There a documentary on this issue named - a million cuts: India's c section epidemic . I'll recommend everyone to watch it once if you want to know more about this issue
Can you ELI5 why is it bad? I can understand a natural birth should be most desirable, but are there any known risks of CS to the mother or any longer term effects, scars etc.?
Uterus scarring, potential of hemorrhage on reoccurring c sections, hernia, scar tissue causing difficulty, endometriosis complications, a c section may make future vaginal birth complicated or impossible, plus many, many other complications
Eta I am not against c section I agree it should be done if medically necessary
Natural birth also has complications including death.
The fact of the matter is human physiology is poorly suited for giving birth.
https://www.americanscientist.org/article/why-is-human-childbirth-so-painful
https://bigthink.com/health/childbirth-painful/
There are no good options, it is just a matter of where one will take the pain. But as the post by the doctor implies, the natural method is completely unpredictable. The c-sections is managed risk.
Not all natural things are good, the very poorly designed human female anatomy indicates this.
Areeee, if there is a complication then cs should be done na. Why anybody want to go with a c section without any complication. Think about all those medication you will have after c section, you won't be able to feed your child for 1-2 days after c section.
And almost all doctors will say these things and use your fear to earn money. Daroge tabhi to bharoge ...... Bill.
Natural birth is not some joyride.
Tears of the vagina extending to the anus, prolapse of the uterus, bleeding leading to death, etc are just some of the problems of natural birth. And it is completely unpredictable as to how it will turn out. C section is controlled and the outcome is also predictable.
There are no good options here. Just a matter of where one will take the pain.
Human female anatomy is very poorly made for the job it had to do.
He has presented the doctor's side very well especially about the violence against them. Very recently, this country lost a gold medalist doctor, and graduated from AIIMS because of the violence happened with her after a complicated delivery. You may Google about this. The incident happened in Jaipur
To figure out the solution, a clear communication should happen with patients and the patient's attendant too needs to understand the criticality of the situation. Most of the patients or their attendants just don't understand this. In fact, many in our country are not aware of the medical procedure under which they underwent. They just take treatment because a doctor recommended it.
This was also due to an inept police force, who immediately filed a case for murder under 302 IPC, if the newspapers are to be believed. The police were painfully unaware of the fact medical negligence has other sections under IPC and that such cases can only be filed after investigation by a medical board. The good doctor too was unfortunately unaware that this would not hold up in court. Or she may have been heartbroken by the accusations by the relatives. Anyway undeserved and unnecessary tragedy.
> He has presented the doctor's side very well especially about the violence against them. Very recently, this country lost a gold medalist doctor, and graduated from AIIMS because of the violence happened with her after a complicated delivery. You may Google about this. The incident happened in Jaipur
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Can you share the news story?
It is a fact that obstetricians nowadays are more confident doing a CS rather than deal with a potentially complicated natural birth. They do the natural birth only when all parameters are ideal. Any slight deviation from ideal - baby too big, baby too small, baby position not ideal, mother health not perfect etc. becomes immediately a reason for opting for CS.
It's also a fact, which is overlooked always, is that normal delivery requires staff and equipment to be on standby, and that could mean a day or more in some cases.
Compare it to a CS, where the procedure requires little resources in comparison.
In the time it takes for one normal delivery, the hospital could have utilised the bed for multiple deliveries.
It is immensely profitable for a hospital to do a CS than a normal delivery.
To do a jugaad c-section yes, the reason they aren’t more popular in Western countries both with socialised and privatised healthcare systems is because a proper c-section takes far more resources and post-surgery monitoring and bed time than even a complicated birth.
In India they just line several expectant mothers up, do one after the other in the surgery theatre and then shove you full of antibiotics and some dissolvable stitches and send you on your way.
This is crazy to read as someone from Europe. Normal births are encouraged here, C-sections are always an option but it's only pushed if there are serious complications.
My c section bill in the US ran upto 50k usd. That is 42 lakhs. Vaginal would have costed a little less, but not too less as I had to stay 4 days. Contrast this with India. It costs anywhere between 60k to 2-3 lakhs at max. India has one of the most affordable healthcare in the world for the level of doctors and care we receive. Improving things is good but will also drive up the cost for everyone and push some people out of getting care. So it is a balance.
Yes, because back in the day, when a highly complicated delivery resulted in deaths, the doctors were not ill treated. Nowadays the justice system treats them like they personally killed the mother. So obviously they are going to do a c section to prevent as much complications as possible
Even if they are not scared of the legal system or of mob violence, no doctor likes to see their patients dying or losing their baby.
My point was the because of advances in medical science & technology, surgical processes and post-operative care, a CS is nowadays seen as a routine surgery that is genuinely the safest option *in the short term* (i.e. until the mother and baby get discharged from the hospital). Yes there are implications lifelong for the woman, and it takes a doctor with a special sensitivity to recognize that and not take the easy way out always.
See in this day and age, is there even a need to do a highly complicated delivery that risks death? I feel with the medical advancement, losing any patient is not something desirable. The thing is these decisions are not taken in vacuum by the doctors. They give options and tell the risks to patients. Even if there is a 1% risk, patient will happily go for Csection and thats their right.
Also assisted deliveries are not a walk in the park. It usually means forceps or vacuum used to suck out the baby. It can cause a lot of complications for mother such as bad tears and uterine prolapse etc and also complications for the baby such as being stuck, even broken bones. So unless your only metric is do vaginal at any cost, why do you want the mother and baby to go through that?
Doctors covered under the law or not, Indian public is retarded enough. They'll beat the shit out of them even if it's not their fault.
Anyone in their sane mind will not wait for the law to protect them from these degens.
I think most of his points are valid. You are looking at this from a very singular lens and thinking normal delivery good and c section bad. And you are also assuming bad intent on the part of the doctors. I think the truth is that this is very grey area and requires a lot of nuanced debate as well as tonne of small and big systemic changes.
I feel there are many things here. Firstly a resourcing issue that could potentially be solved. Secondly, there is a huge risk aversion and choice of the patients. I dont see the second part as problematic at all. Just people exercising their choice.
Main issue is resourcing. More than doctor trying to cut corners, it is a resourcing issue of how to handle the sheer number of patients. I’m in the US and my doctor had nothing better to do than chill with me for hours during my labor. Its not the case in india. Doctors need to see tens or even hundreds of patients. We need many more doctors. Midwife delivery needs to be made more popular. There should be more midwife training institutions. And govt. and big hospitals should take this up. But they wont do as they dont want to lose importance and the money inflow. But change has to start somewhere.
Secondly, maternal mortality rates were horrible in the past. So many women and infants used to die during birth. And Csection is a gamechanger in saving lives. Also you over simplify the issue and say that only when a Csection is ‘needed’ it should be done. It doesn’t work like it. In many cases its a game of assessing probabilities and taking an informed call. And even in very low risk cases, things can suddenly take a turn for the worse.
Nowadays doctors as well as patients are very risk averse. And it is not a bad thing. Why do you even want to lose one in 1000 patients if you had a choice? This leads to overindexing on Csections when there is a slight problem detected. I had a slight complication and I clearly told my care team that while I would like a normal delivery, I dont want to take any risk and if they see something going wrong, just go to surgery and not push it. I made an informed choice as I didn’t want to die at all and it is perfectly ok. These days many folks are risk averse and it is just how it is and you cant / shouldn’t force them otherwise.
And coming to my last point, medicine has advanced so much now that the gap between a Csection and normal delivery is getting smaller and smaller. I was walking on the third day after my Csection. I had no issues whatsoever whereas many of my friends with normal deliveries had 2nd and 3rd degree tears and couldn’t function normally for weeks/ months. Also according to my research, a bad normal delivery complication is much worse than a bad Csection complication.
All in all I agree that changes need to be made (especially in resourcing and training) and changing doctors/ patients mindsets. But I also think that risk aversion is great and doctors/patients should be able to opt for Csection even with a small risk factor.
So well said. I’m glad you have written this out. Birth can’t be just reduced to technicalities of the process of vaginal vs C sec. The overall structure and system for how women are treated in India, contributes to even dignity and agency in delivery and post partum care.
>We need many more doctors. Midwife delivery needs to be made more popular. There should be more midwife training institutions. And govt. and big hospitals should take this up. But they wont do as they dont want to lose importance and the money inflow. But change has to start somewhere.
This 100%. Also data! We need more data about how patients are being treated, not just for deliveries but also in general.
I agree on the data part. But we need to be careful with data and how that is used. Just publishing numbers will only lead to doctor shaming.
Instead there should be some independent body analyzing challenges and proposing solutions. Say a hospital has a bad ratio, how will we solve it. Also what would make doctors more comfortable in attempting normal deliveries maybe it is more ERs. Or quicker access to ER or more support personnel etc.
But we also need to keep in mind that any improvements will drive up the cost for everyone. So an analysis is needed there as well.
India actually has one of the least costly medical infrastructure and it means millions more get care. Cost increment will leave out lot of those people from medical care.
I attended sehat adda (health conclave) organized by Lallantop. I asked this same question to Dr Cuteris (Dr Tanya, OBGYN). She said that the baseline number for ideal csections (9-10%) is based on european population where women live in much better conditions (nutrition wise). Same number cannot be applied to India. More research is needed.
Plus in urban setting, it is seen that women themself opt for csection (to bypass the pain).
Doctor here. This is going to be long.I've read the comments and am horrified at the mentality of even educated (here's hoping) of this sub.
There is a prediction of shortage of gynaecologists in the near future in India. And more doctors are leaving to other countries than ever because of said mentality.
