Rising Caesarean birth

 RISING CAESAREAN BIRTH

What is the issue?

There is a rising rate of caesarean births in India.

Why C-Sections are risky?

• A Caesarean section (CS) is a significant development of modern medicine.
• It is a life-saving surgical procedure when certain complications arise during pregnancy and labour.
• However, the growing practice of CS without a medical indication or following demand by the patient has not brought any benefit to the women or infants
• Adverse outcomes of CS include high risk of maternal and neonatal death, various maternal morbidities, including infections, need for blood transfusion, neonatal morbidities often related to iatrogenic prematurity; and potential complications in subsequent pregnancies.

How prevalent are C-Sections?

• In 1985, an interdisciplinary conference on appropriate technology for birth unanimously accepted a 10%–15% caesarean section rate at community level as reasonable to assist women to deliver safely in the face of complications.
• Yet, the CS rates have been increasing worldwide. In 1990, roughly one in 15 babies was born via CS, which has increased to one in five babies in 2014.
• The lowest rates of CS are found in Africa (7.3%), followed by Asia (19.2%) and the highest rates are found in Latin America (40.5%).
• In the year 2008, the highest proportion of unnecessary CS deliveries were performed in China (32%), followed by Brazil (15%) and the United States (11%) (Gibbons et al 2010).
• India has witnessed an increase of 102% in caesarean deliveries, from 8.5% in 2005–06 to 17.2% in 2015–16.
• Although the rate is marginally higher than the acceptable range defined by the WHO, there is a huge geographic disparity. e.g The statewise data from the NFHS indicate that the CS rate is highest in Telangana (58%) and lowest in Bihar (6%).
• A sharp urban–rural divide in CS rates is also evident, which could be attributed to the availability of caesarean sectionfacilities in urban areas than in rural settings.
• The CS rate is also lower in public health facilities than in private health facilities.

What are the challenges?

• It is difficult to gauge how much could be attributed to unnecessary CS, including patient demand. Decision -making is the most important component of caesarean
• At times, the doctor might leave the decision to the patient to have a caesarean as she might want to have her baby in a particular way or a particular day.
• In India, a very small section of women choose to have CS, being cognisant of the fact that vaginal delivery is an option. Programme and policymakers might not be concerned with this group of women as they have made a conscious choice for CS.
• But this is not the case with rural women.
• The general profile of rural women is that they are uneducated, lack awareness and come from a low socio-economic strata of society.
• They do not have any decision-making power about having a baby, and the low age at conception worsens the situation.
• In such cases, physicians play a crucial role.
• This opportunity gives physicians a window to convert vaginal delivery to CS,as a CS procedure will enhance the physicians‘ income.
• The fact that referring patients from a government hospital to a private facility for CS can earn commission for government doctors has also been reported.
• The Rashtriya Swasthya Bima Yojana (RSBY), a public-funded national health insurance scheme, also covers CS.
• The usage of the RSBY for CS was more than that for normal deliveries, indicating monetary benefit for the private healthcare provider.

What should be done?

• A low caesarean rate is associated with a high maternal and newborn mortality and can indicate lack of access to life-saving resources.
• On the other hand, a very high caesarean rate can be a sign of over-intervention and a trend of medicalisation of birth.
• It can pose a threat not only to the health of mothers and children, but also to health systems.
• To address this, the Indian health system must focus on strategies to strengthen the health systems, including increasing the doctor–population ratio, placing highly skilled and well-trained midwives in labour rooms, allowing birth companions during labour and delivery, providing for painless delivery options, improving labour room infrastructure etc.
• Hospitals and communities should promote health education among women of reproductive age and counsel pregnant women about delivery process.

By: VISHAL GOYAL