Tuesday, March 23, 2010

Cashing in on Cesarean?

Most women are hale and hearty and capable of an uncomplicated natural childbirth, yet surgical childbirths are increasing...

Any sort of experimentation with nature’s way always attracts attention and debate. Medicine in several ways has led to the triumph of human will over nature’s rules. But this time the world is divided over the delivery techniques of childbirth. Today, a mother can opt for a natural delivery or choose the surgical (Cesarean section) route, but a sharp increase in the latter method across the world has stirred widespread concern. While in the US, one in four children is born via Cesarean section (C-section), WHO has reported that one in five deliveries in India is by Cesarean too. Obstetrician David Campbell Walters in his book, Just Take it Out: The Ethics and Economics of Cesarean Section and Hysterectomy (1999) claims that in the US, ‘in 20 years, there will be no more vaginal births.’ If you look at Walters’ claim in light of the existing figures of C-section deliveries in metros like Mumbai and Delhi (20-25% C-section deliveries) and even in most provinces in China (where according to China Philanthropy Times, the average rate of Cesarean birth has reached 40 percent), his prophecy might actually become a reality in a large part of the world… But what is driving doctors and mothers-to-be to opt out of the natural vaginal delivery? Why do doctors like David Campbell Walters (though in minority) advocate that women be allowed to choose a pre-planned Cesarean?

“Apart from the straight visible medical indications that suggest choosing a Cesarean delivery, most of the doctors today want to avoid the possibility of lawsuits for any problems in the child arising during labour,” says Dr. Kiran Dua, an experienced Gynecologist associated with several health care institutions like Lamaze that advocate normal delivery. He adds, “Most of the doctors think that if they can get free in two hours with a Cesarean, why should they monitor someone for 16-18 hours in labour and take stress?”

But while a Cesarean delivery leaves the mother with a severe, longer-lasting pain and with a risk of infections, it may cause harm to the child too in the form of ‘accidental surgical cuts, respiratory problems, failure to establish breast-feeding, and asthma’. Most often, mothers agree for a Cesarean “at the initiation and encouragement of the doctor and then to avoid labour pain”, says 31-year-old Sejal, a mother of two, and adds, “I was ill-informed about the cons of a Cesarean and my girl does have a respiratory problem.”

Vaginal births are not all perfect too, and in cases of poor care and midwifery, they may lead to ‘alterations in sexual sensation and if forceps are used, it may lead to urinary incontinence.’ Cesarean, as an informed choice, is being advocated by many in the US who contend that the costs, risks and benefits of both the procedures are balanced. But “In India, the money a doctor makes in a Cesarean is double the amount you get in a normal delivery, that too with much lesser effort,” reveals Dr. Dua. This leaves Indians with the task of discerning if their doctor is really concerned about their health, or of his/her own vested interests...
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Source :
IIPM Editorial, 2009

An IIPM and Professor Arindam Chaudhuri (Renowned Management Guru and Economist) Initiative

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