Times of India
21 January 2010

Rise of Caesarean sections in India is cause for concern
An ongoing World Health Organisation (WHO) survey has revealed that despite advances in obstetric care, elective Caesarean sections pose an increased risk to both mother and child. The survey, which was published in the medical journal Lancet, found that one in five childbirths in India utilise the surgical option, which can cause major complications. Although that amounts to only 18 per cent of all deliveries occurring via c–section – still over the WHO–prescribed 15 per cent limit – a significant detail is that the incidence of such births has increased from 5 per cent to 65 per cent in private hospitals. What is alarming is that according to the WHO, this increase is not due to medical necessity but is rather motivated by the fact that c–sections are more profitable for doctors and hospitals.

A combination of factors could be to blame. While doctors are often guilty of recommending c–sections when there is no medical need for one, mothers also regard a caesarean delivery as a painless way of having a baby. However, expectant parents must be made aware that a Caesarean delivery is not a harmless option and that, like all surgery, it carries a risk to mother and child. Indeed, the report in Lancet indicates that women who undergo a Caesarean without requiring it were 10 times more likely to be admitted to intensive care compared to those who gave birth normally. The risks of hysterectomy and maternal and infant mortality were also greater.

Unfortunately, it would be impossible to formulate policy that could successfully separate bogus c–section recommendations from those medically required. Medical ethics requires that doctors should provide more comprehensive information to expectant mothers about what their options are. That can be buttressed by greater awareness among patients. In the West, there have been pro–natural birth movements among expectant mothers. There needs to be a similar groundswell here. Greater questioning of the need for c–sections would also lead to obstetricians offering different options.

Unwarranted Caesareans pose a serious public health problem not just to the mothers who have the procedure without a medical reason. Studies have shown that in a developing country, where resources are scarce, large numbers of c–sections that are not medically indicated could represent a serious resource drain that could weaken maternal and neonatal health care as money, medical practitioners and equipment are diverted away from cases in which they can actually improve the chances of mother and child.