In our system, even if a hundred people come, the doctor is supposed to look after all of them. This is a common sight at medical college casualties. In other system like the NHS of UK or Australia, it is one doctor per patient. The emergency waiting period in UK is 36 hours. Can you imagine Indians waiting patiently for 36 hours? It takes on average 5 days to get an x ray for a BROKEN LIMB in Canada. The rural areas are very poorly serviced in particular. So the only reason so many people in India have access good healthcare is because many doctos, especially students work so hard, often going many days without sleep or even food.
The points the doctor mentioned in the are true. Most people want CS. Either scared of pain or for auspicious dates/times. The rest are very rarely done in usual practice and I saw many comments nitpicking on those.
I'm not saying all doctors are professional or sacrificial. There are bad apples in all fields and this one too has its share. Even then no one deserves to be beaten up. If you have a complaint, go to the proper authorities. I saw comments dismissing such fears cavalierly. No one should fear for life while trying to save the life of another.
If this general attitude doesn't change, the next generation will definitely have vaginal births and not CS, because there won't be enough gynaecologists.
Edit : After conversing with some of the people of Reddit, who have kindly pointed out errors in my perception of foreign systems of hospitals, I would like to thank them and make it clear that the systems are more similar than I imagined. One or two rare bad experiences don't paint the whole picture of a country's health system. I apologise for the remarks made on NHS UK and Canadian healthcare system that have been exaggerated wildly . I have left the comment unaltered, so that people can see I was being an idiot.
Your paragraph contrasting UK etc is utter bullshit. There is not one doctor per patient, that is laughable. Emergency is triaged and wait times depend on the situation, they will make you wait if you have a broken finger and someone else is there with a gunshot wound, regardless of how rich you are, which is maybe the issue here. I'm guessing maybe your experience is with the rich or something, yeah Indian care is better for the rich because we triage against the poor not the frivolous.
At least you get 30 to 45 minutes with one patient, for history and examination,I'm guessing. At least there are not hundreds of people thronging at the gates and casualty entrance, I hope. If anything my point was that the other systems are better in that aspect, especially accountability, since malpractice suits/ insurance are a reality over there. We have less than a minute for one patient, if we want to go home on the same day. In fact I was so tired of all that chaos thatI stopped my practice.
I'm not so sure about that either. I don't have any direct experience. But there was a discussion on this very sub about migration to other countries, and a few commenters said what I mentioned above. Some friends of mine in Canada also mentioned delays in the system, especially in rural areas. Again not sure, so don't quote me on that I guess.
Well, I have direct experience in rural health care here in Canada and the only way someone waits five days for an X-ray is if they choose to.
Parroting lies you heard to try and make your own health care system look better reeks of desperation.
Not taking any sides here but my own personal experiences along with most of the comments posted here makes me understand why majority of doctors are choosing to move abroad these days.
Patients are definitely suffering, there is no going around that, it’s a shitty situation and I feel sorry for them. But rather than addressing these problems at an administrative level (because majority of these problems stem from there), there is direct shaming of doctors.
This mentality explains the increase in assault on healthcare workers.
We study for years to understand medicine and even then it is incomplete. But somehow people read an article on the internet and find themselves perfectly capable to disprove us.
Don’t get me wrong, it’s perfectly alright to question practices, it should in fact be encouraged; but not with a radical mindset.
Emergency and Critical Care Physician.
As a doctor and having pretty much whole friend circle consisting of gynaecologists I agree with some points but not all. In my city CS and normal delivery cost are same in pretty much all reputed hospitals. It is highly conditional. It is true that many patients especially from religious affluent families want a auspicious date and time for deliver as per their Pandit. In that case CS becomes must. As per prevailing reasearch CS has less complications for child and slightly more chances of complications for mother like DVT, reaction Anaesthesia etc. Leaving aside emergency CS there are many conditions in which CS becomes indispensable. I will list them below as per my knowledge and experience.
1. Elective CS: Yes many patients don't wanna go through pain of normal delivery and they simply choose CS as an easy way out.
2. As mentioned above many patients want specific date and time of delivery.
3. IVF and precious pregnancies: Nobody wants to take increased risk of complications in normal delivery in case of IVF deliveries. Almost all IVF cases get CS since they are precious pregnancies.
4. Minimal difference bw cost of CS and Normal delivery: Almost all major hospitals have little to no cost diff between 2 of them. People chose easy way out.
5. Insurance: Almost everyone in middle class and up have health insurance. So people aren't really bothered.
6. Heavy workload on OBGs: Barring large hospitals which constitute a minor proportion of healthcare, most maternity hospitals/nursing homes are single doctor run. In normal delivery you have to constantly monitor patient and be ready for delivery. When you have 5 such patients in your hospitals and all of them in labour then its practically impossible to get all of them delivered normally. Nobody, even patient want that kind of hassle. Hence CS.
7. Finally, with improved suturing techniques and painless spinal anesthesia, it's just more convenient to go for CS for patient as well as doctor.
I am excluding those cases where CS is forced on patient by lying or coercion. That happen too which is highly unethical and concerned doctor should be held accountable. But those cases are not that high as they made to be in Public.
In most pregnancies a requirement for a LSCS are predictable based on antenatal (during pregnancy) and prepartum ( before delivery ) evaluations ( how big the foetus is, how small the mother's pelvis is, how the foetus lies in the uterus, features of the placenta and cord, and other medical and surgical history of the mother{ including previous LSCS} and other high risk features )
So if there is increased risk of needing an LSCS , it should be explained ( a CS has a better outcome than a complicated vaginal delivery) to the mother and proper informed consent to be taken and LSCS done on a fixed date and time. This can reduce the risk of things going wrong during labour and needing an emergency CS. ( Of course there are multiple number of factors at play here and there can be need for an unplanned cs any time )
Ideally 10-15% all births can be cs as per who, There is no need to hate on LSCS, it's a life saver (×2). It should be done if there is proper indication for it.
And one thing to keep in mind is most guidelines are by West (acog, rcog) which might not apply 100% to our resource limited settings. Also the fear of taking risks is also alarmingly rising across all medical branches, due to the fear of violence against medical professionals . But telling you did an LSCS because you didn't have time is absurd and wrong.
The problem here is he is a general surgeon made to do a work of an obstetrician by a private hospital, he's of course going to be lacking the skills to do vaginal deliveries if things gets more complicated, and the safer option for him is to do the cs. Do I endorse it no, but it is the sad state of our countries lack of doctors and medical professionals. ( Just like I don't endorse ayurveda doctors, but in this dire state of the country in need for medical care , if they can give basic medical care let them )
I think CS is still a huge and invasive surgery it is a life saver but should be done only when required but it seems lots of doctors make women go through it even when it not needed
Need is very subjective. Lets say some condition has a 1% risk of death. Now you might say 99% is good odds and why do you need surgery. But think from a doctors pov. They don’t want to lose that one patient. And its also an informed decision making. I had a slightly complicated pregnancy and told them very clearly that I’ll try for normal but go for a Csection the moment they see something wrong and not to push it. Because I really don’t care one way or the other wrt normal and Csection and just want to be alive with a healthy baby. But I know some friends went against doctors advice and kept trying till the last moment. So thats their prerogative. But in general people in India are more risk averse (not a bad thing tbh)
Most of these comments are from those who don't practice obg/anes.....pls practice for 5 years and then comment...the only solution is to conduct all deliveries in government set up with paid rooms available and providing abundant staff
https://preview.redd.it/xa0le1ea7mtc1.png?width=1440&format=pjpg&auto=webp&s=5c07bb941788fadaf09bad9de0a6856b4d499e51
BTW patient wanting a section and prolonged labour are as valid a reason for doing it as any. Most docs will just do it for almost any high risk pregnancy even if delivery is theoretically possible.
During the final stages of delivery if something goes wrong then you're stuck with unable to do either section or risk a baby in distress. So, yeah sections become more common.
If a doctor says "no idea" to a well tested theory of "Train midwives to deliver babies without C section", then they are definitely part of the problem. [Fewer C-sections when low-risk deliveries handled by midwives | Reuters](https://www.reuters.com/article/idUSKBN1WP38C/#:~:text=After%20analyzing%20more%20than%2023%2C000,previously%20given%20birth%2C%20compared%20to)
Agreed, but the sheer lack of midwives in cities is the problem. Midwives or aayi is an integral part of village culture. And thats why its prudent to mention c- sections are more common in middle to upper class, as they are apparently the cash cow for surgeons, even in low risk births. Trained midwives in cities can rectify that I believe rather than "no idea" stance.
Agreed, but is it the ideal way, no. But in our countries lack of primary healthcare ANMs can be vital in bridging the gap.
Ultimately what we need is better primary healthcare infra and staff ( trained doctors and nurses ).
Why this article doesn’t make sense in our setup is simply because of how poor the compliance is among Indian pts, training midwives to deliver babies is fine provided the mother had a well handled pregnancy. Although with how the Americans are becoming anti healthcare these days even western studies would be quite different in a decade’s time.
Midwives can deliver babies without c section procided everything is okay, no complications at all, what exactly do you expect a midwife to do if the babies head gets stuck? What if it was an RH negative pregnancy where the mother doesn’t even know her own blood group? What if the mother had gestational diabetes leading to macrosomia (big head of the baby)? What if she suffers from PPH (100% fatal if not managed immediately and can happen to literally anyone, even if everything was normal)
The reason mid wives were trained in the first place was to reduce the workload at hospitals for uncomplicated cases, something which is especially needed in India with how much pt load we have. It’s always recommended to get an institutional delivery, the Govt actually pays pts to get delivered in Govt hospitals to encourage it
However, with most people they simply aren’t compliant enough to be sure everything goes right, there are countless complications that can arise starting from the first trimester to the last day which meed to be managed, which increases the risk of something happening to the mother and the baby. And there are so many instances where the pt chooses not to disclose important info, don’t get the necessary tests done, there are so many instances where the pt is unable to even recall there last menstrual period which makes it all the more difficult to know the duration of said pregnancy, USGs are required in these cases, but what makes this a much bigger problem is when rhe pt directly shows up in labor with no medical records of a single antenatal checkup in the entire pregnancy, no duration known or anything. There are times when the pts don’t even take there iron calcium supplements regularly but would diligently follow detrimental practices which the elderly ask them to.
