When it comes to giving birth, the World Health Organisation (WHO) has a recommended rate of 10-15% for cesarean or C-section deliveries. Up until 2010 the number of C-section births in India was 8.5%, well within the recommended level.
According to the National Family Health Survey conducted in 2015-16 in 15 Indian states and union territories, in some states the rate of C-section births was as high as 87%. The yearly rate of increase in cesarean deliveries has been 16.7%, one of the highest in the world.
Many factors have been responsible for this, but the issue has been taken up by the Women and Child Development minister, Maneka Gandhi, who has sought surgical data from all private hospitals to ascertain the actual numbers of C-section deliveries.
This step was taken in the wake of a petition submitted to her on Change.org by 137,986 people asking her to make it mandatory for all hospitals to declare the number of cesarean deliveries.
The financial policies of private hospitals and doctors seeking easy money have been blamed for the escalating figures.
An accounts head of a private hospital in Kolkata, speaking on condition of anonymity, said: “We charge 150,000 rupees [US$2,250] for a cesarean delivery, and in the last six months there have been no normal deliveries in our hospital.” The minimum cost of a C-section delivery is 40,000 rupees in an urban hospital in India.
I reached out to around 50 Indian women, based both in India and abroad, through social media to find out if they had given birth normally or by C-section. Almost all the women based in India, except for one from Bangalore, said they had C-section deliveries.
However, S. Bhattacharya, a communications specialist from Bangalore, said her normal delivery was complicated and, in retrospect, far too risky. “Looking back I feel it could have gone grossly wrong, but I was lucky.”
Roshni Mukherjee, a journalist, said that her doctor in Kolkata had given her the option and she really wanted to go for a normal delivery. “My doctor waited for 12 hours after inducing pain but thought it was too risky to wait longer so she went for C-section.”
Gynecologist Dr Vineeta Kaul, who delivered Roshni’s son, said: “I get very few patients like Roshni who are willing to go for a normal delivery. Thirty per cent of my patients tell me from the very beginning of their pregnancy that they wouldn’t want to go through the pain of labor and would opt for C-section. Some even tell me not to inform their parents or in-laws because then they would be pressured to go for normal delivery.”
Another issue that Indian hospitals face is the lack of infrastructure or trained personnel to monitor a pregnant woman in labor, which is crucial for everything to go right in the case of most normal deliveries.
“In first world countries there are professional midwives who do the delivery and the process is not entirely dependent on the doctor,” said Dr Kaul.
In India, because of its overwhelming population in both urban and rural areas, the doctor-patient ratio is skewed. In such a situation, it is impossible for a doctor to devote so much time to a single patient – be it in a rural hospital or in a specialty hospital in the city.
I spoke to a number of Indian women who had given birth abroad in places such as Malaysia, Dubai and the US who said that they had to go for a C-section because of complications.
Mumbai-based obstetrician Dr Rajiv Punjabi, in an interview with news website Quartz, said: “There has been a rise in the number of patients who are obese and are at risk of developing gestational diabetes.”
It could be the changing lifestyle of the Indian woman that is responsible for the rise in C-section deliveries. For their grandmothers, C-sections were virtually unheard of.
Dr Kaul said: “In that generation, people had a number of children, so neonatal mortality rate and maternal mortality rates were high. Because of the lack of medical facilities available it was accepted at that time, but now if we can use the facilities to reduce the dangers then there is nothing wrong in it.”
Many healthcare specialists and doctors believe that if hospitals charged a flat rate for both delivery procedures, they would not insist on C-section deliveries and this would help bring down their numbers. It is also important to offer counseling to couples to give them the information to make informed choices and to establish exercise centres run by clinics and hospitals where pregnant women can prepare their bodies for normal delivery.
C. Menon, an events manager based in Dubai, said: “I was told by my doctor of all the medications available to handle the pain of labor, from epidural to pethidine. There was a center in the hospital I was going to where I did gentle exercises under a trained instructor. I was in labor for 14 hours and four people monitored me constantly. There was a lot of effort to ensure a safe normal delivery I feel.”
In countries where normal deliveries are promoted, there is a culture of ensuring that women are informed about healthy diet, exercise and pain-management procedures, something that is lacking in India at the moment.
Eighty-year-old Basabi Mukherjee, who had both her children through normal delivery, said: “I used to wipe the floors with a cloth and water every day in a sitting position during my pregnancy because my doctor said that prepared my body for a normal delivery. I have my doubts how many women today would have the time and inclination to do that.”
While Maneka Gandhi will have to curb the money-making aspect of C-sections, she has a tall task at hand if she is planning to promote normal deliveries. It seems that C-section births have become psychologically and culturally ingrained in Indian society.