The caesarean section (C-section) versus normal delivery debate has made a comeback after Ministry of Women and Child Development wrote to Union Health Ministry to make it mandatory for hospitals to display their rate of caesarean.
The move came after a petition on change.org, which had received 1.3 lakh signatures, was submitted to Union Minister Maneka Gandhi against abnormally high rate of C-section deliveries in India.
Doctors however say it is unfair to see rise in C-section delivery rate in isolation as every pregnancy is different from other as it involves various factors.
“Looking at an individual parameter called C-section is wrong. We also need to consider the age of conception of a woman, pre-pregnancy health parameters like anaemia, body mass index, Vitamin D level among others, thyroid, diabetes and hypertension status before analysing outcome of delivery option,” said Dr Sangeeta Pikale, Gynaecologist.
She said Indian health care requires a registry for all diseases. “Registries will help us analyse health sector better as presently we rely lot on guidelines, studies, prevalence rates abroad and since Indian health parameters are different from those seen in countries like USA and UK,” said Pikale.
The Federation of Obstetric and Gynaecological Societies of India (FOGSI), an umbrella body of gynaecologists in India, is in process of having Indian guidelines for caesarean section and vaginal delivery with the help of international criteria and guidelines.
“At FOGSI, we are working on Indian guidelines for caesarean section and vaginal delivery with the help of international criteria and guidelines. The process has been initiated,” said Dr Rishma Dhillon Pai, President of FOGSI.
However, she said there are many variables like abnormal presentation such as breech or transverse lie, foetal distress, a prolonged labour, bad obstetric history, pregnancy in older woman with high blood pressure and diabetes among others, which play a role in deciding C-section as a delivery option.
“If one woman is having a normal delivery, it doesn’t mean others too will have a normal one. Only the doctor present at that moment is the best judge. In pregnancy and labour, dynamics keep changing every minute and nothing can be pre-decided,” said Pai.
In a 2015 news release, referring to new findings, the World Health Organisation (WHO) had said when caesarean section rates rise towards 10% across a population, number of maternal and newborn deaths decreases. It said it is important to ensure a caesarean section is provided to the women in need and not to just focus on achieving any specific rate.
Doctors say there is an urgent need by the government to work in improving patient-doctor relationship.
“Such statements issued by ministry will develop mistrust between patient and doctors and will results in refusal of surgery when it is a must, leading to more maternal and foetal mortality and morbidity,” said Dr KK Agarwal, National President, Indian Medical Association, an umbrella body of modern medicine practitioners.
He said rates of caesarean will always be higher in secondary and tertiary care hospitals because of referral of high risk pregnancies.
“In such hospitals, there will also be reduced rates of maternal and infant mortality. Similarly, rates of caesarean will be higher in urban scenario than the rural scenario because of better facilities and again with reduced rates of maternal and infant mortality. We should rely on national average and not a city average. One cannot rely on the results of a petition,” said Agarwal.