health

Updated: Mar 12, 2019 17:30 IST

In just a decade, the number of women who opted for a Caesarian section (C-section) more than doubled across India, especially in the cities, according to a new study that attributes the rise to reasons such as fear of pain and complications among mothers, and a rise in maternal age.

Nearly 17% women in 2015-2016 underwent a C-section, compared to the 9% in 2005-2006, the study by the Mumbai-based International Institute of Population Sciences (IIPS) found. This rise includes both first-time mothers and those opting for a C-section for subsequent deliveries. The researchers used data from the National Family Health Survey. While the rise in C-section deliveries is a global trend, what is concerning, according to experts, is how women were opting for it even when there is no medical need to undergo the procedure.

Across the world, C-sections are associated with higher rates of maternal morbidities such as obesity, and complications in subsequent pregnancies. In fact, the World Health Organisation says C-section rates in any population should ideally not exceed 15%. “When we looked at the demographics of the women who chose the C-section, we found the rates had risen across states, among the poor and rich, educated and illiterate alike,” said Sanjay Mohanty, professor at IIPS and the author of the study.

“The fear of pain, increase in the number of older mothers, which is known to increase complications, may also be reasons,” said Mohanty, adding there were also those cases where mothers wanted to have the baby at an “auspicious day and time”.

Senior doctors, however, pointed out that women were not the only ones asking for the procedure, and that many doctors themselves suggested it fearing litigation if the delivery fails.

Dr Nozer Sheriar, an obstetrician in Mumbai, said doctors often suggest C-section as they are worried of the consequences if something goes wrong. “There is least acceptance among people if things don’t go as expected in obstetrics, when compared to any other speciality,” Dr Sheriar said.

Senior doctors said C-section deliveries need to be done judiciously as it poses risks associated with anaesthesia and surgery-related infections, as with any other procedure. “Women often request for a C-section as it usually has a shorter admission time compared to normal deliveries, where a woman may need eight to 10 hours of hospitalisation,” said Dr Ashok Anand, head of the gynaecology department at the state-run Sir JJ Hospital in Byculla. Dr Anand said another concern was the dying art of vaginal delivery — using forceps — among doctors.

“The younger breed of doctors do not get enough opportunities to learn forcep delivery from their seniors. There are women who initially opt for normal deliveries, but when in labour, ask the doctors to perform a C-section. It is our responsibility to motivate them to continue with the normal deliveries,” Dr Anand said.

Another way to stem C-sections is by targeting first-time mothers. Dr Arun Nayak, professor and unit chief at the civic-run Lokmaniya Tilak Muncipal General Hospital, Sion, said C-sections among first-time mothers can pose a threat to their subsequent deliveries.

“Mothers who opt for a normal delivery in their second pregnancy after a C-section in the first are at greater risk of uterine rupture,” he said.

Dr Pankaj Desai, the former president of the Federation of Obstetric and Gynaecological Societies of India, said one of the gravest risks with C-sections is a complication called invasive placenta, where the placenta infiltrates the walls of the uterus, resulting in up to 20% mortalities.

Better communication with mothers is the key, said Dr Sheriar. “If a woman undergoes C-section during her first pregnancy, she is most likely to opt for it in subsequent ones. We need to target and counsel first-time mothers to ask for normal deliveries, to reduce the numbers of unnecessary C-sections.”

The study additionally found that out-of-the pocket expenditure of C-sections in 2015-16 was four times higher in private facilities (Rs 30,000 on an average) compared public health centres (Rs 6,500).

The author, Mohanty, said the data suggested a growing commercialisation of the procedure. The results of the study were published in the scientific journal Social Science and medicine in February.