Deliver, The Informed Way

An increasing number of women are taking well-versed decisions when it comes to THE right method of child birth. Reshma O. Pathare throws light on caesarean or C-section delivery, so that you know what to expect, beforehand.

The birthing trends in India, especially among urban Indian women, are undergoing important and yet drastically diverse changes. According to various medical journals, there has been a 13 per cent jump in C-sec deliveries across India, with working women mostly coveting the procedure. Ob-Gyn Dr MangalaPatil, from Wockhardt Hospitals, Mumbai, observes, “Women are now more career-oriented. They marry late and also suffer from a lot of health issues such as thyroid disorders, PCOD, blood pressure, diabetes, obesity and infertility. The stressful and sedentary jobs we have makes it increasingly difficult to maintain work-life balance. This makes them susceptible to high-risk pregnancies that call for C-sec deliveries. Earlier only 10-15 per cent would opt for C-sec due to medical reasons, but now it is observed that overall almost 50 per cent of the women opt for C-sec.”
Ob-Gyn Dr Anita Soni from L. H. Hiranandani Hospital, Mumbai, also affirms that while she personally recommends vaginal deliveries for being natural and physiological (unless there are pressing medical issues that make C-sec unavoidable), she has observed that around 5-10 per cent of her patients opt for C-sec because they are not willing to bear labour pains and another 5-10 per cent of patients plan their deliveries via C-sec to keep up with mahurats(auspicious timing) for the baby’s birth.

Is C-sec bad?
The trend brings us to an important question: Is C-sec really an ‘unwise’ or ‘hasty’ way to deliver vis-à-vis vaginal delivery or is the discussion
a brouhaha over half-baked facts? Ob-Gyn Dr Anuradha Sadashivamurthy from Cloudnine Group of Hospitals, Bengaluru asserts, “There are no pros or cons for either choice of delivery. It is rather a natural selection depending on the conditions that prevail for both mother and child. There has been incredible advancement in anaesthetic and surgical techniques and along with paramedical support such as sonology. In a well-equipped centre with well-trained doctors, the complication rates are minimal for either of the procedures.”
Gynaecologist Dr Gauri Pimpralekar from Sahyadri Speciality Hospital, Nashik, adds to this saying, “C-section is advised only if there are any factors putting baby or mothers or both at risk. Nowadays, monitoring systems like NST, foetal doppler and ultrasound gives intensive observation of the fetus. That way even small changes can be picked up and C-section can be done if required. Yes, the rate of C-sections has been increasing but at the same time maternal and foetus outcomes have also improved. Foetal deaths have been reduced.”

When is C-section needed?
Undoubtedly, both forms of deliveries, if done with the aim of maternal and foetal well-being, are right in their place. Then how must a woman decide which is the best option for her?
Ob-Gyn Dr Nozer Sheriar from Hinduja Healthcare Surgical, Mumbai explains, “Personally, I have always believed that it is good to have
a normal delivery because after C-sec, there are post-operative care and precautions that need to be taken. However, there are various medical reasons due to which a C-sec delivery is recommended over a normal one. If the patient has something obstructive such as fibroids causing a hurdle in
a normal vaginal delivery, then I recommend C-sec delivery.” She suggests that in case of premature delivery, severe hypertension, IVF pregnancies or to protect the pelvic flor from stretching, C-sec deliveries can be opted for. That being said, Dr Sheriar observes that the most common reason for patients choosing this method is the fear of pain. She adds, “Such patients can be motivated and convinced for a normal delivery and nowadays, we also have the option of epidural anaesthesia to decrease the pain during labour.
As a doctor, my job is to help them make the best informed decision depending on their circumstances.”
Adding to this, Dr Pimpralekar says, “C-section is unavoidable in cases such as large baby in a mother with small pelvis; as also, breech position of the baby (buttocks or legs down instead of head of baby), transverse position or oblige position. For emergency reasons like foetus heart sounds dropping or increasing beyond normal limit, baby passing stools (meconium) inside the uterus, baby not getting enough oxygen, or any reason where the health of mother or baby is in jeopardy it is best to opt for C-section.”

What are the pros and cons?
As with any medical procedure, both C-sec and vaginal deliveries have pros and cons. Ob-Gyn Dr Anu Sridhar of Fortis Hospitals, Bengaluru, believes that in normal deliveries, while there is early mobilisation in patients, pain is less as compared to C-sec and the psychological feeling of well-being is quicker. On the downside there is a slight possibility of 2nd/3rd/4th degree perineal tears, bowel and bladder incontinence. You can even experience pain during sexual intercourse for a prolonged period.
As for C-sec, there are anaesthesia-related risks, likelihoods of respiratory distress syndrome in the baby and repeat C-sec needed during future deliveries.
Dr Sadashivamurthy gives a note of advice,“C-section, when well timed and performed by a well-trained qualified surgical team, has fewer complications. Issues like being confined to bed, back pain, and hindrances in lactation have been long gone. Similarly, a vaginal birth when conditions are favourable, is just as safe and associated with few adverse outcomes.”
Vaginal births, however, need active participation from the mother and baby. You need motivation and the baby has to be in sync. Dr Sadashivamurthy warns, “There will be some amount of stretching of the vaginal tissues and pressure effects on the bladder and rectum. However, all of this can be corrected with good pelvic floor exercises postnatally.”

Better understanding creates co-operation
Presently, there is a societal debate going on about whether women are being compelled to opt for C-sec deliveries even when the conditions are conducive for a normal one. Fertility Consultant Dr Ritu Hinduja from Nova IVI Infertility, Mumbai, makes a pertinent point about the issue as she says, “It is the moral obligation of the doctor to ensure that the patient and family members fully understand the medical situation, so decision making is transparent. Barring extreme circumstances that may force a doctor to take suo moto decisions in the larger interest of the patient, better understanding creates cooperation, which results in better clinical outcomes. Patients not fully understanding the implications of caesarean sections could be one reason why they are skyrocketing in India. However, patients also have to realise that drastic changes in lifestyle and dietary habits create complications in women at a young age, that affect the natural way of giving birth. At an advanced age, women start having health problems such as diabetes and other age-related medical conditions. While elective C-section reduces foetal and maternal morbidities, infection, increased blood loss or injury to abdominal organs are known complications. Doctors need to weigh the benefits against the risks of both vaginal delivery and elective caesarean section, and counsel the patient accordingly, thereby assisting them to make an informed decision while choosing their preferred route of delivery. Couples should also know that this decision cannot be imposed on them and that they have every right to choose the method of delivery.”

The wise choice
Suffice to say that, with medical advancements and by making a prudent choice of a doctor with whom a woman can have an easy dialogue during her pregnancy, the choice of whether to opt for a C-sec delivery or a normal one, becomes much more easy and informed. Certain medical conditions in the pregnant woman or in the foetus close the option of a normal delivery. On the other side, leaving irrational fears of excessive pain during labour and scary perineal injuries behind, if a woman can embrace the possibility of a normal delivery, it becomes an added psychological incentive to bond with the new-born.
Ultimately, what matters is that the mother and child are safe; whatever procedure ensures that, is the best for you!