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No Love For Labour
by Neeta Lal Bookmark and Share

In keeping with Delhi's dizzying urban growth trajectory, its would-be-moms are also rooting for fast-track deliveries. In fact, a first-of-its-kind childbirth survey, conducted by Delhi's leading hospitals, reports an alarming and unhealthy spiral in the number of caesarean section (C-Sec) deliveries amongst the city women. They are up from 40 per cent in 1997 to 65 per cent - despite a World Health Organization (WHO) directive that such deliveries should not exceed 15 per cent in any society.

These and more such disconcerting findings are revealed in a survey conducted by a dozen of Delhi's leading hospitals led by Sitaram Bhartia Hospital. According to the survey, Apollo Hospital records the highest number of C-Sec deliveries at 65 per cent, Max Healthcare comes in a notch lower at 55 per cent, Sitaram Bhartia scores 40 per cent, while Guru Tegh Bahadur and Lady Hardinge come in at 20 per cent each. 

Though the exact percentages of C-Sec deliveries for other Indian metros are unavailable, doctors in Delhi fear that the Capital could easily be the leader of the pack in this department. What is it that spurs such a high percentage of Delhi's women to opt for caesarean deliveries, earlier the last resort for obstetrics to save a mother or child's life? In fact, for working women, elective caesareans - where a woman opts for a surgical procedure over a normal delivery - have become more the norm than the exception in urban India, point out doctors.

The reasons for this unhealthy trend are manifold. Rising affluence which prompts women to opt for pain-free caesareans, scrunched-for-time professionals with limited `time-off' from work and astrologically-inclined women keen to control the `auspicious' time of their progeny's arrival! In fact, Mumbai-based numerologist Sanjay B. Jumaani admits that over the last decade, the number of women coming to consult him about a `fortuitous' delivery time for their newborn has gone up dramatically.

The changing dynamics of the Indian family, too, have contributed substantially towards this trend. Delhi-based natural childbirth expert Nutan Pandit, who has written several books on childbirth and conducts natural childbirth classes, feels that the lack of a strong familial support system - a given in a joint family system earlier - is sorely missing in today's nuclear units.

As Priti Malhotra, 32, who gave birth to Anya a couple of months ago through a C-sec, puts it, "My parents and in-laws are in the US. So I preferred to get over my birthing quickly to spend more quality time with my newborn. In fact, my husband and I chose a Sunday for my delivery because it's his day off and he could be around to help me!" Adds Supriya Kakkar, 26, mother of six-month-old Vaidehi, "If I do have a painless birthing option that I can afford and it also saves me time, why shouldn't I go in for it?"

With such convenient logic, never mind the repercussions on the baby and mom's health, small wonder C-Sec delivery figures have ratcheted up so dramatically. This, despite the health risks involved in this kind delivery for both the mother and the unborn child. Childbirth through a C-sec, reiterate obstetricians, has a three times higher rate of maternal death than a normal delivery. Studies also reveal that more than half of maternal deaths due to anesthesia-related complications occur in elective caesareans.

"In addition," elaborates Dr Neeta Singh, senior consultant, Gynaecology Department, All-India Institute of Medical Sciences (AIIMS), "C-sec deliveries are more likely to cause foetal distress - usually respiratory discomfiture for the unborn baby or an erratic Foetal Heart Rate (FHR) as compared to a normal delivery. In fact, a first C-sec delivery for a mother can lead to placental disruption in subsequent deliveries. In addition, if a mother opts for a C-Sec for her first- born, her chances of delivering without surgical intervention in subsequent pregnancies fall remarkably."

Apparently these medical reasons do little to deter women from opting for elective C-Secs. Such is the nonchalance associated with C-Sec deliveries these days that, that in a bid to contain this unhealthy trend, many Delhi hospitals are organising childbirth classes to motivate expecting women to go in for normal deliveries.

Sitaram Bhartia Hospital has been conducting `motivational classes' under its natural birthing programme for two years now. The hospital also recently invited Dr Dermot MacDonald, former Director of National Maternity Hospital, Dublin, and honorary fellow of the American College of Obstetricians and Gynaecologists, to help them tackle this issue. MacDonald advised the hospital to first conduct an audit of its C-Sec deliveries and then target the socio-economic group that was going in most for such deliveries.