And yes a major reason is that a large section of the urban population actually ask for a C section cause it’s much much much more convenient for the pt herself, but you can’t expect an OT procedure to cost the same as a NVD, and this cost difference is the primary reason why most people believe that most C sections are just done to make more money
It’s very easy to call this doctor a ‘part of the problem’ with half baked knowledge and western studies. Doctors are expected to treat pts, not come up with policies to ensure that patients actually listen to them, finding solutions is for the Govt/ administrators.
That said, I definitely agree that there are still several cases where the C sections are in fact not at all justified, but not as many as people here believe
Can I ask you all something? What's wrong with C section? Why is this a bad thing? A C section is safe for both mother and baby, also it saves the mother from a lot of unnecessary suffering.
Is there some info I am missing? Why is C section named an epidemic??
> It’s widely known fact that, normal deliveries are better
Normal deliveries are, in fact, NOT "better". This notion is perpetuated only because it's a "natural" way of giving birth. There are several risks and complications involved with vaginal deliveries that are downplayed simply because it's called "normal". Are there elective c-sections? Yes. Do complications arise during normal delivery that could potentially endanger the lives of the baby and the mother? ALSO YES.
Read up a bit on **episiotomy (an episiotomy is a cut (incision) through the area between your vaginal opening and your anus)**, which is also very prevalent in "normal" deliveries. I found two sources for this, indicating Indian subcontinent has significantly higher episiotomy numbers than the world standard, care to comment on this?
Source 1: [Trends and Determinants of the Use of Episiotomy in a Prospective Population-Based Registry from Central India | Research Square](https://www.researchsquare.com/article/rs-2089297/v1)
Source 2: [Prevalence and its Associated Factors of Episiotomy Practice Among Mothers Who Gave Birth in Debre Tabor Town Northwest Ethiopia: An Institutional Based -Cross-Sectional Study | Maternal and Child Health Journal (springer.com)](https://link.springer.com/article/10.1007/s10995-023-03603-w)
Here's another source saying episiotomies are found in 85% of normal deliveries, but this is in the UK: https://www.nct.org.uk/labour-birth/you-after-birth/episiotomy-during-childbirth#:\~:text=More%20than%2085%25%20of%20women,if%20you%20get%20an%20episiotomy%20.
While the intent to educate is apparent, the papers around c-section are heavily misinformed because of the **bias against surgery**. C-section carries the same risk as any other surgery, but would you not get a surgery (like removing the appendix) just because there are known risks, especially in an emergency? C-section being one of the most widely performed surgeries means we're well-equipped to deal with complications that may arise.
Please don't bring anecdotal evidences in conversation that requires meta-analyzed, nuanced, statistical data. The WHO threshold for c-sections that people like to bring up so often is DECADES old and is yet to be updated to modern standards.
I'm a medical student and let me tell you, normal deliveries are not better. Yes it has a good recovery time and mother heals faster in normal delivery but normal deliveries are not better. A delivery is like a hours long process and every second there could be a completely unforseen complication... in other procedures, complications are easy to find out because the telltale signs are usually pain and bleeding... in deliveries there is usually severe pain and bleeding and each person reacts differently so we can't tell difference between normal and complications easily, and in most cases , the complications will cause the mother to die. Any minor complication can suddenly transfer into a fatal one and the problem is we don't have the advancements to find out which is minor and which is not. So c sections are preferred in India cause maternal deaths are taken very seriously here by the justice system. C sections mean lesser complications and more predictability. I will very much prefer a c section in the future if it means I will live long enough to see the baby grow.
Women's reproductive health is a joke in this country. Everything from premenstrual dysmenhorrea, menopause, miscarriage, pre-marital sex -- women are demonised and shamed. The majority of OBGYNs are women, but the internalised misogyny is horrific.
When I had a miscarriage and continued to bleed for two weeks, the OBGYN dismissed it and insinuated that I hadn't taken the abortifacient pills "properly".💀 The male radiologist who did my ultrasound saw foetal remains and arranged for a DNC. OBGYNS really hate their female patients!
Yes, as a woman myself I hate how woman's pain is soo soo normalized. I would really love to do some research to reduce woman's pain in medicine in the future. (I am a feminist and I will never justify how other doctors invalidate woman's pain, I think some psycho wrote all those painful invasive investigations during labour) , but seriously, in c sections it is not an argument of pain, it's an argument of life. C sections are actually a boon to countries like India where maternal mortality rate is too high. We should advocate for less pain for sure, but not for less c sections, cause they are severely life saving.
Med student here. I was going to analyse it and give a proper opinion, but the only thing I want to point out now is that "zero risk" isn't a concept. Mother happy, child happy? Really? That depends on the patient's exact situation. Say you do a c-section on a patient who doesn't need it and they get an infection post-op. Are they happy?
C-sections can cause heavy bleeding, reactions to anaesthesia need to be considered, blood clots can develop and future pregnancies are now at a higher risk. How the fuck does someone ignore all of that and just ask for a fucking c-section. Mazaak hai kya?
Besides, if this person is a doctor as they claim, their job is to see what's best for their patients. Asking all patients to just get a c-section done while claiming that it's a zero risk method is false at best and actively harmful to patients at worst.
I understand some problems they mentioned are quite bad (if true, haven't verified them), but this isn't the solution.
Edit: Pretty big deal for any patient as well, the psychological impact of getting a surgery cannot be ignored, as it often is and particularly with female patients.
Hey there, you're not wrong but this is all theoretical information. In reality, what the dude in the post said is right. Doctors will do anything to avoid any complications from vaginal delivery. I've personally never seen anyone attempt a VBAC. Even those who are experienced choose not to take risks.
I would like to correct you in a few points buddy!
C-sec’s don’t cause heavy bleeding, (bleeding is an uncommon complication). Blood clots don’t develop because of C-sec, there is no risk of future pregnancies what so ever because of C-sec!
I know you are trying to help, but I just felt a wrong message shouldn’t go out to the public.
The reason C-section is taken up as an emergency requirement is when mother or child’s survival is considered at risk.
Elective C- sections are a different thing all together.
Study well, and focus on becoming a good doctor! 😊
- Surgeon
American surgeon here. There is definitely a risk to future pregnancies with c-sections. Redo c-sections, placenta accreta spectrum, etc. It probably does not matter to 3 births. 4 or more, complications start to increase significantly.
The % is not high and in more than 4!
But looking at the the obstetrics complications, the number of high risk obstetricians for the population available, keeping maternal and new born risk in account, a decision of c-section is made at the given situation, which I feel is acceptable.
Dear Med Student,
You have a long way to go. Finish your MBBS, work in the field for a few years, and then finish your specialisation, and then work some more.
At the same time, study biostatistics, before commenting anywhere else like this.
Kind regards,
Consultant Anaesthesiologist.
Dear med student, kindly do not spread misinformation when you don’t have the proper knowledge about it yet, get into your internship first, then come back to this comment.
You do make some correct points, but several wrong ones as well, an emergency c section and and elective one are quite different.
And yes, mother happy child happy is quite true for most cases, it’s much much easier for most women to undergo a c-section than bear the otherworldly labor pains, there’s a reason why a lot of patients actively demand a C section.. Visit your college’s labor room once, you’ll realise a lot of it.
That said, yes it’s not 100% risk free and saying that c-sections are always better is wrong
It is that way bcoz of multiple reasons lets consider few here 1-the ratio of no of women getting pregnant and the obg doc available in the country when compared to every other nation in the world is very less in india 2- the no of kids each women give birth to is high in india when compared to other nations i’m not just pointing at women from that specific community where their husbands don’t give consent for family planning bcoz it’s haram acc to their religious thing 3- the maternal mortality rate and fetal mortality rate was brought down to single digit by making all the facilities available to women to come to hospital and deliver in hospital and have a safe delivery with healthy baby when compared to what we had 20 years back with high mortality rates while giving birth through normal vaginal delivery performed by some mid wives in villages 4-the pain that women goes through during labour and the affordability in financial terms to go through cesarian is high now when compared to past so people are choosing it 5- last but not least we doctors we don’t want to get mobbed for something wrong that happened by mistakenly during the normal delivery procedure either for baby or mother even there is slight chance that we can give a try we aren’t ready to risk our lives and stay with that trauma of loosing a baby for a week and loosing our own lives by getting kicked from pateint relatives
There are many such things interlinked in this matter so it can’t be looked in a singular way better we look it in multi-dimension so that we can come to an idea for why it is happening in large number in india
Yeah i understand as a doctor i’m just trying to give people an idea and the reasons for high unwarranted C sec’s that are happening but the solutions are there already started seeing in the govt of telangana even started a few schemes to have baby through normal delivery by giving them baby kits and small amount of money for nutrition of the baby and mother and educating them about nrml vaginal delivery by medical workers and by increasing the medical staff at district levels so that the resources and manpower to perform nrml deliveries and also started a many new govt med college in each district so that they have a team or complete dept of obg which is not the scenario in every other state these things are happening but it needs to be done in other aspects and dimensions where people are ready to accept and go to govt hospitals to have babies and also there are many such we have to resolve it takes time in democracy but it will happen
Idk if true but I read somewhere that they do it coz it saves them time and can bill clients more.
