Caesarean Deliveries: Scientific Progress Gone Boink

Over the past months, a few of my friends and acquaintances have delivered babies. All of them have gone to private hospitals here in Bangalore, some large, some small. Nothing out of the ordinary here, right?

Well, what is out of the ordinary is that the fact that almost all of them have delivered their babies by Caesarean Section (C-Section).

The Indian medical academic community (see p. 6 of that article) estimates that the rate of C-Sections in private hospitals in India is as high as 45%. A conversation I had with the labor and delivery department of a reputed private hospital here, however, puts that percentage at a mind-boggling 70%.

This rising trend in the use of C-Sections for delivering babies is not unique to India.

A Time magazine piece (Too Posh to Push, April 19, 2004) highlighted some of the countries with higher than recommended rates of C-Sections (the World Health Organization recommends that C-Sections make up less than 15% of all births). England has a 22% C-Section rate, while Italy's had climbed from 21% more than a decade ago to 33% at the time the article was published, and Brazil takes the cake with some private clinics in that country reporting C-Section rates as high as 90%.

There are, of course, cases of maternal and fetal distress when C-Sections are warranted. And advances in technology, anasthetology and obstetrics have meant that more C-Sections have been performed in recent years in such cases, and they have resulted in more mothers and fetuses surviving childbirth.

There are a few other reasons, however, for this rising trend in the deployment of C-Sections:

• women opt for C-Sections as a matter of convenience - they want to avoid going through long and painful labor;
• doctors, overwhelmed with the number of patients they see, have neither the patience nor the time to allow labor to take its normal course; and
• doctors push C-Sections (which cost twice as much as normal childbirth) on their patients because their hopitals or clinics recuperate the investments they've made in purchasing expensive machines for conducting C-Sections.

And in India, add at least a couple more reasons to that list.

According to this Hindu article, some families are opting for C-Sections because they want their baby delivered at an "auspicious" time. The normal childbirth process, of course, affords no such control over the time of birth. Secondly, some fathers-to-be are "forcing their wives to undergo caesarean section, believing that normal delivery hampers their sex life."

There are, thus, two main prongs in the list of reasons why C-Sections appear to be the preferred form of childbirth: one is the woman or her family's search for control (over pain, over time of birth, over post-delivery sex life) and the other is the doctor's search for control (over cashflow generated by deliveries and over his/her time).

While C-Sections have generally become safer over the years, doctors warn that certain risks remain. C-Sections are major surgeries and among other risks, although the mother may allay the pain for a few hours, recovery can be long and painful. This is definitely not to say that normal childbirth is a walk in the park. There are risks for both mother and child associated with prolonged labor.

Given this scenario, if you are a woman that prefers normal childbirth, what are your options?

There are quite a few steps you can take to be fully prepared before you enter the birthing room.

The first step is to educate yourself regarding the pregnancy and its various stages and the whole labor and delivery process. The internet is a veritable treasure trove of information on this topic. There are also books such as What to Expect When You're Expecting that take you through the pregnancy in an organized and methodical fashion. The third source is information is, of course, your doctor. Do not hesitate to ask questions during your visits.

In fact, talking to your doctor should be a priority. Talk to her about her thoughts on childbirth. What are the scenarios in which she would resort to a C-Section? Is her staff supportive of normal childbirth? Is the hospital equipped to take you through that process? What happens if you go into labor and she is away that day? What are the policies on letting someone (husband, mother) stay with you during labor? And educating yourself allows you to ask the right questions.

If you can find a natural childbirth class near you (most hospitals offer one these days), take it and take your husband or mother (whoever will be with you during labor) to the classes. So you have two minds thinking the day of the delivery rather than just one (labor is as much in the head as it is in the body). Practice the breathing and relaxation techniques they teach. They really do work.

Finally, and most importantly, establish a rapport with the doctor so you feel comfortable and can trust the doctor to do what is right in the end.

Because, no matter how much you've prepared yourself and how much you want natural childbirth, circumstances may prevent that from happening and your doctor may decide that you will need a C-Section after all.

That brings me to the most important point of all - prepare as much as you can to have the kind of childbirth you want, but also prepare yourself to go with the flow. Because while there are many things you can control, it is also wise to acknowledge that there are many more things you cannot.

And that, from personal experience, is a recipe for smooth labor (if there is such a thing).

Note: This article is not meant to be a substitue for professional medical advice. Please consult your doctor for advice regarding your specific circumstances.

Crossposted on Blogpourri.