According to a Report by BMC Public Health, in India, with the increase in institutional deliveries there has also been an increase in caesarean section (C-Section) births. Of 22,111 live births analysed, 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries.
Prevalence of C-Section births were 13.7% and 37.9% in the public and private sectors, respectively. Their findings showed that C-Section births are nearly three times more in private facilities as compared to public sector health facilities.
The higher rates of C-Section births, especially in private sector, not only increase the cost of care but may also pose unnecessary risks to women (when there is no indications for requirement of C-Section surgery).
We see this stark difference in vaginal vs C-Section births because many women are unaware of the options available to them during their pregnancy.
This misconception must be rectified as this may not be true in all cases.
Women in India must be educated regarding the options that available where a mother can evaluate if she is eligible for vaginal birth after C-Section (VBAC). VBAC is also called TOLAC (Trial of Labor after Cesarean).
In fact, even their husbands need to be educated regarding the same as they are involved in the decision making process.
Today, women and their doctors can work together to determine the safest option for both the mother and baby. The decision to perform a VBAC (Vaginal Birth after Caesarean) is based on a number of factors.
A few questions that most Indian women struggle with are:
Consulting an expert gynaecologist in the field of VBAC and availing the best medical service is very important.
While choosing a hospital, a mother must lookout for expert doctors and best of facilities as not all the hospitals allow or hold much expertise in VBAC.
Uterus (scar) rupture - So these patients need close monitoring.
Ideal Maternal age/weight/height during VBAC (that needs to be maintained) which most women don’t maintain because of their unhealthy lifestyle are,
1. BMI should be 30 or below
2. Women of age 35 and above may face problems, who opt for VBAC
Adequate awareness must be made in order to ensure that pregnant women either availing public or private health facilities are well informed before choosing the method of delivery.
We also need to take measures to strengthen existing public health facilities as well as ensure that C-Sections are performed based upon medical indications and not for convenience of the healthcare facility.
(Dr Jaishree Gajaraj is a Senior Consultant, Obstetrics & Gynaecology at Motherhood Hospital, Chennai.)
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