It is a well-known fact that C-sections are increasingly preferred to normal deliveries in urban Assam. We explore the reasons behind this significant change and the repercussions to women’s health
According to the latest National Family Health Survey 4, released recently, the percentage of C-sections has increased from 15.5 to 23.6 over the past decade. This is well over the World Health Organization benchmark for C-sections of around 10 to 15 per cent of the total population. In Assam, 10 per cent of deliveries in government hospitals were by C-section while in private hospitals, the percentage rose to 41 per cent (Annual Health Survey, 2011). So, what has led to this phenomenal rise in numbers? Has the number of high-risk pregnancies doubled or tripled or are we simply opting for more C-sections?
Subhasita Pujari works with the Jet Airways in Jorhat, an upper Assam town, and is the mother of 4-year-old Shrihan. Her first pregnancy progressed without any issues, yet she ended up opting for a C-section. ‘I was terrified by the stories around labour pain and couldn’t imagine giving birth the natural way. You can say I took the easier path’, she says in a chat at her spacious Club Road home. When I ask her if the doctor at the premier private hospital in Jorhat where she gave birth laid out all the options before her, she appears a little confused. ‘No, they just said if a normal delivery scares you, a C-section is the only option’. As a third world country with limited resources, I understand that birth pools and yoga classes to prepare you for pregnancy are a little too much to ask for, but so does paying close to Rs 60,000 for a C-section.
In the West, you are given options for pain relief, if you choose to opt for one. Saba Hussain, a PhD student at Warwick University, UK is the mother of a precocious 4-year-old, Zayed. While recollecting her experience, Saba shares, ‘There is a stigma around women saying they can’t bear pain as though they are not women enough or something. So women are left afraid to talk about pain during pregnancy. As a result, most women go into labour as though pain is their destiny and have no pain management option. In the west, women are asked to tell the midwife/doc about what they would like to do in the event they want pain relief. There is a hierarchy of pain relief options-I chose a pethadine injection which puts you to sleep. Women need to be in control of labour and pain management’. Thanks to her normal delivery, Saba could hop into the NICU next door and check him out. As most of us already know, a C-section is a major surgery and it could take months for a complete recovery. Also, due to the painkillers ingested earlier, breastmilk is often delayed. Most young mothers I come across remember how they struggled with breastfeeding in the initial days. Forget colostrum, most mothers I talked to couldn’t produce even an ounce of milk in the first ten days which means the baby had to be mostly formula-fed, which in turn raises risks of infection.
So, what is the way out then? Doctors should provide adequate counseling, especially to first-time mothers about the benefits of a normal delivery and dispel their fears. I remember when I walked into the most popular maternity hospital in Guwahati a couple of years ago with mild labour pain, a young female doctor told me, ‘Yes, it is the initial stage. It might take a while before they intensify. When is your operation scheduled?’ When I replied I hadn’t opted for a C-section and the senior doctor I was seeing knew about it, she cautioned, ‘Remember, you have to bear your labour pain yourself, neither your husband nor someone else has to bear it’. Doctors really need to be more responsible with what they say! But why blame doctors alone, the unholy nexus between hospitals and pharma companies is an open secret, where surgeries that are not essential are done by the minute. An ‘elective’ C-section is all well and good, but are women given other options? Choice is only choice when we are aware of the whole picture.
It would also be good to be aware that maternal obesity and late pregnancies also affect your choice. While the former can be managed, the later in a world where careers take precedence have simply to be accepted.
6 Reasons to Opt for a Natural Delivery
- Labour is often shorter
- Breastfeeding is facilitated
- Faster recovery time
- Lose baby weight faster
- Greater connection to the experience
Safe Ways to Manage Labour Pain
- Try breathing in and out: In the initial stage of labour, breathing in and out helps keep you calm, you can also try varying your position
- Birth pool: Helps soothe your pain and makes you more relaxed, less likely to need intervention or pain medication
- Gas and air (mixture of oxygen and nitrous oxide gas): Reduces pain but doesn’t take it away
- Tens Machine: Electrical signals are produced and this numbs the pain signals so you won’t feel it. You are in control, you press when you need it.
Note: Pain medications such as Pethidine are also prescribed in case you don’t get any relief. The last in line is an epidural, an anaesthetic which is injected into your back.
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