Why C-Section Deliveries Are Rising At An Alarming Rate In India?

The latest edition of the National Family Health Survey (NFHS) revealed that India steadily moved towards population stabilization. The report also revealed that while, on the one hand, there are fewer births that are taking place, the trend of C-Section deliveries is becoming common amongst new mothers. The most common major operating room procedure performed is a cesarean birth or C-section for short. Research by the World Health Organization (WHO) substantiated that the estimated C-Section births would be 30 percent of the total births by 2030

The growing disparity of C-section births in government and private hospitals is problematic. In NFHS-4, which was released in 2015- 2016, about 40.9 per cent of cesarean deliveries were performed in private hospitals, compared to 11.9 per cent in the government sector. Fast-forwarding to NFHS 5, 47.4 percent of babies born in the private sector are being delivered by surgical methods compared to just 14.3 percent in the government sector. On a macro-level, the statistics imply that one in five women who go to any medical facility, public or private undergo a C-Section delivery.

Experts have actively debated cesarean births on demand by mothers in recent years. Experts have categorized maternal reasons for childbirth in six main categories: the fear of childbirth, safety concerns related to health risk perceptions, negative experiences of previous births, reliance on science and surgery, access to biased information, and superstitious beliefs of inauspicious birth dates. Most women had more than one reason for opting for cesarean birth. Dr Ian Askew, the Director of WHO's Department of Sexual and Reproductive Health and Research and the UN joint programme, said, "Caesarean sections are critical to saving lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed".

However, Dr Askew further added, "Not all cesarean section births carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby." Doctors undertake cesarean sections in situations like prolonged labour, fetal distress, or because the baby is in an abnormal position. Like all other surgeries, C-Section surgeries also come with their risks. The potential heavy bleeding and risk of infection, extended recovery times after childbirth, a significant delay in breastfeeding the child, and establishing skin-to-skin contact could lead to complications in the future.

'Long, Tedious Process Of Natural Delivery'

Dr Meeta Saxena, who had two c-section deliveries, said, "In my case, I had a medical condition, and therefore, the doctors did not recommend that I undergo the stress of labour. A normal delivery requires a lot of pushing and enduring the pain, and because of some problem in my lungs, it was not recommended that I undergo normal delivery. My surgery was planned according to the changes in the heartbeat, and a suitable time was selected".

However, she further added, "Especially in North Indian states, women still prefer a normal delivery because it is considered that they recover faster and that they would be up and about very quickly. However, ladies in middle-income and urban families are not keen on enduring the pain or the long procedure of a normal delivery since it is unpredictable and might last for more than 24 hours. Therefore, the youth is not keen on undergoing the long, tedious and arduous process of delivering a child. That could be one of the reasons why youngsters insist on cesarean since surgeries are safer now. Moreover, people have high expectations that the child should not face any distress during the long hours of labour'.

National Statistics On C-Section Births

The cesarean and normal deliveries gap could be easily seen in urban and rural settlements. In Tripura, 95.7 per cent of births in urban areas are c-section deliveries, compared to 54.7 per cent in the rural areas of the state. Choosing the easy way out with c-section deliveries might come with its own set of risks and health hazards. The stakes could include excessive scar tissue formation, infection (a risk that is doubled compared to vaginal births), blood clots and injury to the bladder. Potential problems that arise with each subsequent C-section include placenta accreta, or when the placenta implants abnormally—and bowel obstruction.

While looking at the national statistics, one cannot undermine the prevalence of c-section deliveries in urban settings. In Andhra Pradesh, 63 per cent of the private sector and 26.6 per cent of births in the public sector hospitals were cesareans. In Chhattisgarh, 57 per cent of births in the private sector and 8.9 per cent in the public sector were through C-sections. In the private sector, the figures for the rural and urban sectors stood at 54.5 per cent and 60.4 per cent, respectively. The rural-urban numbers in the public sector were 7.1 percent and 17.8 percent, respectively.

Inequality amongst the urban and the rural touched newer highs in Bihar, where 39.6 per cent of births in the urban areas and merely 3.9 per cent of births in the rural areas were cesareans. The WHO stated, "When medically necessary, a caesarean section can effectively prevent maternal and neonatal mortality. Two new HRP (human resource planning) studies suggest that when the caesarean section rate in the population increases by 10 per cent, the number of maternal and neonatal deaths decreases. When the rate goes above 10 per cent, there is no evidence that the mortality rate improves."

Until as late as the 1990s, the physician called for the c-section or expected delivery. Moreover, it was believed that if a woman delivers a baby via c-section for once, all the subsequent deliveries should be through the same procedure. However, advanced medical technology has proven that now it is safe and acceptable to have a vaginal birth after a c-section delivery. Mothers may choose a C-section over vaginal birth to avoid vaginal injury or pain in the perineum and abdomen for a few days after birth.

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