Karnataka has reported an alarming number of caesarean deliveries, with private hospitals accounting for a staggeringly high rate of the surgical procedure.
With no proper monitoring system in place, C-sections accounted for almost 40% of the total deliveries in private hospitals so far this year, while the corresponding figure for government hospitals was 24%.
According to data available with the department of health and family welfare, in 2019 (up to June), there have been over 89,000 childbirths in private hospitals of which 36,000 (40%) were caesarean deliveries.
In government hospitals, there were 1.32 lakh deliveries out of which 33,000 (24%) were C-sections. The World Health Organisation considers the ideal rate for caesarean sections to be between 10% and 15%.
DH examined the statistics of deliveries — both normal and caesarean — over the last three years and found that the trends were similar.
In 2018, the Union Health Ministry had instructed states to monitor data on deliveries through HMIS (health management information systems) and flag it during review meetings if caesarean rates were found to be high.
When DH spoke to Jawaid Akthar, principal secretary, department of health, he said there was no monitoring mechanism.
“The department per se cannot monitor. If there is anything wrong, people can send in their complaints to the Karnataka Medical Council,” he said.
The reasons
There are several factors that lead to caesarean deliveries, said Dr Hema Diwakar, former president, Federation of Obstetric and Gynaecological Societies of India. “There is a legal sword that is hanging over the practitioners. If there is a complication and the matter is in court, we are only questioned why a C-section was not conducted. No one asks why a normal delivery was not conducted,” she said.
Even patients in private hospitals believe they must have “risk-free” procedures for the money they pay, she said.
Speaking about tier 2 and 3 cities, Dr Hema said, “It is a question of availability of anesthetists. One doctor could be doing the rounds in two-three districts. If we have a woman in the labour ward, a decision has to be taken by hook or crook. There might be no backup if she develops complications later,” she said, explaining why most hospitals prefer caesarean as the surgery is planned in advance.
There are others who feel there should be some mechanism in place to check the practice.
Dr Asha Benakappa, a senior pediatrician in the city, said, “With the numbers being so high, there is an urgent need to have monitoring mechanisms.”
Robson classification
The Federation of Obstetric and Gynaecological Societies of India (FOGSSI) is now seeking hospitals to submit them real-time data on pregnancies and caesarean sections and classify them under the Robson classification chart.
The Robson system classifies all deliveries into one of 10 groups on the basis of five parameters: obstetric history, onset of labour, fetal lie, number of neonates and gestational age. The 10 sections include twin deliveries, the child’s position being unfavourable for delivery, previous C-section etc.
“There are five factors that we are struggling to regulate. For instance, when a doctor says a pregnancy was conducted due to mother’s distress, where is the evidence for it,” asked Dr Hema.