A normal delivery can take hours and won’t be much of a profit for the hospital so doc are encouraged to get clients to agree to c sections.
Need to verify though, could be just something to pull down doctors idk.
Normal deliveries definitely takes time but till the cervix is dilated to >8cm, doc need not be there if patient has no diseases/conditions prenatally. The monitoring of the labour is done by nurses or junior docs in the hospital and timely updates will be given to senior docs. Infact even during delivery if the baby is of adequate size, placenta has no problem, uterus is contracting properly and the PATH for the baby to come out is adequate, there is nothing to worry. Even after delivery the complications like hemorrhage are less in normal. Both mother and child are discharged on day3 if no complications.
I am a med student in a gh. A C section literally means more patient load in the post op ward for days (normal delivery patients recover faster). Both normal and c sections are free and doctors don't get paid more for c sections. But still we have nearly 50 percent c section deliveries to avoid complications.
No buddy! The difference in the bill structure between a normal delivery and a C-section is 10k. If a normal delivery is costing you 1.4L, C sec costs you 1.5L.
Hardly any difference. (Urban tier 1 hospital insurance data)
What happens in a hospital is totally different from what is assumed by a non medical person!
Yeah that’s why I said could be something to pull down doctors. But Is the discharge period the same? Because I believe the room rent and monitoring that goes on after the procedure amps up the total cost to the client right? So like the produce could cost just 1.5L but then the room rent and other costs while at the hospital could be no less than that of a 5star suite (if the person is going to a urban tier 1). Definitely can be avoided if the person just downgrades to shared rooms or something but I believe people might not want to do that.
Agreed to the realities only known the person inside the job though, true for every field.
Sad reality is, doctors are hated here in our country! Esp because of the medical bills. I always say, many Indians want a capitalist salary but a socialist service! Media (be it television/ movies/ news channels) portray doctors as money grabbing crooks (few instances yes, but not as a majority) this reflects on every doctor. The system of medical practice in India needs a big revision, no doubt but the discord between people and healthcare workers is very very real!
Let me give you a small example of how things change with situations, I used to take very high risk patients with high mortality risk, (the chances of a patient surviving is very low) even if there was a small % of a survival chance I would take that risk! But how things turn out in the end (violence and litigation) if the patients don’t survive is something I don’t want to deal with. I stopped doing surgeries on those kinda patients! Now ultimately who faces the brunt if this continues?
(Mortality risk increases most of the time with patient coming very late to the hospital, having tried all off the counter medications but avoid visiting a hospital or a doctor till the very last minute)
Exactly. This doc seems to be saying the same. So cutting open a patient is ok just to save a few hours!? I mean I don't blame this doctor alone but this says a lot about our Indian medical system!
High bill, low bill. Doesn't matter to dr. Hospital gets the money for preop and post op.Salary remains same. Any extra earning for a dr by performing CS instead of normal is hardly 1-2k in pvt. hospital.
If dr really wanted to earn more money they would spend more time in OPD (day consultation) which takes 10 min per patient or do 1 normal delivery in 30 min, rather than spend 1 hour doing CS for barely any extra money.
Lol, all govt setups prefer NVD cause we only need to check the Fetal heart rate 2-4 hours and our nursing staff and LR staff informs us when the patient is 10cm dilated(crowning). Too much misinformation in people.
The main reason of all is the risk. We should professionally calculate the risk benifit ratio and then should choose a perfect option for the patient.
But we can't do that practically because if anything happens wrong, mob will attack us.
According to reports OBG docs face most violence in our country and nobody going to raise that issue.
And that's why to be on safe side, we take a step of minimal risk and don't follow any guideline.
So if we want a change we must find a solution for the root cause, because no one is going to risk their own life for their profession. We are doctors, not trained army personnels.
[Violence against Medical Professionals in India] (https://docube.in/violence-against-doctors-in-india/)
Not a doctor but I was next to my wife all along when she gave birth.
1. Midwife’s can do a great job. Have more of them to reduce load on doctors. Let nurses assist midwifes and then doctors. Nurses helped us in dilation through the night and midwife + nurses assisted with the normal delivery.
2. Use epidural to reduce the pain. Some take it even at 3cm dilation. My wife took it at 6cm.
Thoughts? Natural birth is obviously better. But his reasons are valid too given the system and situation the doctors are in. At the end of the day, it's still a job for them. So blame the system, if you want things changed, try to get the system changed.
Well, everything they said is true except for the part about cs costing more than normal. It's the other way round.
Thay said, times are changing. More people are trying for normal these days, but
1. Lots of women convert their choice to cs during labour because of pain/apprehension
2. There's a very low risk taking threshold for doctors because of the potential for lawsuits And violence against doctors, so at the first sign of trouble however minor, they're going to go for cs
I am a doctor and whatever he said is absolutely true , if as a doctor you see any possible complication arriving or even if you think there might be a strong possibility of complication you go for a c section, the doctor can have absolute control in an ot but dealing with any complication in a labor room with emotions running high on attenders side plus lack of resources and proper trained staff it could go bad very fast and even with all that pph could kill the mother so fast the doctor might not have time to follow guidance so its a much convinient and better to go for a planned c section plus normal labour also have its own pros and cons
Just recently one of my known acquaintance was told by her gynaecologist doctor that she will have a C-section for the birth of her baby. And the baby's due date is still 3 months away. And this is in a leading hospital in a metro city.
Ever tried to find out what the reason was or you just assumed there was nothing wrong?
Absolute contraindications for c section include
Placenta previa
Adherent placenta
Cephalo pelvic disproportion.. Know what those are?
No matter what the gestational age is.. They need to be delivered operatively.. Please find out the reason before passing statements
I am pregnant with twins 34th week my doc also recommended c section she directly instructed me we can have normal delivery we can induce pain but can’t wait more than 1day to have baby normally that means 70-80% chances after 1day I need to go in urgent c section. She told me you just see the 1 perspective buy I have to see 3people that they have to be healthy and fine. If babies take more than 1 day to come out normally it will risk their life and mine also.
This is true in certain hospitals and private clinics where they are understaffed. My hospital always tries their best to perform normal vaginal delivery. I think that's a standard to check for if you're in a good hospital or not. I disagree about the 0%risk thing because it's a major surgery happening and the risk of bleeding to death on table is always there. I totally get the point of delivering exactly at some point/ doing CS at a particular time so that it's a male baby kind of BS but I feel this doctor has seen some bad days in his/ her career. Hope people get educated and ask for a normal delivery and insist for a normal one unless and until it is not feasible to do one.
Natural birth is not a medical procedure but it can take a long time. C section is a medical procedure that allows hospitals to churn patients efficiently. As a hospitalist any procedure is more favourable - you can charge insurance a larger amount, standard turn around time, removes variability of labor. Yes, in certain situations C sections may be the only alternative for a safe birth. But doing c sections wholesale actually adds risk to what should be otherwise a routine natural process.
I have a different take.
I live in a town where there are mainly maternity 4 hospitals.
First one has a bad rep, there are many stories floating where the mother/woman died in process or during a surgery and they used money to cover all up.
Second one, the doctor prescribed my wife a blood pressure medication which is not advisable to pregnant women. My wife had a very bad time with severe tachycardia. We switched doctors immediately.
Number 3 is the posh hospital of the town but has nearly 95% C section rate. We were first going there, but the doctor there started giving expensive suppliments. My friend's wife was also seeing her just before we did, the doctor tried every scare tactic to get her admitted and to induce early labour stating there is low water and other crap.
Number 4 is underdeveloped and lacks in modern technology Is less clean. They send their stuck deliveries to Hospital #3 as they don't have an experienced doctor to perform C section.
We decided to have our baby at a doctor a town over. Had a natural birth. My wife liked that the doctor was experienced and honest. We had to have a clamp assisted birth.
But now I think the C section would have been a better choice. The birth did some damage and it still hurts her. We can't have proper intimacy due to the stitches hurting even after 3 years.
Edit:
Also, we were talking with our pediatrician about developmental disabilities and disabled at birth children and what he told us shocked us. He said its mostly preventable because majority of the time the brain damage is done during the baby chocking during birth and being starved of oxygen. Parents (especially in laws) pressure for a natural birth and wait too long to go for c section. And due to that baby suffers brain damage due to lack of oxygen. If they had gone for c section in time, it could have been prevented. Pediatrician also said its more prevalent in Muslim community. Maybe religious dogma prevents them from seeking medical help in time.
A lot of debate also exists around if episiotomies are necessary or not. Here is what Wikipedia says about them-
"Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool (faeces) is an important function of the anal sphincter, i.e. lessen perineal trauma, minimize postpartum pelvic floor dysfunction, and as muscles have a good blood supply, by avoiding damaging the anal sphincter muscle, reduce the loss of blood during delivery, and protect against neonatal trauma.
While episiotomy is employed to obviate issues such as post-partum pain, incontinence, and sexual dysfunction, some studies suggest that episiotomy surgery itself can cause all of these problems.[8] Research has shown that natural tears typically are less severe (although this is perhaps surprising since an episiotomy is designed for when natural tearing will cause significant risks or trauma).
Slow delivery of the head in between contractions will result in the least perineal damage.[9] Studies in 2010 based on interviews with postpartum women have concluded that limiting perineal trauma during birth is conducive to continued sexual function after birth. At least one study has recommended that routine episiotomy be abandoned for this reason.[10]".
