A highly educated lady has
raised a storm in the media, because,”an
absolutely unnecessary Caeserian Section was forced upon me to deliver my baby”.
I am not dumb (or hypocritical)
enough to fight with her over her claim. In today’s India, no field is free
from crass commercialism and unethical pursuit of money at all costs. Medical
profession, maybe, has even a larger share of its bad apples than the rest!
What is appalling is that
the lady has also launched a campaign on social media & through newspapers
to demand that, ‘every hospital should be
made to display the number of normal & caeserian deliveries and their
proportion’! She has produced statistics to show that not only is the
number of caeserian deliveries increasing but their ratio to normal deliveries
too is getting skewed. A senior leader of the ruling party, a lady minister
known to have a bleeding heart for everyone except humans, has not only
understood what is a highly technical matter, but agrees with her and has
endorsed her demand!
Whether it be the problems
of the handicapped, the ban on cow slaughter, patriotism, or performance (or
lack of it) of our sportspersons in international events, our politicians (or
media) have never shied away from giving their opinions; hastily, without due
thought, loudly & often! They never let a simple, stupid question like, ”What
do I know about it?” stop them! In fact, I feel the entire country will be
stunned if some politician utters a learned, measured opinion on some topic
after carefully studying all aspects!
Largely what the lady
states is firstly, the number of Caeserian deliveries is increasing, in
absolute terms, day by day, and secondly, the ratio of Caeserian deliveries to
normal deliveries too is getting skewed. To halt this pernicious trend she has
demanded that all hospitals should be made to display both the number of normal
as well as Caeserian deliveries they perform. This is expected to give an idea
to an unwary patient if a hospital performs a disproportionately large number
of Caeserian deliveries. She has put up an impressive amount of statistical
data in support of her argument.
Let us try and put things
in perspective.
It’s an undeniable fact
that compared to a hundred or even fifty years ago, the number of people dying
in road traffic accidents or aeroplane crashes has increased a thousand-fold!
Same can be said of domestic use of electricity and a large number of other
comforts we take for granted as part of our daily, modern life. But, if as a
result someone suggests that we completely ban the use of motor vehicles,
planes or electricity, we will send him straight to the loony-bin! I know the
point seems overstretched, but bear with me for a moment.
Humankind is constantly
striving to change for the better. It is in our genes. With these changes, lifestyle
changes; and these changes bring with them newer values to which we adapt. With
them come newer problems too, but we overcome them or adjust with them. We
don’t reject all change, out of hand, because all this seems like too much of a
bother!
Let us begin to understand
this business of numbers and ratios with a simple term. There is a statistic
(or number) called Perinatal Mortality Rate (PMR) that is accepted and used
widely, all over the world to measure the quality of healthcare that the mother
receives during her pregnancy and particularly during childbirth. It indicates
the number of newborn babies that die in every 1000 deliveries. For example in
a study conducted in 1940 at Luckhnow’s Queen Mary’s Hospital the number was
114. As per the data released by The World Bank last year, in 1990 the PMR was
36.2 (average) world-wide & 57 in India. By 2015, these numbers have come
down to 19.2 and 28, respectively. This dramatic fall within just 25 years, in
the number of newborn babies dying, was certainly not achieved by online
petitions or government diktats! The credit goes to the rapid all round
qualitative improvement in services provided by the health sector. And the
lion’s share of that effort is being borne by the private sector. Let us leave
the dismal failure of the government, both state & central, to provide even
the most primary healthcare services to the common man as a topic for a
separate article! But it is an undeniable truth that among other factors, the
ability of the modern technology to identify the ‘at-risk’ babies accurately
and in time, and the timely delivery of those babies by Caeserian Section has
proved to be a major factor in this remarkable achievement. A large study conducted in California (Identifying the Sources of the Recent
Decline in Perinatal Mortality Rates in California : WILLIAMS, RONALD L.; CHEN,
PETER M.) recognizes
Caeserian Section deliveries as one of the major factors in drop in the PMR.
Except for the hilarious
condition found only in Hindi movies, "हम मॉं या बच्चा दोनोमें से सिर्फ एकको ही बचा सकते है!",
Caeserian Section deliveries are usually performed to save the baby. The rapid
socio-economic changes during the last 25 years have added many subtle facets
to this simple rule. It wasn’t unusual for a woman to bear 7-8 or even 10
children, particularly in rural areas, not so long ago. Deliveries were
conducted at home by other family members or neighborhood Ayah/Dai; and losing
an occasional child out of so many pregnancies was accepted fatalistically.
Even if a doctor was available to attend the delivery, this same attitude
granted him a wider margin of risk available to try for a normal delivery.
