When the stork visited our home last year, there were equal measures of happiness and confusion in our lives. Before the baby arrived, there was to be a long, winding path of eating right, walking carefully, reading positive books and saying no to smoking, drinking or any bad habits. However, that was just the tip of the iceberg. In the next 40 weeks, I was to undergo aches unheard of, hormonal changes ridiculously disturbing – and insomnia.
What I didn’t know was, that the kind of delivery I wanted would also not be under my control.
The War of Birth: Natural Vs C-Section
Throughout my pregnancy, I wanted a natural aka vaginal delivery. I had read a lot and was convinced it would be the best way. Fortunately, the doctor I chose was in agreement. He is the owner of a private maternity clinic and the president of a medical organisation; he confirmed that my pregnancy was hassle free and that a natural delivery would be perfect. But, I moved to Kolkata in my eighth month and the new doctor I consulted, seemed to favour a caesarean section. “98% of the women want a caesarean delivery themselves. You don’t want a vaginal birth, trust me,” he insisted. I asserted my preference, however, and this time, he nodded.
Everything was on schedule, when – on the 34th week – the doctor declared that my placenta had matured and I should, therefore, deliver my baby in the next couple of days. I was aghast as this meant my baby would not get a full term to develop. I asked him if it could wait till my husband reached Kolkata but he said no.
In what was the eleventh minute of my pregnancy, I was now searching for a new gynaecologist. I blindly went to a nearby clinic which had a doctor with great credentials. After hearing everything, she said, “Your reports look great and you don’t need to deliver by tomorrow. I don’t know what your doctor meant but if you want, I will ensure you have a normal delivery.”
Why I Changed Doctors During my Pregnancy
So I quit the previous doctor and consulted this one. Three days before my due date, she informed us that normal deliveries were seeing a decline in Kolkata, so there weren’t too many epidural anaesthetists (the specialists responsible for injecting a steroid in the backbone that lessens labour pain). Experimenting with a below average epidural anaesthetist meant hara-kiri with one’s body (even paralysis).
“I would still like to go for a vaginal birth, so could you recommend an anaesthetist?” I asked her.
She said she wouldn’t couldn’t take her chances. Looking at my parents directly now, she added, “Her baby is over 3 kilos. A normal delivery could harm the child as it is bigger than the vaginal passage.”
That sealed it. My parents refused to listen to my pleas and I was sold too; nothing came over the baby’s well-being, right?
Three days later, I had a planned caesarean section.
Many Women are Having ‘Unnecessary’ C-Sections
Sadly, many Indian women share similar stories. The decision to have a vaginal delivery by the mother is often overruled by the doctor who instead opts for a quick caesarean section – unnecessarily so, in many cases.
This denotes an unethical trend – according to World Health Organization, caesarean sections should be well under 10-15% and that was the case till 2010. But this percentage has alarmingly increased in just five years with metropolitans faring worse than smaller towns.
In a recent study done by the London School of Hygiene and Tropical Medicine on ‘provider perceptions related to high rates of caesarean sections in Delhi’s private hospitals’, it was identified that more than 1 in 2 women were delivering by caesarean in Delhi’s private healthcare sector. This rate cannot be explained by medical or demographic factors, therefore it seems likely that providers are choosing to perform caesarean for non-clinical reasons.
The nature of the private healthcare system puts immense time pressures on obstetricians, who often respond by adjusting their practice to suit their schedule, rather than their patients’ needs. This can be linked to the commercial nature of the private sector, in which doctors are encouraged to see as many patients as possible in order to run profitable businesses. In addition, a perception of caesarean section as the ‘safe’ option for delivery, both in terms of maternal health and protection from litigation, has led to its use being normalized amongst obstetricians, even for low-risk deliveries.
– Study by the London School of Hygiene and Tropical Medicine
As Rashmi Thakur, mother to a seven-month-old baby, from Delhi said, “My pregnancy went without a single hurdle but my doctor pushed me towards a C-sec till the last day and by the end, we relented. I still feel cheated about how my wishes were disregarded.”
What is the Solution?
It is important to increase the availability of well trained midwives who can monitor every delivery properly so that the burden on the doctor is reduced. This will ensure that the need is not felt to ‘shorten the process’ through an unnecessary C-sec, believes Dr Meenakshi Gautham, IDEAS country coordinator, India, and Public Health Foundation of India.
“But proper guidelines need to be laid by the government or the federation of obstetricians along with patient education,” she said.
Note: Emergency caesarean or self-planned caesarean deliveries are not in the scope of this article.
(Runa Mukherjee Parikh has written on women, culture, social issues, education and animals, with The Times of India, India Today and IBN Live. When not hounding for stories, she can be found petting dogs, watching sitcoms or travelling. A big believer in ‘animals come before humans’, she is currently struggling to make sense of her Bengali-Gujarati lifestyle in Ahmedabad.)
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