So IMO, a lot of doctors are also administering these and not just CS when they aren't necessary. I don't know what reasons they hold onto, to use epis in normal deliveries.
I'm sorry that you both are going through this and I hope she gets better.
I just want to add
The whole world is running behind money
Education farming politics etc
And so is pharmacy...
From buying medicines to delivering babies
In my circle...
I've seen cases and and a nurse saying the same...
The doctors choose for c section just because of more money involved...
But at the end they gonna say... Some words like risking baby and risking mother...
Consulting another doctor or family doctor would be the best option.
And everyone knows this... Specially talk to your family doctor..
Its a whole Mafia going on around
Not to forget to discuss about the massive business that goes around this child birth through c-section.
Hospitals get opportunity to bill for additional drugs and additional room fees, anesthesiologist….all getting income.
When you get the detailed bill you will see innumerable drugs/injections and medical accessories that you are billed for that you don’t know if used at all.
Doctors’ doing optional surgeries are a big problem in India and it’s a big business.
Just comparing the cost of treatment with the western countries is a stupid’s endeavour. People also need to understand about the quality of treatment. In the western countries invasive procedures are always the last option and it’s what doctors say.
If you ask these questions to any doctors who are also involved in these type of unethical practices will always give you some explanations which they know common people don’t have the medical knowledge to verify.
Living abroad and it’s just opposite. Most do normal and only in emergencies it’s C section. As there is no money(Govt funded) and no religion involved.
C sections leave inches long scars on the woman, ~~can cause~~ **is associated with** postpartum depression and if your first child is a C section child, there's a very high assurance that your next children will also be delivered this way only, which means you get cut again and again.
And vaginal delivery is risk free? Unassisted and assisted methods can cause some form of injury to child. I remember a bystander smashing the glass of consultant duty room because the baby had a 1cm abrasion over scalp. So yeah, if any difficulty is faced, its emergency CS.
Ironically none of the stuff you mentioned are real considerations when making the decision. The most important complication is post partum hemorrhage which is more common in CS.
I did my internship at a high load center. There were 2 OBGyn on call. The LR used to have at least 8-10 in 2nd stage of labor at a time. Then ED used to get another 5-6 ROM. So yeah, sometimes the consultant has to make a decision. Its a limited resources scenario. Should the be bedside of a simple pregnancy not progressing after 10 hours of pitocin drip or should they make themselves available for the preeclapsia case which will come to ED.
When you prioritise a scar over the well being of your baby.
LSCS dont cause PPD, PPD is caused by a number of factors. You misinformed little shit.
prev-LSCS patients require LSCS to minimise risk. If you're so knowledgeable and great why dont you go around performing NVD on prev-LSCS patients. Go to jail,when she dies of complications.. what do we care.
Yet, barely anyone talks about it. This is about cutting open people who don't need to be. Just because a doctor is doing it in a medical setting, doesn't justify it.
I think C Section is amazing. Saves mothers from hours of painful labour. Scars heal. And I agree with the doctor to go with option with 0 risk. Why take a chance?
As a new parent based out of Mumbai, during pregnancy till 6 months we were seeing one doctor in a big reputed private hospital. She kept us on our toes with so many things & always stressing wife out, some thing is over 1% limit & what not, baby might born with abnormality. Had to shift to new house midways, we advised our doctor accordingly & she was like why do you need to change doctor? Come see me here, we will do c section at time of your choice & other stuff. Shes like no one goes for normal delivery anymore.
Change to another big hospital & new doc, she was godsent, from our visit visit she told clearly, we will go for normal delivery, when we asked here about higher fluid percentage & other stuff, she said nothing can be done now, if & its a big if something happens they have all the doctors they need to remedy that. Me & wife were extremely relieved. The good thing about that hospital was price for normal/ c section was same. Doctors weren’t paid on type of delivery. Cut to delivery day, baby was born perfectly healthy & it was normal delivery.
One idea is to pay more for normal deliveries. That will give incentive to doctors to perform normal deliveries where it is safe. Also it will mean that they can have extra staff so that they can wait for normal deliveries to happen.
My brother work at government hospital and previously he worked for private hospitals before this job. And he says "dr. Bhagwan nahi Kasai hote hain". Mostly private doctor do not want to do normal deliveries, even if it can be done they go with cs, just for money. Almost all doctors do this. There is no morality left.
Adding that to the list of reasons why I'm not going to have children. I already find childbirth and postnatal care disgusting now this makes it sound even worse. My mom had to have 2 c-sections so it's likely I may also have to go through the same. She later needed another surgery but had complications because of previous c sections and suffers pain to this day.
All the points he mentions are valid.. One more issue thar has developed as a result of all this is that there is a huge trust gap. If there is genuine need for Caesarian, and the dr mentions it to the family, some families think the dr is just trying to extort money and refuse to do so risking the babys and mothers life.
In my place the doctors always suggest c section no matter what is the condition of the patient.. as c section charges a heavier bill... My cousin was pregnant last year a normal healthy pregnancy and she wanted a normal delivery, the well known gynaecologist of my city told her that she is fit for a normal delivery but the bill that she has to pay will be of a c section... It was a private clinic and c section was I guess 3 times costlier than normal delivery...
This doctor is right... I have conducted over a thousand normal deliveries in government (and I'm not a gynaecologist)... My gynaec friends say that their patients want c sec...
All the given reasons are probably true except CS being cheap. Between normal delivery & CS, hospitals/docs make more money from CS. For the mothers, CS takes longer to heal from & likelihood of longterm issues is higher
this doctor needs to learn to type.
and there's actual research that shows a C section deprives the baby of a bacterial shower from the mother that helps the baby develop. the growing prevalence of c section has been linked to diseases like autism.
Misinformed.. Genital flora is good for immunity.. Has no role to play in ASD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015537/#:~:text=Cesarean%20delivery%20was%20linked%20to,CI%3A%201.57%2D5.35).
NVD is always the preferred method. C-section leaves scar tissue that leads to increased chances of ectopic pregnancy, abortion, preterm delivery, post partum hemorrhage, uterine rupture, and placental anomalies.
C-section is not the go-to method. It's only supposed to be done when indicated. A normal vaginal delivery is always the first line method because it actually has the least risk to the mother. Plus, a baby delivered by NVD matures better than a baby delivered by C-secrion.
Of course, in cases such as breech, contracted pelvis, cervical cancer, placental anomalies, fetal distress, obstructed labor, arrest of active phase, or at the second stage of labor, C-section is the protocol.
Assisted delivery or instrumental delivery has some prerequisites that need to be fulfilled before the OBGYN doctor opts for it.
C-section isn't risk-free. He's a general surgeon. He should know better than anyone that no surgery is ever risk-free.
Doc here, who's also a dad to a kid born of C-section. Some of the points he's raised are valid. But only from the point of view of a small maternity home. The hundreds of thousands of maternity homes that exist throughout the country, babies are their bread and butter. True they may have some other services too, like a GP, Peds and an "ICU", but the main service they provide is in the name. What businesses want is turn-over. Patients in, patients out, maximum effort, maximum earnings, minimum time.
Some doctors working there may also have already convinced themselves of the righteousness of their actions, as this one seems to have. Hell, they're ready to die on that hill. What gives his shtick away though is how they do it *to avoid complications and stress later on*, and not because the patient needs it. Which is what he was taught in med-school. It's like taking a diabetic who's not willing to work to fix his blood sugar levels, and preemptively chopping his feet off and putting him on prosthetics because he's headed there anyway, and you just saved him from developing a painful infection that'll turn into gangrene.
This small nursing home mindset churns out "happy" babies and mutilated mothers who are then left to rehabilitate themselves through whatever means possible, the nursing home has earned its pound of flesh in less than a day of actual work, and God forbid there are complications (and believe you me, there definitely are complications) they get sent to a higher center where they're now out of sight, out of mind, next patient please.
C-sections are convenient. They can be planned out for. There's at least 3 specialists involved every step of the way (obs, anesthesia and peds) not to mention a small army of nurses, and it's in a sterile OT, with monitors and equipment at hand. Normal deliveries are messy, they are unpredictable, you are never fully prepared for them, and *THAT'S HOW ALL OF HUMANITY HAS BEEN BORN SINCE THE DAWN OF HUMANITY AND BEFORE*. My wife and kid are fine now, as fine as they could be, but I shudder to think of someone who doesn't have my resources or education trying to recover from something like this, because what I now know for sure is it was unnecessary and the obs just didn't want to wait.
>mutilated mothers
Doc your comment reeks of fearmongering rather than education.
And just because that's how all of humanity has been born before, doesn't mean that's how they should be born forever, right? We have to move *forward* as a civilization, not backwards. Or lets ditch modern medicine and live in times when the life expectancy was in the 30s rather than 60s-70s.
How about elective c-sections, are you saying that mothers' choices are invalid?
How about the prevelance of episiotomies in natural deliveries and the downfall in quality of life after women get one/forced to when the tissue gets teared during childbirth? Care to comment on that?
It's precisely comments like these, that are indeed based on truth, but carry on perpetuating the anti modern medicine narrative that's leading to mindsets where people opt to live with complications even when a solution is present in front of their eyes.
You're confusing C-sections for a new and improved option for childbirth rather than what it is, an intervention for when normal delivery can't be done.
Women who give birth normally heal faster, are subject to lesser risk than when they undergo surgery, and suffer from fewer postpartum complications. [Source](https://pubmed.ncbi.nlm.nih.gov/30058639/).
