body proactively
The Silver Lining
The good news is that our medical fraternity has started taking action to correct the situation. Many doctors are actively taking steps to curb the trend that is fast becoming common place throughout the country. It is important to spread awareness about such doctors, and to applaud their efforts.
Mumbai-based Dr. Rajiv Punjabi, of Tulip Women’s Health Care Center, has an ‘equal charges’ policy for C-section as well as vaginal deliveries. Dr. Pratibha Narayan, who is with The Birthplace, Hyderabad, is another doctor following this policy. Following Maneka’s proposal, some hospitals have already started coming forward with data regarding their ratio of C-sections vs. normal deliveries.
As a parting thought, we would just like to say – knowledge is power. Take care of yourself – and don’t forget to share this critical information with all your pregnant mommy friends.