[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]O[/dropcap]ne of the topics hotly debated today is how C-section (Caesarean) delivery rate is rapidly increasing in India, more so in Chennai, esp in private hospitals in urban areas, and how the Government is unable to control this. Though there is no thumb rule on an acceptable % of C-section cases out of total deliveries, there is a general belief that anything above 15% could be high. WHO also appears to have done some surveys in many countries and concluded that 10-15% C-section cases may have been justified, though the justifiable absolute % can vary from country to country. It is as high as 50% or even more in some places.
Why should C-section be avoided?
Till about a couple of decades back, Caesarean mode of child delivery was considered very undesirable, and it was the prayer of the families of pregnant women that the delivery should be ‘normal’. The reason was it used to be considered a major ‘operation’, it would weaken the woman and take longer for her to recover after delivery.
But now, after the safety of the procedure has improved vastly, many women prefer C-section delivery since the pangs of delivery are substantially reduced. And gynaecologists in private hospitals and urban areas, appear to prefer it too, because the average billing per case is substantially higher for C-section than for normal delivery.
Why should C-section be avoided? All said and done, even if the absolute life risk at delivery is fairly low in both the cases, the risk is relatively higher with C-section than with normal delivery. There are higher incidences of post-partum depression and lower breast-feeding rate with C-section. If the first child birth is done through C-section, chances are very high that future child births may have to be done through C-section. Besides, children born through C-section have a higher chance of developing childhood asthma, breathing problems, etc.
[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]B[/dropcap]ut are there reasons other than commercial that also contribute to increasing % of C-sections? The answer is, “Yes”. Lifestyle change is one of the primary reasons. Due to the increasing % of working women, decreasing amount for physical work (at home and at office) and hence exercise, increasing availability of gadgets, increasing cases of overweight, BP, diabetes, etc., more women require C-section than in the past. Also, C-section becomes impractical late at nights due to non-availability of anaesthetist and support staff at that time, which makes some women prefer C-section before hand when the doctors and support staff are available.
Every delivery is different, and the attending gynaecologist is the person best equipped to decide whether to go in for normal delivery or C-section.
C-section is costlier because of longer stay in hospital, special tests if required, use of Operation Theatre, equipment & consumables, pharmacy, Recovery Room, etc, fee on account of midwife & nurses, and increased post-Operative Care.
Every delivery is different, and the attending gynaecologist is the person best equipped to decide whether to go in for normal delivery or C-section. In justifiable cases, not going in for C-section delivery could even risk the life of the mother and/ or the child.
Under these conditions, how can the Government, the expecting mother, and/ or Insurers (who cover Maternity costs) ensure that the gynaecologists don’t go in for C-section unnecessarily only to increase their/ hospital’s income?
[dropcap color=”#008040″ boxed=”yes” boxed_radius=”8px” class=”” id=””]I[/dropcap] know a male gynaecologist in Chennai (who has worked in UK for 17 years) who owns a Hospital; he has come up with a simple solution to this issue. He covers Maternity Service as a Package in his Hospital, starting from the time of detection of pregnancy to a few consultations after the delivery. He charges a fixed fee regardless of whether the expecting mother requires C-section or delivers normally. Thus, he has removed the incentive to convert a delivery into a C-section from the equation. In fact, he covers even unanticipated exigencies and any additional tests or procedures that may be required, all within the same fixed fee.
He assumes a certain % of C-sections, a certain % of normal deliveries, and a certain % of exigencies, and has arrived at a weighted average cost which is what he charges as the fixed fee from all the expecting mothers. In fact, he offers more than one package, providing for rooms of different tariffs.
The advantage of this model is not just the saving in fee for the expecting mother who may have to undergo C-section (or for the Insurance Company involved), but the comfortable feeling to the expecting mother that she would not be forced into unnecessary C-section it becomes necessary.
The Government may consider making it mandatory for private hospitals to offer such an option to expecting mothers. Even if the fee fixed is slightly higher than a fair weighted average, it may be worth implementing.
PS: The gynaecologist referenced in this article is willing to assist the Government, any Insurer/ gynaecologist/ hospital in implementing this model, including in arriving at the fair weighted average fee. Anyone interested may email the author of this article at: firstname.lastname@example.org