[ksakotai]

Just read the article in page 2 of TOI Hyderabad. It says AP tops c-section rates in India, with a whopping 70% rates.

This rampant malaise is spreading like wildfire in urban and semi-urban India where many doctors do not have the patience to allow mothers to labor on their own. Hospitals, including the corporate ones, feed on mothers' natural fears for the health of her baby and wave the "risk to your baby" flag to force her to agree to unnecessary procedures such as Induction, Epidural or c-sections.

A fellow member made the comment about having more midwives - that is the best suggestion that I have heard in this thread. Just a few decades ago, all births were being helped only by traditional midwives, and most births were normal, and at home. Why mothers and babies were dying were because of lack of sanitation, infections etc, and not due to birth.

All the talk about baby swallowing waste, baby in breech position etc needs to be taken with a grain of salt. Yes, in extreme case we need to intervene, but in overwhelming number of cases, small amount of waste (Meconium) being swallowed is NOT by itself a necessary and sufficient condition for c-sections. Babies swallow meconium all the time, and only the extreme situation is dangerous. Nor is a breech baby a signal for c-section. There are various exercises, and positions that mothers can take in order to rotate breech babies without any harm. And thousands of babies are being delivered normally in breech condition everyday in the world.

Epidurals are NOT essential in the birth process, except in extreme situations - most hospitals push drugs like Epidurals or induce contractions with drugs such as Pitocin - all of which mostly lead to c-section.

Another myth is that once a c-section, always a c-section. VBACs (vaginal birth after c-section) is definitely possible.

Above all, mothers need to be supported, encouraged to trust their own bodies, and given privacy to labor on their own terms. This along with continuous monitoring by their health care provider team will ensure that outcomes will be favorable. While we cannot guarantee normal delivery in 100% of the cases, a full trial of labor has numerous benefits for both mother and baby.

How do I know this? Please visit healthy-mother (dot) com.

Note: I am NOT plugging anything here - I don't care if no one from the forum visits. We are only trying to effect positive change in birth practices in urban India one mother at a time. I wanted to clarify many of the points raised in the forum so that people can get a correct picture from someone who is in the business of providing maternity care.

thanks

Krishnan

[amitk26]

We are discussing only the phenomenon of C-sections triggered by greed and insurance settlements in metro cities but there are other factors as well ,

My sister is a gynecologist who practices in a small town where fees are extreamly negligible compared to metros ( full cost of C section around 10-15 K in smaller private nursing home compared to 50K+ in cities like Bangalore).

She shared few observations when this topic came up.

1. A large majority of urban middle / upper middle class women are obese with weak muscles and variety of complications due to poor lifestyle resulting in more c-sections today compared to 20 -30 year before.

2. Rural poor women are undernourished and ill-fed many times and brought to city as last resort if the case goes beyond conrol of local midwife.

3. Many times uneducated or partially-educated patient in semi-rural areas insist on costly procedures else they conclude that doctor is incompetent.
In some cases she told if she prescribes less costly formulations for various supplements seeing financial status of the patients but the people are not happy thinking that doctor is not prescribing the good drugs and prefer to go to someone else who milks money.

4. Sis has got latest color Doppler ultrasound machine but she does not believe in unnecessary screening of poor people until it is really required but this often results in unhappy patients who do not come back for second visit thinking they are not getting good enough care. So as a compromise she some times do that scan for well off patients because they insist and feel happy and take fee.

[vivekiny2k]

Originally Posted by ksakotai

Note: I am NOT plugging anything here - I don't care if no one from the forum visits. We are only trying to effect positive change in birth practices in urban India one mother at a time. I wanted to clarify many of the points raised in the forum so that people can get a correct picture from someone who is in the business of providing maternity care.

thanks

Krishnan

I have been a supporter of natural living just as you sound here. But we can not discount the change in lifestyle in recent years. You can not expect a mother to deliver a baby normally when 90% of her lifestyle is totally different from what it used to be in 70s. And all of us are used to more comfort, living in AC etc. The natural tolerance to pain has gone down. and the pain itself can kill, it's not just a symptom.

Secondly, given a choice, any parent will like to be safe than sorry. Breech babies may have been delivered normally in old days, but given the options and the risk involved (I am sure you see them too), I doubt anybody will or should still opt for normal delivery.

[Mpower]

Need to have a review and rating system for doctors/hospitals just like we do for cars.

