Health Minister Dinesh Gundu Rao said the number of C-sections in private hospitals are extraordinarily high and promised to look into the possible reasons.
Published Dec 18, 2024 | 7:20 AM ⚊ Updated Dec 18, 2024 | 7:20 AM
Excessive weight gain during pregnancy in this population is a risk factor for children developing ADHD. (Creative Commons)
Doctors in Karnataka’s private sector are a miffed lot after Health Minister Dinesh Gundu Rao told the state legislative council that caesarian sections are on the rise in corporate hospitals.
The minister even went to the extent of saying that private hospitals recommend C-sections to charge more money from the patients.
Incidentally, nearly half of Karnataka’s childbirths are through C-sections. Minister Rao told the council that 46 percent of childbirths in the state were through C-sections. He was responding to a question by Jagadev Guttedar on the increasing C-section deliveries.
“while the percentage of C-section deliveries in government hospitals is around 36 percent, it is 61 percent in private hospitals. In some private hospitals the C-sections exceed 90 percent,” the minister informed the council on Monday, 16 December.
Health Department data showed that the proportion of C-section deliveries increased from 30.7 percent in 2018-19 to 32 percent in 2021-22, 38 percent in 2022-23, and 46 percent in 2023-24.
The state government has now announced a comprehensive programme to reduce the number of C-sections. Rao said that the focused programme would include training healthcare providers across Karnataka’s government hospitals to create awareness of normal deliveries, provide counselling for women soon after confirming pregnancy, and auditing C-sections in all hospitals to know the reasons.
The government would announce the details of the initiative in a month. The minister, however, stressed that there was a growing disparity between delivery practices in government and private hospitals.
Explaining the reasons for increasing C-sections in private hospitals, Minister Rao said it helped the respective managements to charge more and raise revenue.
“C-sections in some private hospitals exceed 90 percent. They do this as they can charge more from the patients. Private hospital doctors are not very interested in promoting vaginal births,” the minister claimed, adding that the government was promoting deliveries in state-run hospitals.
Incidentally, districts like Tumakuru have particularly high rates of C-sections accounting for 65.1 percent of total deliveries in 2023-24. Other districts with increased rates included Udupi, Chikkamagaluru, Chitradurga, Bengaluru Rural, and Kolar.
The minister’s statement in the council has left the doctors miffed. They felt it was “unfair” to blame the private hospitals.
Speaking to South First, Gynaecologist and Obstetrician Dr Hema Diwakar opined that terming C-sections “unnecessary” would create distrust among patients and their families.
“Decision to go for C-section is based on premature, breech, twin, high risk, previous C-section, etc., Dr Diwakar, also the Managing Director of Divakar Specialty Hospital and Member of FIGO Executive Board, said.
The main concern for doctors is the safety of the mother and child. Many times courts have questioned doctors for not opting for C-section to be on the safer side,” she said.
Private hospital doctors said pregnant women and their families often ask for C-sections due to various factors. Driven by cultural and astrological beliefs, muhurta (auspicious time) for childbirth has been one of them.
Bank employee and first-time mother Meera Sharma (name changed) said she opted for a C-section to ensure her baby was delivered at a specific time.
“We planned the entire pregnancy, and the muhurta had to align,” she said.
Dr Diwakar explained that such demands, once rare, were now shaping the birthing choices of many families. While doctors acknowledged the emotional importance of these requests, they emphasised that medical safety remains the priority.
Meanwhile, Dr Sowmya Sangamesh, Consultant Gynecologist at BGS Gleneagles Hospitals in Bengaluru said opting for C-sections for couples who had undergone years of fertility treatments was emotional.
“Couples, for instance, who have waited for 14 years for a child, would choose C-section since they do not want to take any chance,” Dr Diwakar said.
Doctors explain that after a long and arduous journey of miscarriages and failed attempts, the couples preferred the certainty of a planned C -C-section over the unpredictability of natural delivery and emergencies.
“For couples with a history of fertility struggles, the fear of complications during labour is significant. Planned C-sections can provide reassurance in these cases,” Dr Sangamesh said.
Dr Diwakar further said that if medical scans established the baby to be large (foetal macrosomia), the parents, worried over possible complications that might arise during normal delivery, would opt for a C-section.
Doctors said that while vaginal delivery would be possible, the risks of shoulder dystocia (foetal shoulders getting trapped after the head is delivered) or prolonged labour could not be ignored.
“It is a matter of shared decision-making. If the family is anxious and unwilling to risk complications, a C-section becomes the safer option,” Dr Sangamesh explained.
Doctors said Minister Rao correctly identified one of the major factors — fear of labour pain — making women opt for C-sections. Dr Sangamesh said that despite advancements like painless labour (epidural anaesthesia), some women still dread intense labour pain.
Dr Diwakar said the fear was often compounded by stories shared by friends or family members. “Even with promises of an epidural, they have a nightmare about intense pain and would rather go for a C-section,” she said.
Private hospital doctors said that though attempts were made to educate women, ultimately their comfort and choice mattered the most.
Women who have experienced multiple miscarriages or a stillbirth often approach childbirth with heightened caution, Dr Diwakar pointed out.
“Women with a history of recurrent losses do not take chances,” she said.
Dr Sangamesh said patients could no delivery could be said as risk-free. “It’s either high risk or low risk. It is a retrospective analysis. No mode of delivery, no pregnancy, can be confirmed to have normal labour. As labour is a major event, anything can happen at the time of delivery,” she elaborated.
Dr Diwakar welcomed proper audits and ways to minimise the C-section. She opined that it would help in course corrections (like early transfer to advanced medical centres, early detection of complications, supervised labour and action based on progress).
“We welcome proactive steps to minimise C-sections, but to make a blanket statement that C-sections are unnecessary and are done for monetary gains is unfair,” she opined.
Doctors felt the state government’s decision to train healthcare employees and doctors to counsel the women would be a “great idea”.
“If we counsel, it helps because we reassure them (patients) that if there is an issue during labour, we will play safe and not take risks. Then, they agree to a trial. However, no one should make the woman feel guilty about the option that she chooses. This should be kept in mind,” Dr Diwakar opined.
Dr Sangamesh said corporate hospitals have trained professionals to help women understand the labour process. “They (the women) are counselled.”
Doctors South First spoke to said C-sections were on an uptick not just in Karnataka but across the world. The possible reason could be an increase in medical disorders such as diabetes and hypertension during pregnancy.
However, the state government’s move to audit the C-sections and ensure that access to healthy delivery options would be critical to understanding the reasons for the rise in C-sections.
Dr Diwakar said the Federation of Obstetric and Gynaecological Societies of India (FOGSI) has called for clinical audits of C-sections in all hospitals every quarter.
FOGSI recommended that audits should include the rate of C-sections, indications for C-sections, and procedural complications. It urged hospitals to follow WHO’s Robson’s 10-group classification system to classify C-section cases.
(Edited by Majnu Babu).
