The Moga Civil Hospital has seen a steep rise in the number of Caesarean section (C-section) deliveries at night. This is an abnormal trend for a government hospital that encourages women to go in for normal delivery. Data shows normal deliveries in the hospital are higher during the day, indicating more C-section patients are operated at night.
Of the 2,256 C-sections conducted from April 1, 2016, to March 31, 2017, 1,338 babies were delivered at night, while only 918 Caesareans were performed during the day.
The data for normal deliveries is the opposite. Of the 2,987 normal deliveries, 1,600 babies were born in the day and 1,392 arrived at night in the same time period.
There have hardly been any C-section deliveries from 4pm to 8pm in the year, raising doubts about doctors manipulating the time of delivery.
CASHING IN ON CONVENIENCE
Three years ago, the National Health Mission (NHM) announced financial incentives for conducting Caesarean deliveries at night. The policy was aimed at ensuring the availability of the obstetrics team at night for the convenience of pregnant women coming to government hospitals.
The obstetricians, who were not very keen on duty during off hours before the policy was implemented, now prefer conducting most deliveries at night. “Caesarean deliveries were performed at night before this policy as well but the numbers were certainly not this high. Now doctors prefer Caesarean deliveries at night,” said a senior doctor on condition of anonymity.
The government pays an incentive of Rs 3,000 per C-section delivery in the night to the obstetrics team of six, including Rs 1,000 to the gynaecologist, Rs 700 each to the paediatrician and the anaesthetist. A sum of Rs 600 per delivery is given to the paramedical staff, including Rs 250 to the staff nurse, Rs 150 to the operation theatre (OT) assistant and Rs 100 each to the two Class-4 employees.
‘Rs 40 LAKH TAKEN AS INCENTIVE IN YEAR’
With 1,338 babies delivered through C-section at night in 2016-17, the obstetrics team of Moga district alone made Rs 40 lakh.
Hospital sources say the team ends up making more money from these incentives than their salaries. “Each of the three doctors has earned not less than Rs 7-8 lakh per annum from these incentives,” the senior doctor said.
Chief medical officer (CMO) Narinder Singh admitted that certain doctors carry out C-section deliveries after 8pm for night allowance but he has been issuing notices to doctors to encourage normal deliveries bring down C-section births to 15% to 20%.
“We even send a monthly report of deliveries to the higher authorities to bring this matter to their notice,” he added.
WHAT DOCTORS SAY
“Unless there is an emergency, I avoid doing C-sections at night. But yes, the incentive is being misused by some doctors,” said Dr Gagandeep Singh, an anaesthetist at the hospital.
“The cash incentive was started to bring down the child mortality rate. Most patients come in the day but it takes six to eight hours to induce labour for delivery due to which most Caesareans are done at night. The incentive also gives us the satisfaction of benefiting from doing extra work,” Dr Manisha Aggarwal, a gynaecologist at the hospital, said.