ROHAN SHRIVASTAV | NT
PANAJI
Private hospitals in Goa perform far more caesarean (C-section) deliveries compared to government hospitals, according to an official survey.
In the private hospitals in the state, 48 per cent of deliveries performed were caesarean, while in government hospitals, the figure was 20 per cent.
The nationwide average of caesarean section surgeries rose from 8.5 per cent among all deliveries in the 2005-06 survey to 17.2 per cent in the 2015-16 survey.
In urban Goa, private hospitals performed 58.9 per cent of deliveries through caesarean operations, whereas the percentage in government hospitals was 18.8, according to National Family Health Survey-4 (NFHS-4) conducted for 2015-16. The survey shows quite a similar figure for the rural areas of the state – 37.7 per cent of caesarean section deliveries were performed in the private hospitals and 21.8 per cent in government hospitals.
In order to curb needless C-section deliveries throughout the country, the Union Health Ministry has written to all the state health departments directing them to convince the private hospitals to avoid needless caesarean section deliveries.
Director of health and services Dr Sanjeev Dalvi said that the state health department frequently receives circulars from the Union Health Ministry asking it to communicate with the private hospitals to perform caesarean section deliveries only when they are required. “We normally discuss this in a meeting, which is organised to review maternal health programmes where we do tell them to avoid needless caesarean section deliveries and also ask them to convey the message to the local gynaecologists,” said Dr Dalvi. The health department has no power to act against the private hospitals for carrying out needless caesarean section deliveries, Dr Dalvi said. “We cannot dictate terms to private hospitals. All we can do is appeal to them.” He said that NFHS-4 is a broader term statistics, so the C-section decision is taken by the medical expert at that particular moment. “The department cannot monitor and study the reasons of caesarean section deliveries, as many of them are being performed simultaneously across Goa,” he said.
However, doctors from private hospitals have a different perspective on the issue. They feel that there are various aspects and circumstances, which lead to caesarean section deliveries.
Dr Connie D’Silva of Rajgiri Victor Hospital, Margao, explained various factors. He said, “While taking a decision whether to perform either normal or caesarean section delivery, there are a lot of individual factors that are involved on maternal and foetus side.”
D’Silva said that if the first delivery is by caesarean section then there is a high possibility that the second baby may also be delivered by caesarean section, which may be one of the reasons that adds up the number to the statistics.
Dr Sophia Rodrigues, gynaecologist, Manipal Hospital, said that with time, people’s thinking has changed over the years. She said that there are patients who pressurise the doctors to perform caesarean section delivery as they want to escape the labour pain during the normal delivery.
“It’s not that we doctors are happy to do caesarean section deliveries. Now probably the increasing trend is that it’s the patient who starts demanding planned caesarean section delivery, especially the educated class, as they don’t want to go for normal deliveries and don’t want to go through the labour pain,” said Dr Rodrigues.
According to her, the other factors are that the doctors also get stressed out when they know that patients are not going to respond the way a doctor wants. She said that today doctors are scared, as there is lack of communication, trust, and risk of security to doctors as they are threatened, attacked and cases filed in court.
“Doctors opt for caesarean sections in cases of delayed marriage and delayed pregnancy wherein the risk of miscarriage is high. Therefore, it is advised to perform caesarean section delivery,” she said. Dr Rodrigues said that there is a need to counsel patients throughout their pregnancy in order to win their confidence and guide them for their own health interest.