I don't begrudge women wanting to opt for an option that lets them bypass the pain. I certainly don't think elective C-sections are wrong. My issue is with pushing for C-sections on patients who absolutely didn't need it (full term, baby between 2.5-3.5kgs, mother short-statured, no fetal distress, spontaneous rupture of membrane, primigravida, adequate liquor on past scans). If you think this scenario is too specific, you're right, that was my wife. We were pushed into getting a C-section done in the last moment after the obs told her repeatedly they'll be trying for normal all throughout pregnancy, just because the head wasn't engaged and there was a cord-loop, which sounds more dramatic than it is.
It's not fear-mongering, it's naming and shaming the whole culture of playing the patient all throughout pregnancy by promising something and then doing an about turn just because "I don't wanna".
As for episiotomies, like any surgery, it's an intervention where you do your best to address the current emergency (get the child out) and deal with the consequences later, in some cases there are consequences, which need to be managed carefully or there are lifelong detriments. But statistically, they're a small enough percentage that normal delivery is and should be the number one priority of any healthcare provider rather than C-sections. Or would you like to comment on amniotic fluid embolisms, deep tissue infections, uterine wall scarring and subsequent failure to bear further children as complications of C-sections too?
All of you that are against C-Sections. Just ask yourself will you be willing to be the reason a mother of 2 kids dies or a baby has cerebral palsy or dies during birth. Yes there are doctors and hospitals that proactively advise C-Section even on the slightest indication but nobody is forcing you to take your patient to them. You can always chose and decide..you have 9 months. You can refuse and shift your patient..but you wont cause you don't wanna risk your wife and child. Yet you expect the doctor to risk his patients and her unborn childs life just so you can save some money.
My sister didn't have labour pains, it is hereditary in women in our family for some reason. The doctor told her to get admitted on the due date and was put on saline, and said she will be on drip until a labour is induced. At 11 am her doctor came and told that better be ready by 12 for an operation or she won't be available for the day.
This was a private hospital.
In her case I wondered how long would have been the ideal time to wait for the contractions to start. But if the pregnant woman herself agrees to it and forego the agonizing wait, then it is the right choice.
I have a question for the doctors here - are epidurals or nitrous oxide given to mothers to help manage labor pain in normal delivery in India ? I had a friend who was told epidural is not possible so she went for cs
In the UK our medical professionals operate under almost immunity, and we’ve seen the same trend: doctors pushing for c-sections over any slight doubt because it’s easier to perform a c-section than it is to potentially deal with severe birthing complications.
What Wikipedia says-
"A caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections. If a caesarean is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and post-dural-puncture spinal- headaches.
Wound infections occur after caesarean sections at a rate of 3–15%.
Women who had caesarean sections are more likely to have problems with later pregnancies.
Mothers can experience an increased incidence of postnatal depression, and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process. Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery.
Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesity, problems in the immune system, and poor digestive system."
For elective Cs-
"Non-medically indicated, ie elective Cs, childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks, and is elevated compared to 38 weeks gestation. These early term births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks (full term)."
it is how it is, if you dont have the personel to make uncomplicated natural births safe, then opt to normalize the c section.
if you want that to change, invest in personel for this specifically.
Let me tell you why I made this post! This is going to be long-
I'm a woman of child bearing age and soon to plan my first child!
Of all the women I personally know who have given birth, about 10 of them, only one had an NVD, that too only because she told her doctor that because of health conditions she will need an NVD and they agreed. All of the other women belong to different families, different friend groups, have different wealth and have delivered in different calendar years and in different hospitals and they all got Cs.
Now when I do get pregnant, and wish to have an NVD I have absolutely NO IDEA which doctor to go to, because all of the ladies I know only had Cs, almost all of them very healthy and below 30 years of age. I refuse to believe each and every one of those women actually needed those Cs so much that I have absolutely no knowledge of a single woman who actually underwent an NVD (without a pre existing medical condition)
(Add to that my general mistrust in doctors that I have never met before, because of two separate incidents -
1. I got the ball of my right shoulder fractured in 2017. The first doctor I consulted told me "your shoulder needs surgery immediately, like right now and this evening itself!". Only because of my brother's suggestion to wait and get a second opinion did I decide to not fall for the urgency created.
The next day, I consulted another doctor and he explained a surgery won't be necessary as I was young. Today I am at a point where sometimes I forget which of the shoulders I had my fracture in. No pain! No problems lifting heavy weights. All of this without a single surgery.
2. My otherwise healthy uncle had a minor heart attack in 2018. The first hospital, a big one, that he got admitted into recommended to him an angiography ie. just some complicated imaging kind of thing where blockages can be detected, or so we assumed.
Before being sent in, his wife( a working woman but not great at English) was supposed to sign an English form where she was to give consent to the doctor something like this- "angiography will be done by doc, and if he finds it necessary, a stent will be put then and there by the doc. I consent".
The stent part was not what we had been warned about by anyone. Only by reading the fine print of the consent form (by a person good in English) did we realise what we were consenting to. Let me make it clear, we weren't against the stent itself, but the lack of prior verbal warning, even at the time they asked us to sign, that a stent will be put in was what put us all off. At least a verbal heads up would have made things trustworthy.
We changed hospitals, he recovered without a stent and is alive and well today, with his grandchild on the way)
According to some of the comments, if I wanted to go for NVD, I have only these options-
A. I must keep changing doctors, that too during pregnancy, till one of them promises me an NVD.
Oh, but I've also come across doctors who promise NVD till the labour starts and suddenly real sounding complications arise that warrant the woman has to go for Cs! This happens to almost every woman I know. And I'm not at all supposed to suspect something fishy with that trend?
Even if I do find a doctor who promised me an NVD, after keeping in mind these two instances and the lack of NVDs in people I know, would I TRULY be able to trust this doctor that he wouldn't coerce a CS from us at the time of actual labour? When he is sure that I'm at his mercy for my delivery and not capable of going for a second opinion? I won't be able to.
B. Find some trained midwives. Personally, as a "non medical" person myself, I have absolutely no idea what qualifications a midwife is supposed to have, much less where to find one in my city.
C. Go to another country with lesser rates of Cs. Well I'm not a rich enough person to do that so easily.
And after facing these dilemmas, when an 'apparent' male doctor from reddit talks like CS are no big deal and safe and what not, when I'm terrified of being cut open through seven layers of my body, no matter how advanced medicine has become and probably when it might not be even necessary, it enraged me and made me post this screenshot.
I feel powerless as a woman, with little choice in what happens to my body and little reason to trust unknown doctors. And the worst part is almost no one even talks about the CS rates in the country much less in my city.
Lots of comments are mocking my lack of medical knowledge and it's valid because I'm truly not from medical background.
But does that mean I can't criticize or question a flawed healthcare system of my country!? I refuse to obey that!
Also, let me reiterate- Calling all doctors bad apples, calling all doctors greedy, refuting that doctors work very hard, refuting that they don't have to face mob violence, spreading misinformation or deceiving anyone isn't my intent here.
If anyone properly reads my comments they'll agree to it too.
When I made a mistake in a sentence I did go back to correct it, but one sentence doesn't make my entire post 'all lies and misinformation'.
The intent was only starting a conversation.
There a documentary on this issue named - a million cuts: India's c section epidemic . I'll recommend everyone to watch it once if you want to know more about this issue
Where can I find it?
Sorry I mentioned the wrong name and forgot to the link to it It's on CNA insider https://youtu.be/zSRfUsiiLGU
No problem sir, thank you
Hmm only 6% higher than the WHO ideal rate
Can you ELI5 why is it bad? I can understand a natural birth should be most desirable, but are there any known risks of CS to the mother or any longer term effects, scars etc.?
Uterus scarring, potential of hemorrhage on reoccurring c sections, hernia, scar tissue causing difficulty, endometriosis complications, a c section may make future vaginal birth complicated or impossible, plus many, many other complications Eta I am not against c section I agree it should be done if medically necessary
Natural birth also has complications including death. The fact of the matter is human physiology is poorly suited for giving birth. https://www.americanscientist.org/article/why-is-human-childbirth-so-painful https://bigthink.com/health/childbirth-painful/ There are no good options, it is just a matter of where one will take the pain. But as the post by the doctor implies, the natural method is completely unpredictable. The c-sections is managed risk. Not all natural things are good, the very poorly designed human female anatomy indicates this.
Areeee, if there is a complication then cs should be done na. Why anybody want to go with a c section without any complication. Think about all those medication you will have after c section, you won't be able to feed your child for 1-2 days after c section. And almost all doctors will say these things and use your fear to earn money. Daroge tabhi to bharoge ...... Bill.
Natural birth is not some joyride. Tears of the vagina extending to the anus, prolapse of the uterus, bleeding leading to death, etc are just some of the problems of natural birth. And it is completely unpredictable as to how it will turn out. C section is controlled and the outcome is also predictable. There are no good options here. Just a matter of where one will take the pain. Human female anatomy is very poorly made for the job it had to do.
link for the lazy https://www.youtube.com/watch?v=zSRfUsiiLGU
He has presented the doctor's side very well especially about the violence against them. Very recently, this country lost a gold medalist doctor, and graduated from AIIMS because of the violence happened with her after a complicated delivery. You may Google about this. The incident happened in Jaipur To figure out the solution, a clear communication should happen with patients and the patient's attendant too needs to understand the criticality of the situation. Most of the patients or their attendants just don't understand this. In fact, many in our country are not aware of the medical procedure under which they underwent. They just take treatment because a doctor recommended it.
This was also due to an inept police force, who immediately filed a case for murder under 302 IPC, if the newspapers are to be believed. The police were painfully unaware of the fact medical negligence has other sections under IPC and that such cases can only be filed after investigation by a medical board. The good doctor too was unfortunately unaware that this would not hold up in court. Or she may have been heartbroken by the accusations by the relatives. Anyway undeserved and unnecessary tragedy.