Things have changed now,
and how! Now one child is the norm and two definitely is the limit! The nuclear
family, the career compulsions of both husband & wife, and the priority
given to careers of both, together mean that today pregnancy is no more a matter
of chance left to the whims of nature and god. At least 3-4 years’ careful
planning goes into a pregnancy happening. Modern technology has made it
possible to carefully, accurately and safely monitor the status of the foetus
throughout pregnancy and especially during labour. Even a slight departure from
normal sends the parents into panic and puts the attending doctor under
pressure. How long would even the most conscientious doctor insist on
delivering the baby normally in face of a continuous and insistent demand from
the panicked parents for a guarantee
that the foetus is and will be all right? That too with the Damocles’ sword of
accusation of negligent & deficient service hanging over his head, should
something go wrong!
Isn’t it downright hypocritical to
insist that the baby be delivered normally no matter what, and at the same time
expect the baby to come out without suffering any adverse consequences of a
difficult and prolonged labour?
This is not to deny the
claim that the number of Caeserian deliveries is increasing, but simply to put
it in perspective. Medical science has noted this trend long ago and studied it
extensively. It is easy to blame it on “doctors’ greed”, and in the present
milieu this explanation will, no doubt, be even liked by most, like the lady in
question! But it is not so, and it definitely is not the only reason.
The changing lifestyle has
changed us and our bodies in many ways. The old style bending down twice a day
to sweep the entire house & the surrounding courtyards, the squatting
position needed for the plastering of the floors & courtyards with cow
dung,2-3 times a week, the use of Indian style toilets and many such things
that seem to us now as outdated are all excellent exercises to strengthen the
pelvic muscles so necessary for bearing down to successfully deliver the baby
vaginally. Moreover, nature while designing our bodies has different
priorities, so for a healthy mother & child, biologically ideal age is
between 20 & 25.
Our increasing obsession with
education and then career means older & older brides and still older first
time mothers (called PrimiGravidas or simply Primis in medical slang). It is now
quite common to see first pregnancy in 32/33 year old women. These women by
definition fall in the “High Risk Pregnancy” category making a Ceaserian
delivery more likely for a variety of reasons. There is also the added fact
that increasing age and better socioeconomic status are associated with lower
pain threshold. I have seen couples literally begging the doctor for release
after just an hour or two of labour pains, where, particularly in Primis, a
long haul (usually 8-10 hrs) is needed! In spite of all these factors majority
of women still deliver normally, which is indeed a great tribute to the conscientiousness
of medical personnel that attend to them!
Now, about the ratio of
normal deliveries to Ceaserian deliveries.
There are a large number
of half baked or untrained ‘doctors’, ayahs/dais out there, that as
“Gynaecologists” run “Maternity Homes”. You see the boards (but not the
degrees!) in every locality & mohalla. They hide the fact that they can’t
operate by shamelessly advertising that they conduct “only normal delivery”
& “Guaranteed No Ceaser”! If the onesided, incessant & unfair smear campaigns
in the media (like the one above) push ordinary and sometimes even educated
patients into their arms, who is to blame? Patients, that by nature’s
blessings, would have anyway delivered normally, do so, and nobody needs to
complain. (I am not getting into the frighteningly high number of brain-damaged
babies delivered by these quacks because they don’t know any better!) But, when
things go out of hand, the child’s and sometimes even the mother’s life is
imperiled, these patients are pushed off onto a trained gynaecologist. Now does
the gynaecologist operate immediately to save the baby and the mother or does
he/she sit down scratching her head worrying about madam’s ratio? And if we are
to consider the ratio, isn’t that gynaecologist entitled to count all the
normal deliveries occurring in these surrounding “Maternity Homes” to her
credit? And herein lies the biggest fallacy in ‘the ratio’ idea. In all the
statistics that she has so authoritatively quoted, the numbers are collected
and counted for an area or state or a country, not an individual hospital.
Because indeed a referral hospital is by definition going to conduct a large
number of Ceaserian Sections, and sometimes, depending upon the availability of
maternity services in the locality, the number may be much larger than that of
normal deliveries. That doesn’t automatically mean the hospital should be
ostracized!
As long as we insist on
fostering the idea that ‘all doctors are thieves and practice solely to rob the
patient with no regard for the patient’s welfare’ doctors and patients will
continue to eye each other with suspicion and hostility, and healthcare issues
will keep getting more and more complicated.
Afterall, you cannot
legislate honesty, integrity and ethics into society. If that were so, after so
many years of the AntiCorruption act, our bureaucracy and polity should have become squeaky clean!
Let us hope that someone sane
will consider these and all relevant factors rather than ramming one more piece
of senseless legislation down our throats under the force of emotions or
popular demand. Not only will it be useless but is likely to cause actual harm.
A request meanwhile to the Hon.Minister, to instead sponsor a campaign to make
people love not only animals but doctors also!