Have been the victim of too many 'fast talking' docs who waste your time and money. Of course, this is an even serioius matter.

[Ford_madhan]

Here are my points on c-section..

If the baby weighs somewhere between 2.5 to 3kg and the mom is in good health, the doctor's will not suggest c-section. But nowadays most of the baby's are either over weight or the mom is not strong/healthy enough to withstand the labor pain. That's why c-section is recommended.

But the people themselves are also deciding to go for c-section irrespective of what the doctor says for the following reasons. Might be weird but its true.
1. They want the child to be born on a auspicious day and time.
2. Afraid of pain
3. And something to do with their sexual life like not giving mother milk for so and so reason. [ Hope you can understand - this is also true and happens]
4. Doctors suggest this because its easy money for them and if something goes wrong in normal delivery, their hospital name will be spoiled.

[prince_pervez]

^^ Good points there @Madhan.
If everything is normal, all women should undergo a normal delivery for the sake of the baby and avoid c-section. The advantages of a successful normal delivery is more than in a c-section. c-section should be done on the advice of a doctor. If he is correct or wrong or minting money is too feeble an issue to be discussed on the D-day. When I had my baby, the doctor did talk about the c-section as a last option and insisted on a normal delivery if everything was fine. The relation between a doctor and a patient develops in those 9 months and a good doctor with moral values will not suggest money making procedure.
However I know a few gals and relatives who would directly want to do a c-section w/o having to undergo pain. And yes it is easy for me to say and type.

[aargee]

Adding my 2 cents...
IMO, it all depends on which hospital or doctor is treating the patient. In our case, I didn't want to send my wifey all way to TVM. But we heard the doctor was simply awesome & specialist for normal delivery (damn strict too). So we'd to send her there & I was only half hearted as I know about the tricks played by the hospitals where, even, the doctors don't have a say. However things went amazing; this lady doctor made a normal delivery for a 7 months old baby due to some issues for another lady who got admitted in that hospital. That was way too go about her.

Needless to say, we got our daughter also delivered normally by the same doctor.

My Wifey's points - Labour pain lasts only for few minutes after which there's nothing to suffer, however C section is something that takes weeks to heal.

[Nitin]

Originally Posted by aargee

My Wifey's points - Labour pain lasts only for few minutes after which there's nothing to suffer, however C section is something that takes weeks to heal.

When you look at how long it takes for a woman to recover from the C-section, it makes you wonder 'Can't an alternative procedure be performed, to reduce the pain and discomfort of the c-section?'.
To say the least, the pain does last upto a few months, and even after the incision heals, some aches and pains exist for upto a year (not to forget the occassional loss of sensation in and around the incision site).

[SirAlec]

My experience after we had our first son about a year ago.
and helped a friend during his precious moment..

Normal Delivery.
1. Is good if and only if lady is quite healthy, and strong. Pain is unbearable.
2. Can go home on third day.

C-Section
1. No pain during delivery but the section takes lot of time to heal.
2. recovery time is minimum a week, can be more.

What I experienced and what i did
Instead of opting for a big hospital. I went for a private nursing home which had a good reputation. This is pretty easy to find out in your neighborhood.
Why? As for me AIIMS and Fortis etc were too far. Mine was a complicated case so opted for a nursing home which had all the equipments, experienced lady doctor. and was just two blocks from our place. This decision proved fruitfull when the labor pain started in evening. ANd every body knows delhi traffic during evening.

I was amazed to see that in Big hospital in Delhi doctor come on hourly basis. After that they go to another Big hospital, and another and later sit on their own practice. How commercial.

Also during my friends time, i found out that Bigger fancy hospital insisted on C-section. Two benefits for them
1. Doctor didn't want to take any chances with baby and its handling techinics during delivery. Maybe newer doctor are not that experience with normal delivery.

2. During C-Section, they can bloat your bills which ever way they can. Room bills, daily doctor visit, medicine, etc etc.

3. Also they charged us double for an AC room that was near Operation theater than the private ward that was two floors up.It was upto them to keep how many days there and later transfer to another ward.

Thanks
--kenden

[aargee]

@Nitin - what you said bang truth. I'd a positive opinion on c-section & it was my wife who changed it completely. But again, now days, the cost of normal vs "c" is hardly any difference. The hospital charges for some reason or other even if it is normal; we were lucky to get away with just 15-16K in a reputed hospital in TVM. Had it been Chennai, God knows how much they would've milked from me.

