C-section : A requisite medical procedure or a money making tactic?

The cost of a C-section or cesarean section varies widely in India. The charges for the procedure, hospital stay and anesthesia can range from about Rs. 5,000 in a government hospital to upwards of Rs. 40,000. Although, no national survey has thoroughly measured the rate or cost of C- sections so far.

Maneka Gandhi, Women and child development minister, wrote to health minister J P Nadda, proposing to make it mandatory for hospitals to publicly disclose the number of c-section surgeries and normal deliveries carried out by them.

C-section vs normal delivery

Number of factors play significant roles in deciding the type of delivery. C-sections can be planned or done in case of emergencies. Planned C-sections might be conducted where there are medical warnings like high maternal age, breech position of a baby or obesity. Emergency C-sections are a riskier area. The decision can be made due to several medical factors like foetal distress and loss of amniotic fluid.

Going through labour in case of vaginal delivery is painful. However, it is a one-time pain. On the other hand, C-sections could have long-lasting and serious consequences. Some of them could be: infection, injury to organs, increased blood loss, extended hospital stay and recovery time, and risk of additional surgeries such as bladder repair, hysterectomy, or another C-section.

What is striking is that although the procedure can result in complications for the mother and baby, the number of C-sections performed has been increasing over the last two decades, and decisions increasingly influenced by non-medical factors.

Science or commerce of medicine?

Doctor-induced demand

The fact that C-section rates are higher in the private sector as compared to public hospitals clearly states the unregulated nature of private hospitals and profit earning motive. Another very important reason behind C-sections is: ‘doctor-induced demand’. Several obstetricians push for C-sections as it more convenient for them since it may take less time to perform than a normal delivery and is a higher income option for the doctor and the hospital. Besides, doctors are seen with respect and one prefers not to go against their word. Often, doctors misuse this trust and use this fear against the women who might have fears about a normal delivery.

It is often debated that women should choose the type of the delivery they want. But doctor’s role is very crucial in informing women about the pros and cons of having a C-section. This opportunity is being encashed upon by doctors.

To gain surgical expertise

Further, it has also been observed that in the hospitals affiliated to medical colleges, generally have higher rates of C-sections. Reason behind this is that the resident doctors feel that they need to practice to gain expertise in surgical skills. What is even more worrisome is that now many doctors, especially those graduating from private medical collages, have very little experience in conducting normal deliveries. If labour is prolonged, they are quick to jump to a C-section.

Mahurat Baby

The problem of unnecessary C-sections in India is also partially cultural. With the ‘mahurat baby’ trend where astrologers, not doctors, advise families about an ‘auspicious time’ when the baby should enter the world.

Way forward

As per provisions of the Medical Council Act, doctors are supposed to declare the number of C-sections performed in a particular time period, if the information is required. However, these provisions seem to remain on paper. In addition to this, all hospitals should maintain records of the condition of the mother and the baby during labour. This will help the doctors to decide about which way to go- Normal or C-section delivery and will help in monitoring the practices. This could be part of the standards for the Clinical Establishments Act.

The government should also standardise rates for normal and C-section deliveries, which could further be linked with the Clinical Establishments Act. This will help avoid doctors influencing patients to opt for avoidable C-sections. Stress must also be placed on educating pregnant women about normal deliveries and the repercussions of having a C-section.

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