Family Welfare dept asks gynaecs to help reduce number of C-section

The letter on the advisory to reduce the number of C-section deliveries was addressed to office bearers of Association of Maharashtra Obstetrics and Gynaecological societies (AMOGS) and Federation of Obstetric and Gynaecological Societies of India (FOGSI)

Mumbai Maharashtra government’s family welfare department has asked professional bodies of gynaecologists to help in reducing the number of Caesarean section births in private hospitals.

Family Welfare dept asks gynaecs to help reduce number of C-section

With almost 35% of all child births in private hospitals been delivered through C-section this year, the department has insisted that the procedure should only be used when indicated.

The letter on the advisory to reduce the number of C-section deliveries was addressed to office bearers of Association of Maharashtra Obstetrics and Gynaecological societies (AMOGS) and Federation of Obstetric and Gynaecological Societies of India (FOGSI). It raised concerns about the increasing proportion of C-section births in private hospitals over the last few years, and advised private practitioners to stick to the modified Robson’s criteria for every birth.

Assistant director at the State Family Welfare Bureau and nodal officer -maternal health Dr Aniruddha Deshpande said that when avoidable, doctors must refrain from delivering babies through C-section. “It has been observed that many patients, as well as doctors, choose to undertake C-sections even when it is not indicated. This inflates the bill which is often an out-of-pocket expense for the patients. In some cases, patients demand the procedure without the knowledge of the risks involved,” he said.

While he acknowledged that the situation in Maharashtra is not as bad as in some other states where almost 65% of all child births in private hospitals take place via C section, Dr Desphande said that the trend of increasing proportion of C-section births over the last few years is still concerning. In Maharashtra, the proportion is 25% in government sector and 35% in the private sector.

“Since most couples now have only one or two children, every pregnancy has become precious. Patients do sometimes demand C-sections to avoid any risks,” he said. Doctors, he added, must educate such patients.

Reiterating that the ratio of C-sections to normal births in the state is not alarmingly high, AMOGS family welfare committee chair Dr Komal Chavan explained why the number of such births are increasing. “There are certain factors like higher maternal age, diseases like gestational diabetes or hypertension, multiple births and others that increase the chances of a high-risk pregnancy. In such cases, the maternal outcome is better with C-section births,” she said.

She further added, “Doctors come under the purview of the Consumer Protection Act, so sometimes we need to give in to the demands of the patients or it can get us into trouble.”

She also pointed out that FOGSI is already running an initiative called Manyata with the state government under which labour room assessment and accreditation is done. One of the criteria for this accreditation, in fact, is optimised use of C-section deliveries.

Dr Chavan said that patients do demand the surgery at times. Regarding the use of Robson’s criteria, she said it does help in auditing whether the C-section was really needed but the discretion still remains with the patient and the concerned doctor.