Unnecessary C-section 

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APROPOS the news report titled, “I Feel Like Crying: C-Section Making Life Painful for Kashmiri Mothers” published by this newspaper on 15 December 2020; the report highlighted a very serious issue that needs our urgent attention. A few days ago, National Family Health Survey – 5 (2019-20) fact sheet was released for Jammu and Kashmir which contains some perturbing data on the increasing rate of C-Section deliveries in the UT. A total of 41.7% of deliveries are done through C-Section in both Private and Public Health facilities. Public health facilities carry out 42.7% deliveries through C-section while for private health facilities it is 82.1%, which is almost double that of public health facilities. This is up from NHFS-4 (2015-16) when 33% of total deliveries were done through C-Section– 35.5% for public health facilities while 75.5% for private facilities.

Private clinics seem to put almost every mother under the surgical knife. This is at least true for the urban areas of J and K where C-Section delivery rate is 91% in private health facilities. Normal deliveries here are an exception. World Health Organization guidelines insist to limit the rate of “C-Section” deliveries between 10-15% in any region but we have normal deliveries being limited to this rate. According to WHO statistics “when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases” but “when the rate goes above 10%, there is no evidence that mortality rates improve.” The guidelines further advise that C-Section should only be performed if either the baby’s or mother’s life is in mortal peril because C-Section surgeries have some serious short and long-term consequences that affect both the child and the mother as the news report cited above mentioned some problems that the mothers in Kashmir face after going through the surgery.

The news report published in this newspaper states that women opt voluntarily for C-Section deliveries out of fear of labour pain. Even the gynaecologist cited in the report is blaming women for Googling the complications associated with natural birth and then opting for the C-Section surgery to avoid those complications. Even if this is true, it is surprising that the women should not have known about the postpartum short and long-term complications that they and their babies will have to go through after the delivery. It also raises serious doubts about the consent that the hospitals take from such patients before the surgery. As far as informed consent is concerned, the patients should have been informed about these complications. If the mothers had been informed about the whole list of side effects that the C-Section surgery brings with it, they might have preferred the labour pain over the habitual backache, the hair fall and weakening of uterus. These mothers would not have been complaining about all this if informed consent had been obtained from them. Even though there is a vast network of ASHA workers that are responsible to provide medical assistance to pregnant women but given the data of C-Section deliveries they do not seem to assist the expecting mothers in picking up a procedure for their delivery based on informed choice. ASHA workers along with doctors should be made responsible to tackle this concern. ASHA workers should especially be mandated to overlook C-Section surgeries in private hospitals where the doctors seem to encourage C-Section deliveries for financial gains as the Doctors Association Kashmir had alleged in April 2017 when it had come all out against the rising number of C-Section deliveries in Kashmir. It is not about trivializing the labour pain or prohibiting the people from choosing their preferred procedure for the delivery, but the concern is that they should be allowed to choose the option only after informing them about the benefits and drawbacks of various procedures that are available.

Ahmad Hussain

Ahmad [email protected] 

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