While the WHO recommends that C-section deliveries should not exceed 15% of the total births, many hospitals overshoot the prescribed limit three to four times over.
Private hospitals in the city are performing on average far more Caesarean operations than government hospitals, and far beyond the ideal benchmark set by the World Health Organisation and other international bodies working in the field of health.
Not that the government and civic hospitals adhere strictly to these stipulations -- often exceeding the upper limit by 50% to 100% -- but the private hospitals is altogether a different story. Some government doctors allege lure of the lucre (Caesarean will obviously up the bill substantially) of the private hospitals, and feel doctors working there have no patience or the time for a normal delivery as they are more attuned to a quick turnover. Private hospital doctors take umbrage at the allegations and instead suggest that a host of reasons emanating from the lifestyle of expectant moms – almost all from rather well-to-do families – is to blame.
According to standards set by the WHO, Caesarean operations should account for only 10 to 15 per cent of the total number of deliveries. The government-run Vani Vilas Hospital had 17,359 births last year of which only 4,181 – or 24% -- were Caesarean. BBMP hospitals had similar figures - of about 16,000 deliveries, 5,000 (31%) were Caesarean. But the figures are skewed in favour of C-section deliveries in private hospitals. Fortis Hospital on Bannerghatta Road had 601 childbirth cases in the last six months of which only 275 were normal deliveries, which means 54% were via C-section. In Manipal Hospital, there were 1,700 Caesarean cases, but only 900 normal deliveries – 65% being Caesarean — in 2010. Cloudnine in Jayanagar has around 220 to 230 deliveries in a month of which 33 per cent are Caesarean.
A gynaecologist with a government hospital, who did not want to be named, said, “The main reason is money.
Gynaecologists are paid anywhere between Rs 10,000 to Rs 15,000 for a C-section. So, they ensure that it’s a C-section delivery. This happens more regularly in smaller clinics and maternity homes. After inducing pain, doctors can wait for up to 12 hours, depending on the condition of the patient. But in most cases, doctors don't wait that long. After two or three hours they provide some excuse or the other and perform a C-section.”
Others allege that doctors in private hospitals invariably force patients to opt for a Caesarean operation. “These doctors instil fear in their patients by suggesting that BP or blood sugar levels are high when in reality it would be normal or only slightly high,” said a doctor from a private hospital.
“I have had a number of such patients who come to me for a second opinion. But this is a trend mostly prevalent in small nursing homes and private clinics.”
“In corporate hospitals, doctors are usually paid about the same whether it is a normal delivery or a C-section. But there is a huge difference in the charges levied on a patient. The difference is pocketed by the hospital. In corporate hospitals, there are some doctors who only do C-section, no matter what. For a normal delivery, a doctor needs to continuously monitor the patient. This could mean monitoring the patient even for an entire day. But these doctors are so busy that they don’t have the time for it.” Gynaecologists in private hospitals, however, deny that money is a factor. They point to a number of reasons for this trend.
InfertilityDr Kishore Kumar, CEO and MD of Cloudnine said, “Ideally, only 10 to 15 per cent of total childbirth cases should be Caesarean. But today, there is an increase in infertility treatments which means an increase in C-section deliveries too. It’s a general practice all over the world that patients who have undergone IVF or other infertility treatments undergo C-section too as they are in the high-risk category. In Bangalore, an increasing number of patients undergo these treatments.
“The other reason is the increase in the number of expectant mothers being diabetic. When the mother suffers from diabetes, the weight of the baby increases. The average height of the Indian woman varies between 5 ft and 5.3 ft. Considering this, the weight of the baby should only be 2.5 to 3 kgs, but if the weight of the baby increases, normal delivery could be dangerous. The other problems include high BP and hypertension.”
Not that the government and civic hospitals adhere strictly to these stipulations -- often exceeding the upper limit by 50% to 100% -- but the private hospitals is altogether a different story. Some government doctors allege lure of the lucre (Caesarean will obviously up the bill substantially) of the private hospitals, and feel doctors working there have no patience or the time for a normal delivery as they are more attuned to a quick turnover. Private hospital doctors take umbrage at the allegations and instead suggest that a host of reasons emanating from the lifestyle of expectant moms – almost all from rather well-to-do families – is to blame.
