In many parts of urban India, women having cesarean section deliveries seems to be the norm and those having normal deliveries almost seem to be an exception. But are the women aware of the risks?

It is estimated that cesarean section rate is almost as high as 65 per cent in the some of the private hospitals in Delhi. So is there a financial factor? A cesarean delivery costs an average of Rs 20,000 more than normal. So are hospitals just trying to make more money off cesarean section deliveries or is it just the progress of Science? There is also an angle that young couples are opting for cesarean section because they can time the birth exactly to match the right stars.

The big question asked on the show India 360 on CNN-IBN was whether the rise in cesarean sections is an unethical medical practice? To debate the issue on the expert panel were Assistant Professor, Centre For Social Science and Community Health, JNU, Dr Rajib Dasgupta, Consultant Obstetrician and Gynecologist, Fortis La Femme, Dr Tripat Choudhary and astrologer, Ajai Bhambi. The show was compaired by Sagarika Ghose.

Quick Buck for Hospitals ?

Is the reason for the rise in cesarean section deliveries in urban India the fact that hospitals recommend it to pregnant women in order to make money? Dr Rajib Dasgupta was of the opinion that that could not be the only reason behind the increase in cesarean section deliveries.

“Overall, data suggests that being in a private sector hospital would increase your chances of having a cesarean section delivery. However, all of this cannot and should not be attributed to the fact that doctors want to make money. That could be one of the reasons. Several other factors are added to it. One is that cesarean section is being seen by women especially those from higher socio-economic groups as a modern, superior technological solution. Another reason is that in private sector urban kind of situation all births are necessarily seen and attended by obstetricians whereas in primary settings we have mid-wives and nurses attending more births,” said Dr Rajib Dasgupta.

In a hospital like Fortis, a normal delivery costs Rs 50,000 while a cesarean section costs Rs 65,000 plus hospital stay and room charges.

“I can speak for myself and I’m one of those who from the very beginning has been charging exactly the same for a cesarean section and normal delivery. So I don’t think for me that’s a criterion. There is a trend across the world for an increase in cesarean sections. They have become much safer over the years. When it started, people were losing mothers to cesarean sections so there were not many fetal indications for cesarean section. But as time has gone by, we can save babies who are much smaller at the time of birth both in terms of gestation and size. Since nursery care has become better, cesarean sections have been done even for fetal indications,” said Dr Tripat Choudhary.

Importance of Cesarean Sections

The WHO, however, states that cesarean sections should be done only as a life-saving measure when there is a risk of fetal or maternal death. Dr Tripat Choudhary countered the dictum and said if there was an accidental hemorrhage, if she didn’t operate, the baby would be dead but they would lose the mother as well. “But there are times when the baby is not dead and if I do a cesarean section I could save the baby,” said Dr Tripat Choudhary.

So is there data on a direct co-relation between maternal and fetal mortality and cesarean sections?

“A recently published paper by a maternity hospital in Bombay demonstrates beyond a 10 per cent rate of cesarean sections, outcomes do not necessarily improve. The WHO puts the rate of cesarean sections at 15 per cent for the population. In this hospital in Bombay, from the 1950s to the 1990s, the rate has increased from 2 per cent to 20 per cent. A threshold of 10 per cent is what they give,” said Dr Rajib Dasgupta.

Dr Rajib Dasgupta’s view indicated that there was little improvement in maternal and fetal mortality even with cesarean sections, making it a contentious issue.