Suresh Unnithan
Thiruvananthapuram: Despite restrictions from the World Health Organisation (WHO) caesarean sections (C- sections) are surging alarmingly in Kerala. Normal delivery has become negligibly rare. It is regrettable, pregnancy and childbirth is being seen as a money-spinning proposition for those in the health care business. More shockingly, majority of our women are deprived of their precious privilege to give birth to their baby through natural process, thanks to rampant growth in caesarean sections. As Kusumakumari, a technocrat turned social activist observed “the freedom for natural delivery is denied and snatched away from women at large under multiple pretexts.” According to her “number of normal deliveries is near to nil in cities. Even for the first delivery cesarean section is opted, mostly out of compulsions,” she says in anguish.
Armed with data collected through multiple sources Kusumam elaborated that the percentages of Cesarean births have shot up to even 60% in some districts in Kerala (according to unconfirmed reports the state average could be anything above 80%). “The World Health Organisation (WHO) the ideal rate for caesarean sections to be between 10% and 15%. It had also warned that as with any surgery, caesarean sections are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. However these warnings are totally ignored and cesarean has become rampant and the process is insisted to anyone who consults hospitals for delivery reasons.”
In a written response to Kusumam in January this year the district medical officer (DMO) of Thiruvanathapuram has stated that in the capital district of the state the number of cesarean delivery is much above the stipulated 10-15 percent. As per the statement from the DMO in the year 2020 out of the total 28641(including government and private hospitals) births recorded in the office 12866 were through cesarean secession. This means the number of cesarean section was around 45%. As per the statement from the DMO number of cesarean births is on the rise. As per the records, in 2021 the number of cesarean births was 48%. Outs of 34762 child births 16472 were cesarean.
The situation is similar in other districts even. As per the data different districts in response the queries under RTI Act from first day of January 2018 last day of December 2021 Government Medical College GMC) Ernakulam has recorded 3275 childbirths of which 15 11 were cesarean section. This means about 46.14 percent of the child births were through C.
As per the RTI response made available to Kusumakumnari, in Kannur GMC the number of normal delivery is declining and cesarean cessation is on the rise. In 2019 Kannur GMC recorded 27.67 % C- cessation. In 2020 this figure raised to 54.13% and in 2021 the percentage of C- section in GMC kannur was 60.07%
The latest reports from Alapuzha are also alarming. In 2021 percentage of C- section recorded in the government medical college was 46.13 which was much above the desired level of 10%. In government medical college Thiruvanathapuram the percentage of C- section recorded in is still higher – nearly 50. But in Wayanad it is a bit less compared to the other districts. In the Manathavadi district hospital number of C- section cases little over 30%.
Compared to all, Malapuram is ahead in normal child birth rate. As per data available from Government Medical College Manjeri under RTI the normal delivery is over 70% and C- section cases are less than 30%.
In recent years, governments and clinicians have expressed concern about the rise in the numbers of caesarean section births and the potential negative consequences for maternal and infant health, but commercial potential has forced the hospitals and doctors to forgo such concerns, says Alemma, a retired professor of Nursing. Aleamma in her 40 years of service has helped over 750 natural child births.
“As a medical professional specialized in child birth I always advice the expectant mothers to prefer for normal delivery for multiple reasons. The prime factor is, needless injury and cuts to the body has to be avoided. The C- section process demands administering anesthesia drugs, analgesics and even anxiolytics. Better to avoid such drugs as far as possible for such drugs have aftereffects. More than that, normal delivery, though a bit painful is the healthiest and comfortable way of giving birth to a child.”
According to a senior lady doctor who prefers not to reveal her identity is quite anguished the way “doctors are promoting C- cessation for pecuniary gains. The doctors are to advice for C- section only when there is any medical urgency.” The lady doctor, seasoned gynecologists who has performed hundreds of C- cessation further said “most of the C- cessations could be avoided giving proper care during pregnancy. But that is hardly done and finally the expectant mother, even if she is young and going for the first child, will concede for C- cessation.”
