Ideally considered to be the last resort in medical field, surgeries are becoming festive in Kashmir, as more women are worrisomely preferring Cesarean sections over natural deliveries. But this labour-pain evading procedure ends up only hurting the back of young Kashmiri mothers.
By Asif Khan, Arbeena Shah
INSIDE Srinagar’s LD hospital, Nazima is struggling with her baby bump.
Dressed in a sloppy Frock Shalwar, she’s being assisted by her mother—reciting ‘Bismillah’ recurrently in a hope to give some spiritual strength and solace to her daughter.
While being wheeled to the observation room, Nazima is all set to go under surgical knife for delivering her first baby.
As her husband and mother trial behind, she looks a bit edgy but, for now she just wants to get rid of the pain she is in.
“Myoun Khoedah dee taar (My Allah will take care of you),” Nazima’s mother comforts her daughter before taken to the theatre for Cesarean Section.
Lower segment Caesarean Section (LCSC) or simply C-Section is the surgical delivery of a baby through incisions in the abdomen and the uterus.
Kashmir is witnessing a hysteric rise in C-Section rates as more women are backing the wrong horse by opting for surgery to deliver the baby.
An RTI (Right to Information) filed by the rights activist M M Shuja recently disclosed that out of the total 20,329 deliveries carried out in five months— from April 01 to August 31, 2020—in Kashmir, at least 8,677 were conducted through C-Section.
These numbers put the overall percentage of C-Section in Kashmir at over 42.68, against the WHO-recommended 10-15 percent.
C-Section surgeries may be seen as a fast and easy way to deliver, usually to elude the labour pain, but it ties the women to a compromised health afterwards.
Ayesha Wasim, 33, who had delivered her lone child surgically four years ago, became an ugly example when her abdominal stitches developed abscesses and thus, began her saga of pain and suffering.
“My back gives up on me whenever I try to do some work,” she sighed in pain.
Like Ayesha, there’re several young mothers running into some sort of hitch after undergoing C-Section surgery.
Aqsa Azam, a newly mother in her late 20s, preferably sought C-Section as an easy way out.
“I thought I couldn’t endure the labour pain,” she said.
Howbeit, she now seems to lament her choice as she experiences habitual backache and is unable to carry out the routine work duly.
“Although C-section procedure went smooth and pain-free,” said Aqsa, holding the baby boy in her arms while being seated on a chair, “I now feel certain discomfort inside, in addition to backache.”
She prefers to breastfeed her baby on a chair rather than sitting down.
Another mother in her 30s, Nusrat, still feels the aftermath effects of the surgery that she had undergone couple of years ago.
“I feel like crying whenever I change my position during sleep as my back starts aching severely,” she narrated her nightmare.
Apart from low vigour and backache, these young mothers are also annoyed and irritated about the unbridled hair fall.
While carefully fixing her crinkly hair, Bisma Jan, 32, who underwent the surgery a year ago, said, “My hair falls rapidly now, and there seems no end to it.”
Like her, Aaliya Adnan, 33, longs for her voluminous hair which stared thinning after the surgery.
“Initially, it happened because I was anaemic post delivery,” Aaliya said. “But, even after four long years, I’m unable to see any improvement in my hair.”
Although carrying and delivering a life is a woman’s unique power and the most unexplainable emotion in her life, the prevailing health sector is being accused for making it a distressing experience for the mothers by not meeting their expectations.
Privacy and other issues
Apart from the fear of labour pain, there’re plethora of other reasons that drive a mother towards Cesarean surgery.
And one of which remains the lack of privacy in Kashmir’s government hospitals.
The observation ward, where a woman dressed in a maternity gown, is shifted immediately post delivery of her child, doesn’t protect her from the outsiders’ gaze.
Her privacy is compromised when local attendants as well as the ward boys repeatedly peek into the room.
“The authorities need to make the special arrangements in maternity hospitals so that our privacy is honored,” said 37-year-old, Sameera Shafiq.
Witnessing such inapt situation with her own eyes, Sameera was convinced to deliver her baby surgically.
Another young mother, Azfa Andrabi, in her mid-twenties, shared the similar experience with government hospitals and hence, sought refuge in a private nursing home.
Besides privacy, these mothers criticize the poor infrastructure, non-availability of trained midwives and lack of proper counseling in the state-run hospitals.
Aliya Adnan asserted that she wasn’t even counseled for the delivery procedure.
“There should be systematic counseling of women throughout their pregnancy in order to apprise and prepare them for natural childbirth,” she said.
What Doctors Say
The gynaecologists reveal that a Caesarean section is recommended in case any threat to a mother or baby is recognised.
“Usually, if there is a high risk pregnancy such as the expecting lady being hypertensive, diabetic, over-aged, or baby beech is detected, then we prefer delivery through C-Sections since the vaginal delivery can be risky,” Dr. Sumeena, working as a Registrar at Lal Ded Hospital, told Kashmir Observer.
Another Consultant from SKIMS Medical College, Dr. Sami Jan, said that C-section is on rise globally and “women mainly prefer it to avoid the labour pain”.
However, women undergoing C-section are prescribed a prolonged bed-rest, unlike those who deliver normally. They also end up complaining a searing backache after delivery.
Besides, women undergoing C-Section have to bear the anesthetic complications as the surgery is carried out under local anesthesia.
Despite all these complicacies, the modern trend reveals that women voluntarily opt for surgery because they believe it is less painful and safer.
“Women tend to Google the complicacies of vaginal delivery even before coming to us,” Dr. Sumeena continued.
“They catch fear prior to their delivery and thus, prefer to go against the natural process.”
Further, as per the gynecologists, if a woman undergoes C-Section, her uterus becomes weak due to the incision.
As such, during her second pregnancy, the baby is delivered via C-Section only, probably around 37 weeks instead of full 40 weeks.
A senior Consultant at Lal Ded Hospital told Kashmir Observer that women who undergo multiple C-Sections are at higher risk of placental problems as well as heavy bleeding, “which sometimes require surgical removal of the uterus”.
C-sections also serve as a status-symbol for the elite section that prefers private over government hospitals.
The charges vary greatly from a government to private sector, inspiring the rise of many nursing homes in Kashmir as they mostly witness Caesarean surgeries.
“Private sector also contributes to the rising levels of C-Section as there is no infrastructure for carrying out a normal delivery there,” Dr. Sumeena said.
Isha Malik, Clinical Psychologist, said that fear of complications during birth, phobia related to child birth, history of sexual abuse, dysfunctional beliefs about childbirth, history of traumatic births, pre-existing diagnosis of prenatal depression and anxiety, and other psychiatric and psychosomatic issues can lead a woman towards the decision to undergo C-Section.
“Most of the times women are never referred to a psychologist to evaluate the underlying cause of fear and thus, don’t receive the required psychological intervention,” Isha said.
Moreover, vicarious birth experiences i.e., hearing negative stories or receiving alarming information related to childbirth from family and friends also induce fear in expecting mothers.
Similarly, depiction of childbirth in media also creates fear.
Psychologists postulate that husband’s help, support and involvement play a crucial role in decreasing mothers’ anxiety and fear.
They collectively believe that health authorities need to work on prenatal care services.
“Prenatal education, support and coping strategies need to be included in the standard protocol in order to help increase knowledge about birth options and facilitate the confidence in women about their ability to give birth naturally,” Isha said.
Waseem Kakroo, another Clinical Psychologist, working with UNICEF and Institute of Mental Health and Neurosciences, stressed upon the necessity of psychological aid in order to help expecting mothers overcome the fear of natural child birth.
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