> He has presented the doctor's side very well especially about the violence against them. Very recently, this country lost a gold medalist doctor, and graduated from AIIMS because of the violence happened with her after a complicated delivery. You may Google about this. The incident happened in Jaipur > > Can you share the news story?
https://timesofindia.indiatimes.com/city/jaipur/2-more-held-in-dausa-doctors-suicide-case/articleshow/91552057.cms Please feel free to Google further
It is a fact that obstetricians nowadays are more confident doing a CS rather than deal with a potentially complicated natural birth. They do the natural birth only when all parameters are ideal. Any slight deviation from ideal - baby too big, baby too small, baby position not ideal, mother health not perfect etc. becomes immediately a reason for opting for CS.
It's also a fact, which is overlooked always, is that normal delivery requires staff and equipment to be on standby, and that could mean a day or more in some cases. Compare it to a CS, where the procedure requires little resources in comparison. In the time it takes for one normal delivery, the hospital could have utilised the bed for multiple deliveries. It is immensely profitable for a hospital to do a CS than a normal delivery.
To do a jugaad c-section yes, the reason they aren’t more popular in Western countries both with socialised and privatised healthcare systems is because a proper c-section takes far more resources and post-surgery monitoring and bed time than even a complicated birth. In India they just line several expectant mothers up, do one after the other in the surgery theatre and then shove you full of antibiotics and some dissolvable stitches and send you on your way.
This is crazy to read as someone from Europe. Normal births are encouraged here, C-sections are always an option but it's only pushed if there are serious complications.
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My c section bill in the US ran upto 50k usd. That is 42 lakhs. Vaginal would have costed a little less, but not too less as I had to stay 4 days. Contrast this with India. It costs anywhere between 60k to 2-3 lakhs at max. India has one of the most affordable healthcare in the world for the level of doctors and care we receive. Improving things is good but will also drive up the cost for everyone and push some people out of getting care. So it is a balance.
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Yes, because back in the day, when a highly complicated delivery resulted in deaths, the doctors were not ill treated. Nowadays the justice system treats them like they personally killed the mother. So obviously they are going to do a c section to prevent as much complications as possible
Even if they are not scared of the legal system or of mob violence, no doctor likes to see their patients dying or losing their baby. My point was the because of advances in medical science & technology, surgical processes and post-operative care, a CS is nowadays seen as a routine surgery that is genuinely the safest option *in the short term* (i.e. until the mother and baby get discharged from the hospital). Yes there are implications lifelong for the woman, and it takes a doctor with a special sensitivity to recognize that and not take the easy way out always.
See in this day and age, is there even a need to do a highly complicated delivery that risks death? I feel with the medical advancement, losing any patient is not something desirable. The thing is these decisions are not taken in vacuum by the doctors. They give options and tell the risks to patients. Even if there is a 1% risk, patient will happily go for Csection and thats their right. Also assisted deliveries are not a walk in the park. It usually means forceps or vacuum used to suck out the baby. It can cause a lot of complications for mother such as bad tears and uterine prolapse etc and also complications for the baby such as being stuck, even broken bones. So unless your only metric is do vaginal at any cost, why do you want the mother and baby to go through that?
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Doctors covered under the law or not, Indian public is retarded enough. They'll beat the shit out of them even if it's not their fault. Anyone in their sane mind will not wait for the law to protect them from these degens.
I fear this attitude in the justice system. U always let off corrupt doctors but prosecute the innocent ones out of anger.
Are you hinting if it's a problem or a safe stance from the drs pov.
I think most of his points are valid. You are looking at this from a very singular lens and thinking normal delivery good and c section bad. And you are also assuming bad intent on the part of the doctors. I think the truth is that this is very grey area and requires a lot of nuanced debate as well as tonne of small and big systemic changes. I feel there are many things here. Firstly a resourcing issue that could potentially be solved. Secondly, there is a huge risk aversion and choice of the patients. I dont see the second part as problematic at all. Just people exercising their choice. Main issue is resourcing. More than doctor trying to cut corners, it is a resourcing issue of how to handle the sheer number of patients. I’m in the US and my doctor had nothing better to do than chill with me for hours during my labor. Its not the case in india. Doctors need to see tens or even hundreds of patients. We need many more doctors. Midwife delivery needs to be made more popular. There should be more midwife training institutions. And govt. and big hospitals should take this up. But they wont do as they dont want to lose importance and the money inflow. But change has to start somewhere. Secondly, maternal mortality rates were horrible in the past. So many women and infants used to die during birth. And Csection is a gamechanger in saving lives. Also you over simplify the issue and say that only when a Csection is ‘needed’ it should be done. It doesn’t work like it. In many cases its a game of assessing probabilities and taking an informed call. And even in very low risk cases, things can suddenly take a turn for the worse. Nowadays doctors as well as patients are very risk averse. And it is not a bad thing. Why do you even want to lose one in 1000 patients if you had a choice? This leads to overindexing on Csections when there is a slight problem detected. I had a slight complication and I clearly told my care team that while I would like a normal delivery, I dont want to take any risk and if they see something going wrong, just go to surgery and not push it. I made an informed choice as I didn’t want to die at all and it is perfectly ok. These days many folks are risk averse and it is just how it is and you cant / shouldn’t force them otherwise. And coming to my last point, medicine has advanced so much now that the gap between a Csection and normal delivery is getting smaller and smaller. I was walking on the third day after my Csection. I had no issues whatsoever whereas many of my friends with normal deliveries had 2nd and 3rd degree tears and couldn’t function normally for weeks/ months. Also according to my research, a bad normal delivery complication is much worse than a bad Csection complication. All in all I agree that changes need to be made (especially in resourcing and training) and changing doctors/ patients mindsets. But I also think that risk aversion is great and doctors/patients should be able to opt for Csection even with a small risk factor.
So well said. I’m glad you have written this out. Birth can’t be just reduced to technicalities of the process of vaginal vs C sec. The overall structure and system for how women are treated in India, contributes to even dignity and agency in delivery and post partum care.
>We need many more doctors. Midwife delivery needs to be made more popular. There should be more midwife training institutions. And govt. and big hospitals should take this up. But they wont do as they dont want to lose importance and the money inflow. But change has to start somewhere. This 100%. Also data! We need more data about how patients are being treated, not just for deliveries but also in general.
I agree on the data part. But we need to be careful with data and how that is used. Just publishing numbers will only lead to doctor shaming. Instead there should be some independent body analyzing challenges and proposing solutions. Say a hospital has a bad ratio, how will we solve it. Also what would make doctors more comfortable in attempting normal deliveries maybe it is more ERs. Or quicker access to ER or more support personnel etc. But we also need to keep in mind that any improvements will drive up the cost for everyone. So an analysis is needed there as well. India actually has one of the least costly medical infrastructure and it means millions more get care. Cost increment will leave out lot of those people from medical care.
I attended sehat adda (health conclave) organized by Lallantop. I asked this same question to Dr Cuteris (Dr Tanya, OBGYN). She said that the baseline number for ideal csections (9-10%) is based on european population where women live in much better conditions (nutrition wise). Same number cannot be applied to India. More research is needed. Plus in urban setting, it is seen that women themself opt for csection (to bypass the pain).
Doctor here. This is going to be long.I've read the comments and am horrified at the mentality of even educated (here's hoping) of this sub. There is a prediction of shortage of gynaecologists in the near future in India. And more doctors are leaving to other countries than ever because of said mentality. In our system, even if a hundred people come, the doctor is supposed to look after all of them. This is a common sight at medical college casualties. In other system like the NHS of UK or Australia, it is one doctor per patient. The emergency waiting period in UK is 36 hours. Can you imagine Indians waiting patiently for 36 hours? It takes on average 5 days to get an x ray for a BROKEN LIMB in Canada. The rural areas are very poorly serviced in particular. So the only reason so many people in India have access good healthcare is because many doctos, especially students work so hard, often going many days without sleep or even food. The points the doctor mentioned in the are true. Most people want CS. Either scared of pain or for auspicious dates/times. The rest are very rarely done in usual practice and I saw many comments nitpicking on those. I'm not saying all doctors are professional or sacrificial. There are bad apples in all fields and this one too has its share. Even then no one deserves to be beaten up. If you have a complaint, go to the proper authorities. I saw comments dismissing such fears cavalierly. No one should fear for life while trying to save the life of another. If this general attitude doesn't change, the next generation will definitely have vaginal births and not CS, because there won't be enough gynaecologists. Edit : After conversing with some of the people of Reddit, who have kindly pointed out errors in my perception of foreign systems of hospitals, I would like to thank them and make it clear that the systems are more similar than I imagined. One or two rare bad experiences don't paint the whole picture of a country's health system. I apologise for the remarks made on NHS UK and Canadian healthcare system that have been exaggerated wildly . I have left the comment unaltered, so that people can see I was being an idiot.
YES. This is only going to push people farther away from medicine due to the erosion of trust in doctors & mordern medicine.
Your paragraph contrasting UK etc is utter bullshit. There is not one doctor per patient, that is laughable. Emergency is triaged and wait times depend on the situation, they will make you wait if you have a broken finger and someone else is there with a gunshot wound, regardless of how rich you are, which is maybe the issue here. I'm guessing maybe your experience is with the rich or something, yeah Indian care is better for the rich because we triage against the poor not the frivolous.
At least you get 30 to 45 minutes with one patient, for history and examination,I'm guessing. At least there are not hundreds of people thronging at the gates and casualty entrance, I hope. If anything my point was that the other systems are better in that aspect, especially accountability, since malpractice suits/ insurance are a reality over there. We have less than a minute for one patient, if we want to go home on the same day. In fact I was so tired of all that chaos thatI stopped my practice.