According to standards set by the WHO, Caesarean operations should account for only 10 to 15 per cent of the total number of deliveries. The government-run Vani Vilas Hospital had 17,359 births last year of which only 4,181 – or 24% -- were Caesarean. BBMP hospitals had similar figures - of about 16,000 deliveries, 5,000 (31%) were Caesarean. But the figures are skewed in favour of C-section deliveries in private hospitals. Fortis Hospital on Bannerghatta Road had 601 childbirth cases in the last six months of which only 275 were normal deliveries, which means 54% were via C-section. In Manipal Hospital, there were 1,700 Caesarean cases, but only 900 normal deliveries – 65% being Caesarean — in 2010. Cloudnine in Jayanagar has around 220 to 230 deliveries in a month of which 33 per cent are Caesarean.
A gynaecologist with a government hospital, who did not want to be named, said, “The main reason is money.
Gynaecologists are paid anywhere between Rs 10,000 to Rs 15,000 for a C-section. So, they ensure that it’s a C-section delivery. This happens more regularly in smaller clinics and maternity homes. After inducing pain, doctors can wait for up to 12 hours, depending on the condition of the patient. But in most cases, doctors don't wait that long. After two or three hours they provide some excuse or the other and perform a C-section.”
Others allege that doctors in private hospitals invariably force patients to opt for a Caesarean operation. “These doctors instil fear in their patients by suggesting that BP or blood sugar levels are high when in reality it would be normal or only slightly high,” said a doctor from a private hospital.
“I have had a number of such patients who come to me for a second opinion. But this is a trend mostly prevalent in small nursing homes and private clinics.”
“In corporate hospitals, doctors are usually paid about the same whether it is a normal delivery or a C-section. But there is a huge difference in the charges levied on a patient. The difference is pocketed by the hospital. In corporate hospitals, there are some doctors who only do C-section, no matter what. For a normal delivery, a doctor needs to continuously monitor the patient. This could mean monitoring the patient even for an entire day. But these doctors are so busy that they don’t have the time for it.” Gynaecologists in private hospitals, however, deny that money is a factor. They point to a number of reasons for this trend.
InfertilityDr Kishore Kumar, CEO and MD of Cloudnine said, “Ideally, only 10 to 15 per cent of total childbirth cases should be Caesarean. But today, there is an increase in infertility treatments which means an increase in C-section deliveries too. It’s a general practice all over the world that patients who have undergone IVF or other infertility treatments undergo C-section too as they are in the high-risk category. In Bangalore, an increasing number of patients undergo these treatments.
“The other reason is the increase in the number of expectant mothers being diabetic. When the mother suffers from diabetes, the weight of the baby increases. The average height of the Indian woman varies between 5 ft and 5.3 ft. Considering this, the weight of the baby should only be 2.5 to 3 kgs, but if the weight of the baby increases, normal delivery could be dangerous. The other problems include high BP and hypertension.”
Huge demandGynaecologists say another major reason is the increase in the number of patients asking for Caesarean delivery. Dr S Anuradha, consultant gynaecologist, Cloudnine and Samarpan Health Centre, said, “There is a lot of pressure from patients and their relatives for C-section. Some of them are averse to having a normal delivery and undergoing the pain. There is also a craze to have a child delivered on a particular date and at a certain time. Patients use emotional blackmail and plead with doctors to have the child born at a certain time and day. Doctors end up agreeing. Whenever there is a request for C-section we counsel them. But counselling doesn't always work.”
Lack of physical activityDr Praveena Shenoi, consultant obstetrician and gynaecologist, Manipal Hospital, said, “The major reason for the increase in the C-section cases is the lack of physical activity of expectant mothers. They mostly hold a desk job where they have to sit for long hours. They do little or no exercise. In such situations the weight of the baby increases above 3kg and normal delivery becomes difficult. The increase in the age of expectant mothers is also a reason. Money cannot be a reason.”
Dr Gayathri Kamath, consultant obstetrician, Fortis Hospital said the lifestyles of patients is also a factor.
“Most women who come here have fairly affluent lifestyles. They rarely do domestic chores and they eat a lot of fruit and dry fruit compared to the women who go to government hospitals. This leads to an increase in the weight of the baby which makes a normal delivery risky. Anxiety levels of patients are also high and this is transferred to the doctor too. I don't think money is a factor in our hospital. Our fee for a C-section delivery and a normal delivery is about the same.”
Older expectant mothersDr Preeti Prabhakar, consultant obstetrician and gynaecologist, Apollo Hospital, believes that the increase in the age of expectant mothers is a major reason for more C-section deliveries. “Most women who go to a government hospital for a delivery are usually in their 20s, but those who visit private hospitals are usually aged between 30 to 35 years. We even get cases above 40. The older the woman, the more chances of complications, so a lot of them end up getting a C-section. Sometimes, if the heart-rate of the baby drops, the patients themselves request us to do a C-section. Pain tolerance levels for older women is also very low and many of them do not want a normal delivery,” she said.