24September2018

Andaman Chronicle

The Daily Diary of the Islands

More C-Sections In Private Hospitals: Survey, RTI Finding

It didn’t come as a surprise when the Annual Health Survey (AHS), findings revealed recently, the number of caesarean delivery in private hospitals across the nation was more than that in government hospitals throughout India.

 

The findings endorsed those revealed by an RTI query filed in December last. The query threw up scary facts of the situation in Mumbai. In 2008, a total 77,533 deliveries were conducted in private hospitals in Mumbai of which a whopping 18,194 or 23.47 per cent were C-sections. The numbers only went on to grow to 26.35 per cent in 2010.

While the recent Annual Health Survey’s findings that private hospitals opt for Caesarean section over normal vaginal deliveries didn’t come as a surprise, what was of concern was the huge differential. It revealed the number of caesarean deliveries in private hospital was almost three to 10 times more as compared to government hospitals.

Figures in some of the states were far worse than one could comprehend. In Assam, 10 per cent of deliveries in government hospitals were by C-section while in private hospitals, the percentage rose to 41 per cent. Likewise, in Bihar only three per cent of deliveries were done by C-section in government hospitals while this share rose to 22 per cent in private hospitals.

This data was collected by the Census office during the period  between July 2010 and March 2011 covering a sample of 1.8 crore people in over 284 districts in 9 states - Assam, Bihar, Chhattisgarh, Jharkhand, Madya Pradesh, Odisha, Rajasthan, Uttar Pradesh and Uttarakhand.

These states were selected because they had a history of poor health facilties and had been given special attention by both the government as well as non-governmental agencies.

ONLY 10-15 PC OF BIRTHS NEED SURGERY - WHO GUIDELINES

According to the World Health Organisations guidelines, only 10-15 per cent of the births require surgical intervention in India. But many disagree with these guidelines as some gynaecologists believe there are several complications that can arise during the entire term of pregnancy which cannot be predetermined and so fixing a number to it was difficult.

A study published in National Journal of Community Medicine revealed the presence of factors that affected the rate of Caesarean deliveries in India. Reasons varies from psychological, the medical institution in question and socio-demographic factors which play vital roles in the rise in number of C-Sections.

According to this study, there was a vast variation in the figures across states and rural and urban areas ranging from 2 per cent – 30 per cent. Also, there is large difference between births in public and private health facilities averaging almost 30 per cent.

THE ABSENCE OF ‘INFORMED CONSENT’ ALSO A TRIGGER

The study stated ‘Evidence shows that patients who are knowledgeable about their conditions are able to actively participate in shared decision-making. Due to their ignorance about childbirth, they just submissively do what their provider tells them to. Therefore, they can’t effectively talk about birth interventions with their providers, and agreeing for Caesarean delivery for medical and even for non-medical reason without knowing true risk and benefits of the procedure.

Since many providers (doctors) prefer doing caesarean sections, the ignorance of pregnant women is probably what is raising the caesarean section rate.’

In another cross-sectional study of 247 women (published in National Journal of Community Medicine) undertaken in an urban health training centre field practice area of a tertiary care hospital at Nagpur, 65.1 per cent of the women admitted they had very little knowledge about a Caesarean Delivery and 54.7 per cent admitted that whatever knowledge they had was from family and friends.

The study also revealed more than half of the respondents, i.e., (63.6%) conceded that doctors/ hospitals were deliberately opting for caesarean deliveries instead of normal vaginal deliveries.

Other than lack of knowledge, the labour pain associated with normal deliveries is also one of the reasons that women themselves prefer caesarean deliveries. Also, there are a few who prefer caesarean for astrological reasons i.e. wanting a child to be born on an auspicious day. It was revealed that 85 per cent of women who had had their first delivery by Caesarean section have their second delivery by C-Section as well.

According to a finding by University of Washington, women with a prior caesarean section, who undergo labour for their second child, are at increased risk of a rupture of the uterus compared with women who elect another caesarean section birth.

In a first of its kind move, Turkey has banned C-Section delivery and elective caesarean is punishable by law. Turkey has one of world’s higher caesarean rates with almost 48 per cent of births being C-Section. According to their health ministry, up to 70 per cent of all births in some private hospitals involve caesareans.

The Turkish ministry accuses doctors of pushing women towards the operations out of greed – they cost 1,000 lirai.e. aroundRs 24,000 more than natural births in some private hospitals.  Opting for C-Section delivery in Turkey is now a crime punishable with fine of up to 1,000 lira.

Reportedly, China by far has the highest number of women opting for C-Section delivery. Reportedly, almost half pregnant women in China opt for C-Section delivery over normal.

A World Health Organization study, which reviewed 1,10,000 births from nine countries in Asia including India in 2010, revealed more than 60 per cent of the hospitals studied, where these C-sections took place, did it for financial gains and not because it was required.

A C-Section costs upto 4 times more than normal birth

On an average, a C-Section delivery in India can cost anywhere between Rs 30,000 to Rs 80,000 depending on the hospital and the facilities whereas a normal delivery in the same situation will cost somewhere around Rs 20, 000 to Rs, 60,000. It’s said that every forth pregnant woman in the city opts for caesarean section delivery over normal ones and this number only increases in women in the higher age group.

While most of the hospitals and doctors opt for caesarean section delivery for monetary gains, most women opt for it to avoid pain. But what these women don’t realise is that unnecessary C-sections are not just costlier, but relatively dangerous as well.

 

According to a study published in the Lancet, women who undergo a Caesarean section without requiring it were 10 times more likely to be admitted to ICU than those opting for normal vaginal delivery.

In cases where labour had already started, women who had a surgical delivery despite not requiring the procedure were 67 times more likely to be admitted to ICU than those who had a natural birth.

(Readers keen on seeking help on drafting RTI applications may write in to This email address is being protected from spambots. You need JavaScript enabled to view it. or call Gajanan Khergamker on 022-22841593 for any assistance on RTI or to have their findings / issue featured here)