Cesarean section must be done only with informed consent and when required

Health Care, Heart Care Foundation of India, Medicine Comments Off

The procedure may cause complications when not carried our properly

New Delhi, 6 April 2019: Every year, 3 lakh women die during childbirth, 99% of whom are from low and middle-income countries. Maternal deaths following caesarean sections in low and middle-income countries are 100 times higher than in high-income countries, with up to a third of all babies dying, according to data compiled from over 12 million pregnancies. This is as per a recent report published in The Lancet.

A third of all deaths following caesarean section were attributed to postpartum hemorrhage (32%), 19% to pre-eclampsia, 22% to sepsis, and 14% to anesthesia related causes. The study further says that while many women in need of caesarean sections still do not have access to it, particularly in low-resource settings, many others undergo the procedure unnecessarily, for reasons which are not medically justified.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, ““C-sections should be done only when vaginal delivery poses a risk to the mother or baby. This mode of delivery can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications. What we seem to be experiencing nowadays is overmedicalization of normal pregnancy and birth. Natural birth may seem like a waiting game but in the absence of any potential complications due to which a C-section may be needed, it is advisable to let nature take its course.”

The decision to perform a caesarean section is not solely in the hands of the doctor. Patient preferences or caesarean on maternal request also play a part. Some reasons for elective C-sections include anxiety about vaginal birth, fear of vaginal birth (tocophobia), and wanting to deliver on an auspicious date or time.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The patient should be informed that even elective CS is not risk-free and carries serious risks for mother and child. An audit of deliveries cesarean sections, in the private as well as public health facilities, is needed to find out the reasons for the decision to perform each cesarean section before judging that economics and not medicine, influence a doctor’s decision to do a cesarean delivery.”

Cesarean section rates are higher in tertiary institutes or super-specialty hospitals. Similar is the case with senior and experienced doctors, who may not do routine vaginal deliveries. If you take informed consent, then again, the cesarean section rates may be higher. All these non- medical factors contribute to the increase in cesarean section rates. And, while they are not the sole cause, they do need to be considered.