C-sections double in Tamil Nadu over 7yrs, spark debate on need

CHENNAI: Cesarean-section births in both government and private hos pitals have more than doubled in Tamil Nadu in the past seven years, data reveals.Nearly two of every five women admitted Nearly two of every five women admitted to government hospitals for delivery and every alternate woman who gives birth in a private hospital undergo what was once rare enough to be described as a “lifesaving“ surgery , making it one of the most common medical procedures in the state.
Although C-sections have been on the rise in the state for several years, public health experts say it has been the steepest over the past decade. The total number of births in the state, meanwhile, has dropped by nearly 14%, from 10,81,965 in 2010 to 9,21,657 in 2016, while the number of institutional deliveries went up by 0.16%, from 99.81% to 99.97%, in the same period -a time coinciding with a marked increase in C-sections.
The increase in C-sections, which the state health department has documented in its health management information system, has prompted both a debate and concern among doctors, activists and patient groups. When needed, a C-section can save the mother and child from injury or death, but experts say many surgeries may be needless. One of reasons for the huge increase, for instance, is because of the number of women opting for infertility treatment.
“Nearly 99% of the women who get pregnant after IVF treatment undergo C-sections because doctors and parents don't want to waste the money and time invested,“ said Ramachandra Medical Centre senior consultant Dr N Palaniappan, who also heads the Safe Mother Committee at Federation of Obstetric and Gynaecological Societies of India. “IVF options are still not available in government hospitals so the cost remains high,“ he said.
Besides, there are other complications such as anaemia, obesity, hypertension and diabetes that increase risk of complications during normal delivery. While doctors at a tertiary centre with multidisciplinary care and intensive care units may decide to wait, the option is almost ruled out in smaller towns.
Most doctors take an early decision to avoid litigation, said a professor of gynae cology from Institute of Obstetrics and Gynaecology , Egmore. “Every maternal death is also audited by the government. No other specialist is under as much observation as an obstetrician,“ she said.“All maternal deaths are audited and every doctor must answer why there was a maternal or infant death.“
There is no clear guideline on the rate of C-sections. Bodies like the World Health Organisation say that an increase of more than 10% makes no difference to mortality rates. And many experts concur with the state health department view that such surgeries do little to improve the health of mother or child.
C-sections also increase at least double the cost in most hospitals. Key Indicators of Morbidity , Utilisation and Health Expenditure Tamil Nadu, a study based on National Sample Survey (NSS), 71st Round (January-June 2014), shows total expenditure on childbirth at private hospitals in Tamil Nadu, at Rs 32,182, is more than 40% of the national average of Rs 18,730. But in government hospitals and PHCs -where 60% of deliveries take place -the cost is much lower than the national average.
The state health department, which does C-section indication audits for government hospitals, says it may be tough to do similar audits for private hospitals.“The decision may be subjective [so it] is very tough to question,“ director of public health Dr K Kolandasamy said.