[Deep Blue]

"Corporate" hospitals are in healthcare "business", not service. Bottomlines are more important than care.

All C sections are not predetermined. Sections may be either elective or emergency

Elective sections are those where the route of delivery is predetermined as C section due to either maternal or fetal reasons( e.g.,gross disproportion between maternal pelvis and fetal size) Again these indications may not always be absolute.(as in previous C section)

Emergency sections are those where the normal delivery process is allowed with medical monitoring.During monitoring, if there are signs suggesting harm(either to mother or baby) on allowing the natural process, then the obstetrician would convert to C section. So allowing normal delivery does not always mean it will end up as a normal delivery.

One of the reasons why C sections have increased is it has become a very very safe process in the correct hands. The doctors have control of every step(almost) in the process whereas in a normal process, it is not so. This very high safety margin gives rise to the less risk approach because of which procedures like vaccuum, forceps delivery are becoming rarer and probably rightly so.

Some of the unscrupulous reasons for C sections
Patient side -

• auspicious time and date
• not wanting to tolerate labor pains
• there are patients who consider the doctor not good if C section is not done

Doctors side -

• wanting to have a good night's sleep, attending some function
• more fees obviously
• less risk approach

Much of the misconceptions etc would be solved if only the doctors had the time and patience to sit and explain things to patients and relatives. Emergency sections require quick decision making, and patients going to normal delivery need to be primed before.

Have faith in your doc. Most are reasonable!

[download2live]

Most women now a days plan child rather late in life. As per doctors the best time for a woman to have a baby is before 25 years. After that the body starts losing its capacity. Add to that the most of the women are now a days planning a child well beyond the age of 28 since age of marriage has raised to 25 for women.

Add to this the usual make a fast buck attitude of doctors and we end up with a track of the c sections.

Suggestions?
Do some research and find a good doctor in your area. Ask friends. Ask people. And one you find him/her, trust him/her in the suggestions they give.

[idea1979]

Something on similar lines

http://www.team-bhp.com/forum/shifti...justified.html

After all its all about business.

My wify had normal delivery but kido was premature. They kept him in NICU for 2.5 Months Reason: "Weight is low and vital statics needs to monitored." as premature babies MIGHT forget to breathe when they are asleep (SIDS syndrome).

Piad total bill of 4.5 Lac.

I am not blaming doctors here however i am sure medical insurance cover of 5L influenced their decision making.

Forgot to mention, had to creat some noise in order to shift baby from NICU to private room for 4 days of under observation

[kuttapan]

I would like to narrate my(wife's) experience. My son was born at Manipal, Bangalore and was a natural delivery. The doctor was very endearing(Dr. Shobha Venkat). My wife liked her so much at the first visit itself. Since I was particular about being with wifey during delivery and Manipal allowed it, we chose Manipal. Dr. Shobha was very clear that my wife will have a normal delivery, unless there were some unforeseen complications - it gave us the much needed confidence. My wife got admitted on an afternoon with mild pain and had to suffer a full night ordeal, the hospital staff were supposed to call the doctor when it was time for delivery, but they bungled and called late. The poor doctor woke up at 4.15 in the morning and caught an auto(was delayed hence) as her driver wasn't available and came to the delivery room, just as my son came into the world, wailing..I was disappointed that the delivery wasn't done by our favorite doctor, but the duty doctors were good enough.

In the end, we took some flowers to thank the doctor, just for being there with us. I, for one, never second guessed this doctor(normally, I do it all the time). I would have happily gone in for C-section for my wife, if the doctor deemed so. You need to develop a rapport and have confidence in your doctor(easier said than done in today's hospital business, I guess).

[ghodlur]

Even in my wife's case the C section was inevitable.

All through the 9th month, the family doctor had been assuring that it would be anormal delivery and that was what my wife wanted. Seeing the doctor's confidence, my wife was getting confident that it would be a normal one. Howver on the D day as the pains started, the doctor started getting a bit restless sicne the pains were not of that proportions. She was given pain inducing injections but still not strong pains. Finally the doctor decided that C section would have to be done and scared us by saying if not done immediately the baby would be affected. Had to give in the doctors demand and went ahead.

Although the doctor charged us nominally for the operation but still the dream of a normal delivery vanished into thin air within moments. Cant say whether this was "doctored" decision.