Mumbai: Heads turn with 9% rise in C-sections in 6 yrs

Mumbai: To curb the ever-increasing Caesarean (C-section) deliveries at private hospitals and clinics, the State Health Department has written to the Federation of Obstetric and Gynaecological Societies of India (FOGSI), asking it to take immediate measures and to implement the Robson system to classify C-sections based on parameters such as obstetric history and onset of labour, among eight others.

The letter sent to the FOGSI reads, “… the subject is highly sensitive… so we suggest that Modified Robson criteria for Caesarean delivery should be implemented in private hospitals.”

Authorities attributed the trend to the compulsion to visit private hospitals during the pandemic when most government health hubs were dedicated to Covid-19 treatment. Another factor the authorities cited was that more patients are seeking “painless deliveries” and “risk-free babies”.

A senior gynaecologist from a private-run hospital said, “There are several scientific and non-scientific reasons due to which more C-sections take place. Scientifically, a high-risk patient could be one who had IVF, mishaps during pregnancy, multiple miscarriages, genetic problems or comorbidities like obesity or cardiac complications. Among the unscientific reasons are that many are scared of normal delivery. Many women also don’t want to undergo the pain of delivery or some have planned deliveries, like wanting the child to be born on a specific day or time.”

Dr Manjiri Kaba, consultant obstetrician and gynaecologist at Masina Hospital said that medicolegal implications of having an asphyxiated child or a complication in the mother could be the single biggest factor in the rise in caesarean deliveries. Caesarean deliveries, she said, come with their own set of problems. Increased education level of urban patients and advancement of monitoring methods makes the obstetrician intervene sooner to prevent complications in the child and the mother, she said.

Dr Kaba said, “Child birth has been happening for centuries without any kind of supervision. However with advanced technology, we tend to pick the impending complications much sooner, which probably contributes towards caesarean deliveries. All doctors live by the maxim ‘first do no harm’ and I believe no obstetrician would do an unindicated caesarean.”

Dr Ashok Anand, the Head of the Department of Obstetrics and Gynaecology at JJ Hospital, said besides other reasons, many private hospitals don’t have sufficient manpower to keep observing the patient in normal delivery. Whereas, C-sections are done within an hour or two. “There might be a possibility that a few hospitals do this for earning more. Such practices should stop immediately,” he said.