Shahid Akhter, editor, ET Health world spoke to Dr. Sita Rajan, Senior Consultant of Obstetrics & Gynecology at Columbia Asia Hospital, Bengaluru to know about the surge in Cesarean section and the impact of high risk pregnancies.
Cesarean section: Trends and challenges
World over for the last decade and a half, the incidents of a caesarian section has been alarmingly high, and it was particularly more in our country; hence the recent government trend to try and curtail this to keep it at a sensible low level. The recommended level is that it should not be more than 20 to 30% but unfortunately, in our country, it had soared to almost above 60 to 70%.
The government is trying to curtail this but it may not be completely effective as there are various issues involved in the incidents of a caesarian section. In our country, we have patients who come in, mostly from rural areas with prolonged and obstructed labour pain where the incidents of a caesarian will obviously increase. There are patient issues as well as doctor issues.
The patient issues in urban healthcare are such that they do not want to undergo the pain, the trauma and the trial of normal delivery and hence they insist on a caesarian section. It is our duty and it continues to remain our strive to make sure that we try and convince them to try for normal delivery.
In high-risk pregnancies which now is increasing due to various factors - maternal age, other diseases that come in by the maternal age are going up like diabetes, hypertension. All of these with their own complications, again add to the incidence of caesarian section going up. Apart from this, we have fetal problems as well where inactivity, diabetes, or baby becoming too big.
But overall we try our best to keep it at a minimum trying to manage with whatever wherewithal we have in the urban as well as the rural sections to make sure that we keep it to not a very dismally low level but at least an acceptable level.
Normal Delivery after Cesarean section
Once a caesarian can be tried for normal delivery, if twice a caesarian, it has to be a repeat caesarian. In today’s scenario, most people are going in for just two children, the latter part which is two previous caesarian going in for a caesarian again does not feature very often. The normal delivery after a caesarian requires a lot of skill, competence and the infrastructure to provide for the risks.
In a hospital setup where we have all the recommended backing like pediatrician, anesthetist, blood bank, and ICU, all of these are mandatory to be able to try for a vaginal delivery after caesarian. It also depends on what the caesarian was done for the previous time, whether the same indication repeats, and therefore, we are reluctant to try. But otherwise, we make every effort to try for normal delivery, after explaining the very small risks which are involved in doing so.
The patient has to be taken into confidence, their consent is taken and they are aware of the risks in trying for a normal delivery, and more often not, if there is a judicious choice of patient for trial, we get away with it more than 90 to 95% of the times, trying to achieve it and successfully achieving a normal delivery.
Columbia Asia as differentiator in Obstetrics and Gynecology
We give all our antenatal patients a very thorough health check-up, and nothing is missed in the recent whatever are the normal tests to be done, normal guidelines to be followed. As far as possible, we are trying to eliminate any surprise which comes up suddenly.
When they come into labour pain, they are very well prepared with our exercise programs, they are told what should be/should not be done and they are encouraged to be physically active right up until the last minute till they go into labour.
We also have a very good backup in the form of our neonatal setups. The pediatricians and neonatologists are very well equipped and the technology required in the form of high-end ventilators and all the monitoring that’s required is easily done for these babies. That is why we are able to get away with even very low birth weight babies which are less than 1 kilo. In fact, our record is we have managed to make a baby of 650 grams survive, and the child is doing very well.
The high-risk pregnancies are unfortunately going up; in fact, we hardly see a completely normal pregnancy right until delivery. One of the factors that are deciding this is the maternal age, women putting their career before their marital status and maternal status, and therefore they come in older. Unfortunately, the incidence of diabetes in pregnancy is almost as high as 50-60%. Added to that, obesity, thyroid problems are becoming very common, almost 35-45% in the last statistics which we had done.
Apart from these, pregnancy losses, loss of children, loss of fetus even before they are born, and rarer problems like renal transplants in pregnancy, connective tissue disorders - all of these are a completely different spectrum of diseases which are well taken care of because we have a team approach. The physician, the surgeon, and the immunologist - everybody is involved in taking care of a high-risk pregnancy. It is a challenge for a doctor but a rewarding challenge.
Future: Obstetrics and Gynecology
The sex detection and therefore, choosing the sex of the child is going to be completely obsolete. The government has very effective policies in place and therefore that would deter it but the mental makeup and the change in the general population accepting a girl as much as a male child is going to be very helpful.
The next thing is more people working, therefore, more empowerment, availability of information, availability of sharing experiences, and making them more confident and careful about their own health as much as their child’s health or the family’s health.
Therefore, we are going to improve women’s health, in India as well as internationally. The third thing is we are still battling certain problems which come up in the obstetric career of the woman, we hope there will be further advancements in biochemical markers, radiological markers and therefore we continue to maintain a good fetal outcome as well as the maternal outcome.
Dr Sita Rajan (Senior Consultant - Obstetrics & Gynecology)
Columbia Asia Hospital, Bengaluru