'Not money, patients' safety is primary concern'

There is a perception that C-sections are being done only for money. In certain cases, there is a genuine medical need. Patient safety is the primary concern,” says Dr Hema Divakar, Fogsi* Ambassador to the International Federation of Gynaecology and Obstetrics and former president of Fogsi.

Dr Hema touches upon several issues, from the need to have specialists monitoring patients throughout to training healthcare staff, in an interview with Reshma Ravishanker of Deccan Herald.

Excerpts:

The rate of C-sections are high in private hospitals when compared with government facilities. What does this indicate to you?
In government hospitals if there was a 10% increase in C-Section cases, ‘x’ number of mothers and double that number of babies would have been saved. There is not enough supervision there. Also, the profile of patients that hit private hospitals is different. Many mothers themselves are aware of the options available for them and they choose C-section post-counselling.

There is an alarming rise in number of C-section cases. What is promoting this? Is it sheer profiteering?
There is a shift in the trend for C-section itself. There are definitely a good number of maternal requests. Pre-counselling deliveries also matter. For the fear of pain or for assurances of a better outcome, many mothers insist on C-sections. With respect to medico-legal cases, doctors are questioned in court as to “why no C-section was conducted?” In fewer cases, they ask whether normal delivery was a feasible option.

Are there specific clinical reasons for the spurt in C-sections?
Several elderly patients would have undergone infertility treatment. Most of them come with co-morbid conditions that make C-sections necessary. In others, there are chances of complications due to multiple pregnancies.

Though WHO says 10-15% is the ideal percentage for C-section, the numbers are high by several fold. Is there a reason for this?
There is no data about unindicated C-sections. Statistics are not being compiled in a methodical manner. Data tabulation has to be done based on the causes for C-section. This will help rule out the possibility of unnecessary C-sections. It is not just India but several other countries where C-sections are much higher than WHO norms.

Many doctors claim that C-sections are risk-free and have lesser chances of complications. Is this true?
There is a perception that C-sections are being done only for want of money. In certain cases, there is a genuine medical need. Patient safety is primary concern.

Is there a need to improve the healthcare system to minimise the need for C-sections?
There is a need to coach the healthcare sector workers. There is no mid-wifery section in the healthcare field here and specialists are expected to stay by the patient for six hours through the labour.

For instance, if a patient is in labour at 3 pm and the progress is slow, doctors have to be available through the night.

However, in most places, due to shortage of manpower and for logistical reasons, sometimes a C-section becomes the only option. In a few centres, there are complaints that the patient comes in late and is in a critical situation mandating doctors to perform C-section. Hence, decisions are taken based on the individual case requirement.

*Federation of Obstetric and Gynaecological Societies of India (Fogsi)