Cuts like a knife: Have you had a C-section you didn’t need?

Ayesha Baig delivered a baby girl six months ago, but couldn’t hold her for almost a week. It’s her biggest regret and the first thing she talks about when you ask about her C-section.

Chhavi Panchal, a 33-year-old homemaker from Mumbai, also had a C-section, three months ago. “All my friends have had C-sections too, in the name of last-minute complications. Doctors know that will instill fear in us and we won’t argue,” she says.

It’s a problem that’s become so rampant that India now has about four times as many C-sections as it should. And some mothers are fighting back.

Two weeks ago, Subarna Ghosh started an online petition urging union minister for women and child development Maneka Gandhi and union health minister JP Nadda to make it mandatory for all doctors and hospitals to declare the percentage of C-sec deliveries to patients, conduct enquiries against those clinics and hospitals with abnormally high C-section rates, and frame clear guidelines for conducting Caesareans to safeguard the health and rights of women and children.

She has already amassed 86,956 signatories.

“I was advised to opt for a C-section when it was not medically needed,” she says in the petition. “I was cut open to deliver my baby. It was a long, painful and depressing recovery for me. Like me, lakhs of women in India are misled and manipulated so hospitals and clinics can make more money from surgical deliveries.”

Healthcare professionals, mothers and even some doctors say hospitals tend to recommend C-sections in cases where they are not medically required because it saves doctors time and allows them to schedule births.

Partly as a result of such preferences—and partly because of complications arising from women’s increasingly sedentary lifestyles, later-life pregnancies and IVF-related multiple births — C-sections which should typically constitute no more than 10% to 15% of total births, according to the World Health Organisation, account for up to 60% of deliveries in India’s private hospitals — and, increasingly, in public hospitals too.

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The Central government-run Safdarjung hospital in Delhi is a good illustration of how dramatic these numbers are. Safdarjung sees among the highest number of deliveries in the city, and the share of C-sections here is about 22%.

“The number is higher than the WHO recommendation simply because we are a tertiary care hospital where pregnancies with complications are referred from all across north India,” says Dr Pratima Mittal, head of obstetrics and gynaecology. Think about how high the number of needless C-sections must be, if far smaller hospitals dealing mostly with routine cases have nearly triple this rate.

There’s also the vicious cycle to be considered.

“If a woman has her first baby by C-section, the chances of a second delivery by C-section increase manifold,” says Dr Divya Pandey, assistant professor in the same department. “Primary [first child] C-section deliveries must not be done unless there is a clear indication for it.”

INFORMED CHOICES

In the case of Ayesha Baig, a C-section was a medical necessity because she had fibroids that were causing complications. But her ob-gyn, Dr Nozer Sheriar, says some doctors do have a tendency to go overboard with promoting C-sections.

“Making an informed decision is the responsibility of the couple as much as the doctor’s,” Dr Sheriar says. “I have seen a rising number of women asking for a C-section even though there are no medical complications.”

After two miscarriages, Delhi’s Smriti Pandey, 34, was scared that she would lose her baby for the third time. “I was advised to opt for a natural birth, but I did not want to risk it,” said Pandey, who is home with her 10-day-old baby girl.

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Some also want the baby to be born at an auspicious time or a specific date, says Dr Shilpa Agarwal, consultant in high risk pregnancy and foetal medicine at Mumbai’s Jaslok Hospital.

“Then there are friends of the patients telling them about the pain they underwent, instilling fear in them and spreading myths about damage to the pelvic floor, trauma to the baby, injuries to the baby’s face — none of which is medically accurate.”

Few C-section moms talk about the long recovery, the inability to move, the fact that the pain can sometimes be so bad, you can’t hold or feed your baby for days.

Most doctors decide on one fee in the third or the fourth month and the budget remains the same even if it means waiting in labour for eight to ten hours.

That could be a factor too, for some doctors, says Dr Alka Kumar, consultant gyneacologist at Mumbai’s Fortis Hospital.

There might also be maternity targets at some hospitals, for number of deliveries to be done.

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CHOICE VS NECESSITY

Among the factors that raise chances of a surgical delivery are conception in the late 30s and 40s, which raises risk of hypertension and diabetes in the mother. “Uncontrolled diabetes makes the bay bigger, which raises chances of abortion,” says Dr Kumar.

Infertility is another reason fuelling surgical births. “Couples go in for expensive in-vitro fertilisation, where the pregnancy is very precious and parents do not want to take a chance. Also, in most IVF cases, multiple babies make normal delivery difficult,” says Dr Suneeta Mittal, director of obstetrics and gynaecology at the Fortis Memorial Research Institute, Gurgaon. “C-sections are also done in cases where the babies are big — 3.5 to 4kg at birth — or very premature.”

Dr Jayshree Sundar, senior consultant at Max hospital, Saket, believes part of the reason she ends up conducting C-sections in 35% of her deliveries is sedentary lifestyle.

“Nowadays, women spend all day sitting in front of screens and get hardly any exercise, so many cannot go through with the hours of labour,” she says.