Caesarean or Normal: The decision to deliver is unclear in the private health care system of India

Capstone Women

From 2008-09 to 2018-19 the number of c-section surgeries increased by four times in private hospitals, says Health Management Information System.

No matter which part of the world you live in, the arrival of a child is a joyous occasion for every mother. Another similarity among these mothers is the experience of giving birth, as the cases of caesarean are increasing worldwide. In India, the cases of c-section deliveries are surging in the private health care sector.

Mansi Bhatia delivered her baby within a day by caesarean, at a private hospital in her 38th week of pregnancy. During her sonography session, she was told that the amniotic fluid is less and the baby’s weight is not increasing as per the month of the pregnancy, hence there is no point in waiting for normal delivery.  “I was not prepared for surgery, but I was told it is best for the baby. After reports came, doctors said I have to go for surgery immediately in a day or so,” she added. Her pregnancy was handled by her family gynaecologist, so she never bothered to research her pregnancy.

Mansi’s story is an experience of so many pregnant women, who deliver by c-section in a haste without any mental preparation. However, this is not the only reality there are other and dissimilar cases, but the number is really less.

Nikita Mathur, delivered her baby two years ago; she had more complication compared to Mansi. Her amniotic fluid was low, and the baby had two loops of placenta around the neck, she was even informed by her gynaecologist that she should prepare herself for caesarean surgery. “I prepared myself for both normal and c-section delivery, I read a lot about pregnancy and continued pre-natal yoga till my last trimester which helped me a lot,” she said. Nikita nearly paid one lakh rupees at a private hospital, even when she delivered normally and stayed in the hospital for two days.

The data collected by the Union Ministry of Health and Family Welfare under Health Management Information System (HMIS), In 2008-09 there were only four lakh cases C-sections in a private hospital in India which increased to 20.5 lakh in 2018-19. The rise is not limited to the country, according to the Lancet report which covered data 164 countries reported that the cases of c-section surgeries increased from 16 million in 2000 to 29.7 million in 2015.

Dr Shobha Venkat, gynaecologist and obstetrician, said that increased caesarean surgeries in the private health sector are the result of several factors. Late family planning by the people staying in urban areas – usually women who have issues like hypertension and diabetes – belongs to a medium or higher economic background. Another few reason is decreasing pain tolerance of mother and In-Vitro Fertilization (IVF) pregnancies. The World Health Organization (WHO) reported the ideal rate of C-section should stay between 10-15 per cent of the population level.

However, Dr Venkat disagreed with this and said that the percentage is unrealistic, there are so many complications ranging from failed induction (no opening in the vaginal region) to abruption of the placenta (placenta detaches from the womb). “We do not take opinions from mothers; we advise and go with what is best for them. There are many myths associated with c-section, it is theoretical to say recovery faster in normal delivery. I am not promoting caesareans either, nothing can replace natural birth. But we should stop seeing it as something which private hospitals do for money.”

Although, it cannot be denied the cost of health care in a private hospital is a financial burden in itself. A combined analysis of three official report – The Sample Registration System, The Civil Registration System and National Statistical Office, reveals that excessive caesarean deliveries in private hospitals could be costing Indian families over 5,000 crores rupees extra every year.

The financial burden is not the only problem that comes with c-section surgeries, the study by World Health Organization (WHO) reported that caesarean can cause significant and permanent health complication, it can cause disability or death if goes wrong. These surgeries can also pull the resources away from the overloaded and weak health infrastructures. Gynaecologists also say that the blood loss is higher in c-section delivery, and the recovery post-surgery takes a longer time.

Dr Rashmi Kapoor, a prenatal yoga instructor, said that yoga and breathing exercises help pregnant women to have a normal delivery. It also deals with hypertension and blood sugar level, which are some main causes of c-section delivery. “C-section is life-saving when it is needed, but I do not think it always necessary. In caesarean mother does not even know on the other side of the curtain, she is more aware of her environment in a normal delivery,” she added.

On the other hand, the statistics show that the maternal mortality rate has decreased after the introduction of the Institution delivery policy and with the increasing cases of caesarean. The report by National Sample Registration published Maternal Mortality Ratio (MMR) of India has been declined by 17 points from 2014-16 to 2016-18. The yearly estimated maternal deaths decreased from 33,800 in 2016 to 26,437 in 2018.

Asha Kilaru, co-founder of Bangalore Birth Network (BBN) a Non-Governmental Organization (NGO), helping pregnant women in birth options counselling and mother-child healthcare, said, “The whole thing of getting c-section comes from the private health care, but it also comes from society.”

The report published by Clinical Epidemiology and Global Health for India, also suggested the same, the older, higher educated mother from urban areas- belonging to high socioeconomic status are the ones who opt for voluntary C-section deliveries.

Asha Kilaru, views pregnancy and childbirth as a family health issue rather than just women health issues. She added, “We have this narrative that childbirth is risky, it is very painful. So can look pregnancy, that should not be feared, something a woman can get as much support as she wants, in a way that makes sense to her. What I may want for support is different, what you want.”

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