In the recent time, particularly in private practice the toll of cesarean sections are quite high in various parts of India. This author tried to speculate why cesarean sections are rising in India and here are the understandings of this author (which are also enriched by some real life experiences).
First question is whom to blame for this rising trend of C- sections in the private practice, the doctors or the patients. The answer might seem like to both, but I feel doctors. Why? Some people might cite that the ladies today are too softie and want everything smoothly with out undergoing the labor pain. But I feel that it’s not wrong for a woman to avoid pain of all sort in life and even labor pain. Besides alleviating pain, since family sizes are shrinking these days and becoming restricted to 1 to 2 children a vaginal delivery might be perceived as risky health practice by some pregnant mothers and their families, who feel cesarean can be a safe alternative to achieve a complication free birth.
The point to understand in this regard is that patients can actually demand anything based on their understandings, but that shouldn’t be an alibi for doctors to incise a woman’s tummy. Ethically doctors are supposed to explain the pregnant lady and her family about the pros and cons of the cesarean section and also stating when such an operation is really indicated. Unfortunately, these ethical issues are only limited to legal papers and texts with not much real life utilisation. Therefore, in my opinion the doctor should explain clearly the issues of delivery with out any word game during conversation to bend the patient and her family members mind set towards an unnecessary cesarean section.
Next question is why doctors in private practice incline more towards a c-section. I feel ‘money making’ will be a partly correct answer, a better phrase would be ‘easy money making’. When a doctor opts to do a cesarean section he doesn’t need to monitor the patient for long hours (unlike normal vaginal delivery). For long hours of observation, more staff are needed and more time needs to be dedicated, which counts as a negative feature for private practitioners. Not only that for conducting normal vaginal delivery doctors need to be available 24×7 because a pregnant patient may go into labor anytime, and private practitioners wouldn’t probably prefer to compromise their nights sleep regulalrly for their entire life, unlike their days when they worked as a resident trainee doctors. Elective cesarean is just like regular outpatient practice, where the cesarean operation can be done at any time convenient to both the doctor and patient.
A third query can be why then women who want a normal delivery with no indication for cesarean section voluntarily go to the government run hospitals where normal delivery is generally offered for eligible cases. This is a complex issue to answer. Many people don’t find the state run hospitals clean and hygienic enough. These hospitals are often accused for baby missing complaints after delivery. Sometimes, cats and other non-human species can find their way inside the hospital wards, and this author witnessed such multiple times. Unlike private practice setup where a woman can get treated under a particular obstetrician of her choice, in state funded hospitals less likely all women will be delivered by senior experienced obstetricians and things might worsen particularly in night time when the lonely unsupervised trainee doctors makes a mess of situations like when shoulder of a baby which gets stuck in birth canal or the mother starts bleeding uncontrollably. Statistics is always good on paper and presentation, but in real life the loss of life or permanent complication of a mother and/or her baby is cent percent for that individual and her family. Its not wrong for a pregnant female to get delivered under skilled confident doctors rather than unsupervised learners. And at this particular point a cesarean section in private is possibly justified unless the government can make any drastic change in the trend.
Lastly, what can be the solution to avoid the unwanted indication-less c-section problem. Bringing in strong laws is obviously an option to compel private practitioners to follow the conduct of medical ethics. Besides that the country should adopt better recruiting, training and licensing system for doctors from nations that are best in obstetrics care in the world. Also the patients and their family members should be made aware about the wrong doing of unnecessary cesarean sections, so that they can demand a normal delivery when there isn’t any indication for Caesarean section. Furthermore, patients should be given legal right to record their doctors counselling about what mode of delivery should they choose so that at a latter time they can take it to the court as a piece of evidence.
Let’s hope, some day the social media loving policy framers will start tweeting on this topic too to get fame (which seems too delicious to them, ‘the Narcissistic farts’), and bring in some fragments of happiness to their citizens.
P.S.: Views and opinions expressed in this post are author's individual, not meant to hurt anyone in any form. If such has happened unknowingly, please understand it as a mere accident and not intentional.