"It has been established beyond doubt that on all parameters - medical, emotional and economic - a normal delivery is a far better option for both the mother and the child than a surgical one," says Mac Donald. Emotionally, for instance, research has established that normal deliveries augment mother-child bonding. They also minimize the risk of excessive bleeding and infections arising from surgical interventions. Economically, too, the cost of a C-Sec delivery works out to be far higher than a normal delivery. The former costs anything between Rs 25,000-Rs 100,000 (US$1=Rs 42) at a private hospital, and more if obstetric complications arise. A normal delivery costs between Rs 10,000-15,000.

Interestingly, while C-Sec deliveries empty out a client's pocket, they simultaneously enrich those of the obstetricians. The latter may take home anything from Rs 15,000 to Rs 45,000 per such delivery, while the fee whittles down to a third in normal deliveries. However, as Dr Swati Nagaraj, consultant obstetrician/gynaecologist at Max Medicare, says, "Often, it is the women themselves who insist upon a C-Sec despite our advice to the contrary. In these cases we ask the couple to sign a consent form to avoid legal/ethical complications later."

Part of the solution to the problem of rising C-Sec deliveries, according to Mac Donald, lies in demystifying the many myths that swirl around child birthing methods. "Women, even modern, educated women," he states, "believe that a normal delivery will impact their sexual life by widening the vaginal canal that may further lead to a decreased control over their urinary bladder. Of course, these are all myths. And till we enlighten women better about such gynaecological trivia, our societies will continue to witness an unhealthy spurt in unnatural child birthing methods."    

More by :  Neeta Lal
Views: 3981
Article Comment They talk about ethics and then they have a blatant liar quoted in their article.
I have a PHD, so I'm a very educated woman. I'd like to point out to Mr. MacDonald that I experienced a vaginal prolapse and double incontinence after the delivery of my daughter.
It did impact my sex life and my confidence immensely, so I challenge his assertion that a natural birth does not cause sexual problems, loss of muscle tone and incontinence. I also challenge his insistence that a normal birth is better emotionally.

After developing these complications I joined several support groups while I was being treated. I am certainly not alone in this! Many women develop complications related to their pelvic floors after vaginal deliveries and these problems have a deep emotional impact. And yes, they do affect married life.

Has MacDonald never heard of rectoceles, cystoceles, uterine prolapse, rectal prolapse, third degree tears, vaginal wall prolapse, incontinence, obstetric fistulas and pudendal nerve damage ( all of which are problems affecting a significant percentage of women who deliver vaginally )?

I will be having a c section next time, and this is an informed decision I have taken. Nobody has the right to tell women how to deliver. Take your paternalism elsewhere.

I can't believe he has the guts to call the very real effects of vaginal birth a "myth". Where is his proof?
Article Comment Is this article mad?

I am a modern educated woman. On the basis of several research papers and on the basis of the experiences of numerous women in my family, I can assure you the vaginal walls DO slacken after a natural birth and that the incidence of urinary and anal incontinence is much, much higher after a natural birth.

Vaginal childbirth is proven to increase the instance of uterine prolapse, obstetric fistulas, incontinence, and a weakened pelvic floor.

Obviously a c section is not a risk free alternative given that it is major abdominal surgery, but to blatantly claim that natural childbirth does not cause incontinence or sexual dysfunction is completely dishonest.

Also, how can we categorically say that natural childbirth is better emotionally?I don't think I would be in a very great position emotionally after hours of labour pain, intimate and embarrassing medical examinations, pooping on the delivery table and then being stitched back up in stirrups. Perhaps many women are not bothered by it, but it can have a traumatic impact on some women. Secondly, many vaginal deliveries end in emmergency cesareans, forceps deliveries and severe perineal damage. Some women prefer to have a planned c section in order to avoid these emergencies.

And PLEASE don't pretend a vaginal birth is risk free for the baby. It can cause brain heamorrheage, spinal cord injuries, brachial plexus nerve damage, intracranial heamorrheage, and in extreme cases even cerebral palsy. In comparison, a c section is associated with breathing problems which are concerning but to me not as horrifying.

For heavens sake, I wish doctors themselves would stop portraying c sections as some sort of horrifying, evil thing.
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