Aleamma is more critical of the role of private hospitals and doctors in “compelling and persuading” the expectant mothers for C- cessation. “Being a medical professional for the past four decades plus I can vouch, most of the C- cessation could have been normal delivery if the hospitals and doctors were not greedy.”
According to her, lack of understanding on pregnancy and childbirth is a prominent reason for escalation in the number of C- section births. “It has become a passion for the young women to be under the watch and directions of a gynecologist of their choice even from the early days of pregnancy. The hospitals and doctors generally will advise them to go for C- section, explaining the risks of normal delivery. The couple always follows the doctor and nobody else.”
Another retired nursing professional who worked with various leading hospitals abroad says “Misconceptions relating to labor pain sometimes compel the pregnant lady to agree for C- section Guidance and medical advice on normal delivery can drastically reduce C- section. But that is hardly done, thanks to the monetary considerations…..”
A section of the medical experts are apprehensive of indiscriminate C- section “as with any major surgery there are several risks associated with a cesarean delivery. These (risks) include blood clots, hemorrhaging, and reaction to the anesthesia.”
Like C- cessation induced labour also needs to be restricted and normal delivery has to be encouraged, feels many medical experts. A retired principal of a government nursing college in Kerala who is specialized in midwifery says “Labour starts naturally any time between 37 and 42 weeks of pregnancy. The cervix softens and starts to open, you will get contractions, and your waters break. In an induced labour, or induction, these labour processes are started artificially. An induced labour can be more painful than a natural labour. In natural labour, the contractions build up slowly, but in induced labour they can start more quickly and be stronger. Because the labour can be more painful, you are more likely to want some type of pain relief.”
According to a senior gynecologist from Delhi “having a caesarean can increase the risk of certain problems in future pregnancies, including: the scar in your womb opening up and the placenta being abnormally attached to the wall of the womb, leading to difficulties delivering the placenta.”
But the prime contention of Kusumakumari is “predominance of C- section has deprived the women of their right to give birth a child through natural process.” She is right. According to our culture the womanhood is complete only when she herself give birth to a bonny baby.
It is fact in olden days the entire family and even the neighbours use to be elated when the expectant mother entered labor room within the house, specially set up for the delivery. The expectant mother was comfortably taken care, creating conducive atmosphere to make the child birth a pleasant process. “But in this medically advanced world the process of child birth has become appalling experience for the mother and to some extent for the new born. While the mother is still in the theater for post operative care the new born will far from the mother in a cradle or in any medical room for post natal care.”
Kusumakumari blames the governments for allowing the hospitals to make a windfall out of pregnancy and child birth. She rightly points out “WHO says caesarean section should only be done if there is a threat to the life of the mother and baby. In developed countries, home delivery is more comfortable, but here in India pregnancy and child birth has become a thriving business for hospitals, particularly those in the private sector.”
According a senior nurse who served different government medical colleges for over 35 years says “a properly trained nurse is enough to take care of a child birth. But in our state medical doctors are deputed to manage delivery cases, particularly in private hospitals. The reason is obvious.” She further pointed out that deployment of properly trained midwife use to handle delivery cases in the past and during those days the cesarean cases were minimal.
According to a senior medical practitioner “cesarean cessation has to be advised only in critical cases. “But for obvious reasons, even for normal cases caesarian is performed.”
According to Kusumakumari “un necessary cesarean deprives the women of their birth right to deliver a baby through normal process. The hospitals and medical agents have turned even pregnancy and child birth into a lucrative source for making huge fortunes. Due to the hefty hospital cost involved in pregnancy care and child birth many couples have decided not to have more than one kid.”
Kusumakumari further poses a serious question to the organizations vociferously advocating for women empowerment. “There are numbers of organizations supposedly fighting against exploitation of women. Why they don’t muster courage to fight against caesarian which is direct exploitation of women. Why they are not launching any campaign for promoting normal delivery?” There are rare souls to fight for genuine needs of hapless people, she laments in anguish. Further, quoting from Quoting Michelle Obama, Kusumakumari says with a resolve “As women, we must stand up for ourselves. We must stand up for each other. We must stand up for justice for all.”