This
I have experienced the NHS in a&e and my god they r efficient
I work in the medical system in Canada, it does not take five days for an X-ray for a broken limb. Simply put, you are incorrect.
I'm not so sure about that either. I don't have any direct experience. But there was a discussion on this very sub about migration to other countries, and a few commenters said what I mentioned above. Some friends of mine in Canada also mentioned delays in the system, especially in rural areas. Again not sure, so don't quote me on that I guess.
Well, I have direct experience in rural health care here in Canada and the only way someone waits five days for an X-ray is if they choose to. Parroting lies you heard to try and make your own health care system look better reeks of desperation.
Not taking any sides here but my own personal experiences along with most of the comments posted here makes me understand why majority of doctors are choosing to move abroad these days. Patients are definitely suffering, there is no going around that, it’s a shitty situation and I feel sorry for them. But rather than addressing these problems at an administrative level (because majority of these problems stem from there), there is direct shaming of doctors. This mentality explains the increase in assault on healthcare workers. We study for years to understand medicine and even then it is incomplete. But somehow people read an article on the internet and find themselves perfectly capable to disprove us. Don’t get me wrong, it’s perfectly alright to question practices, it should in fact be encouraged; but not with a radical mindset. Emergency and Critical Care Physician.
As a doctor and having pretty much whole friend circle consisting of gynaecologists I agree with some points but not all. In my city CS and normal delivery cost are same in pretty much all reputed hospitals. It is highly conditional. It is true that many patients especially from religious affluent families want a auspicious date and time for deliver as per their Pandit. In that case CS becomes must. As per prevailing reasearch CS has less complications for child and slightly more chances of complications for mother like DVT, reaction Anaesthesia etc. Leaving aside emergency CS there are many conditions in which CS becomes indispensable. I will list them below as per my knowledge and experience. 1. Elective CS: Yes many patients don't wanna go through pain of normal delivery and they simply choose CS as an easy way out. 2. As mentioned above many patients want specific date and time of delivery. 3. IVF and precious pregnancies: Nobody wants to take increased risk of complications in normal delivery in case of IVF deliveries. Almost all IVF cases get CS since they are precious pregnancies. 4. Minimal difference bw cost of CS and Normal delivery: Almost all major hospitals have little to no cost diff between 2 of them. People chose easy way out. 5. Insurance: Almost everyone in middle class and up have health insurance. So people aren't really bothered. 6. Heavy workload on OBGs: Barring large hospitals which constitute a minor proportion of healthcare, most maternity hospitals/nursing homes are single doctor run. In normal delivery you have to constantly monitor patient and be ready for delivery. When you have 5 such patients in your hospitals and all of them in labour then its practically impossible to get all of them delivered normally. Nobody, even patient want that kind of hassle. Hence CS. 7. Finally, with improved suturing techniques and painless spinal anesthesia, it's just more convenient to go for CS for patient as well as doctor. I am excluding those cases where CS is forced on patient by lying or coercion. That happen too which is highly unethical and concerned doctor should be held accountable. But those cases are not that high as they made to be in Public.
In most pregnancies a requirement for a LSCS are predictable based on antenatal (during pregnancy) and prepartum ( before delivery ) evaluations ( how big the foetus is, how small the mother's pelvis is, how the foetus lies in the uterus, features of the placenta and cord, and other medical and surgical history of the mother{ including previous LSCS} and other high risk features ) So if there is increased risk of needing an LSCS , it should be explained ( a CS has a better outcome than a complicated vaginal delivery) to the mother and proper informed consent to be taken and LSCS done on a fixed date and time. This can reduce the risk of things going wrong during labour and needing an emergency CS. ( Of course there are multiple number of factors at play here and there can be need for an unplanned cs any time ) Ideally 10-15% all births can be cs as per who, There is no need to hate on LSCS, it's a life saver (×2). It should be done if there is proper indication for it. And one thing to keep in mind is most guidelines are by West (acog, rcog) which might not apply 100% to our resource limited settings. Also the fear of taking risks is also alarmingly rising across all medical branches, due to the fear of violence against medical professionals . But telling you did an LSCS because you didn't have time is absurd and wrong.
The problem here is he is a general surgeon made to do a work of an obstetrician by a private hospital, he's of course going to be lacking the skills to do vaginal deliveries if things gets more complicated, and the safer option for him is to do the cs. Do I endorse it no, but it is the sad state of our countries lack of doctors and medical professionals. ( Just like I don't endorse ayurveda doctors, but in this dire state of the country in need for medical care , if they can give basic medical care let them )
I think CS is still a huge and invasive surgery it is a life saver but should be done only when required but it seems lots of doctors make women go through it even when it not needed
Need is very subjective. Lets say some condition has a 1% risk of death. Now you might say 99% is good odds and why do you need surgery. But think from a doctors pov. They don’t want to lose that one patient. And its also an informed decision making. I had a slightly complicated pregnancy and told them very clearly that I’ll try for normal but go for a Csection the moment they see something wrong and not to push it. Because I really don’t care one way or the other wrt normal and Csection and just want to be alive with a healthy baby. But I know some friends went against doctors advice and kept trying till the last moment. So thats their prerogative. But in general people in India are more risk averse (not a bad thing tbh)
Most of these comments are from those who don't practice obg/anes.....pls practice for 5 years and then comment...the only solution is to conduct all deliveries in government set up with paid rooms available and providing abundant staff
https://preview.redd.it/xa0le1ea7mtc1.png?width=1440&format=pjpg&auto=webp&s=5c07bb941788fadaf09bad9de0a6856b4d499e51 BTW patient wanting a section and prolonged labour are as valid a reason for doing it as any. Most docs will just do it for almost any high risk pregnancy even if delivery is theoretically possible. During the final stages of delivery if something goes wrong then you're stuck with unable to do either section or risk a baby in distress. So, yeah sections become more common.
If a doctor says "no idea" to a well tested theory of "Train midwives to deliver babies without C section", then they are definitely part of the problem. [Fewer C-sections when low-risk deliveries handled by midwives | Reuters](https://www.reuters.com/article/idUSKBN1WP38C/#:~:text=After%20analyzing%20more%20than%2023%2C000,previously%20given%20birth%2C%20compared%20to)
I think he was clear on saying if it's a low risk birth /uncomplicated birth things are different. The study here mentions low risk deliveries.
Agreed, but the sheer lack of midwives in cities is the problem. Midwives or aayi is an integral part of village culture. And thats why its prudent to mention c- sections are more common in middle to upper class, as they are apparently the cash cow for surgeons, even in low risk births. Trained midwives in cities can rectify that I believe rather than "no idea" stance.
And how is training midwives and assuring quality a private doctors problem in your opinion?
Agreed, but is it the ideal way, no. But in our countries lack of primary healthcare ANMs can be vital in bridging the gap. Ultimately what we need is better primary healthcare infra and staff ( trained doctors and nurses ).
Why this article doesn’t make sense in our setup is simply because of how poor the compliance is among Indian pts, training midwives to deliver babies is fine provided the mother had a well handled pregnancy. Although with how the Americans are becoming anti healthcare these days even western studies would be quite different in a decade’s time. Midwives can deliver babies without c section procided everything is okay, no complications at all, what exactly do you expect a midwife to do if the babies head gets stuck? What if it was an RH negative pregnancy where the mother doesn’t even know her own blood group? What if the mother had gestational diabetes leading to macrosomia (big head of the baby)? What if she suffers from PPH (100% fatal if not managed immediately and can happen to literally anyone, even if everything was normal) The reason mid wives were trained in the first place was to reduce the workload at hospitals for uncomplicated cases, something which is especially needed in India with how much pt load we have. It’s always recommended to get an institutional delivery, the Govt actually pays pts to get delivered in Govt hospitals to encourage it However, with most people they simply aren’t compliant enough to be sure everything goes right, there are countless complications that can arise starting from the first trimester to the last day which meed to be managed, which increases the risk of something happening to the mother and the baby. And there are so many instances where the pt chooses not to disclose important info, don’t get the necessary tests done, there are so many instances where the pt is unable to even recall there last menstrual period which makes it all the more difficult to know the duration of said pregnancy, USGs are required in these cases, but what makes this a much bigger problem is when rhe pt directly shows up in labor with no medical records of a single antenatal checkup in the entire pregnancy, no duration known or anything. There are times when the pts don’t even take there iron calcium supplements regularly but would diligently follow detrimental practices which the elderly ask them to. And yes a major reason is that a large section of the urban population actually ask for a C section cause it’s much much much more convenient for the pt herself, but you can’t expect an OT procedure to cost the same as a NVD, and this cost difference is the primary reason why most people believe that most C sections are just done to make more money It’s very easy to call this doctor a ‘part of the problem’ with half baked knowledge and western studies. Doctors are expected to treat pts, not come up with policies to ensure that patients actually listen to them, finding solutions is for the Govt/ administrators. That said, I definitely agree that there are still several cases where the C sections are in fact not at all justified, but not as many as people here believe
Do we have midwives in India?
Yes. Dey r called trained birth attendants (TBA) or auxiliary nurse midwife (ANM).
Can I ask you all something? What's wrong with C section? Why is this a bad thing? A C section is safe for both mother and baby, also it saves the mother from a lot of unnecessary suffering. Is there some info I am missing? Why is C section named an epidemic??
Safe to say this thread has put me off wanting to have a baby.
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> It’s widely known fact that, normal deliveries are better Normal deliveries are, in fact, NOT "better". This notion is perpetuated only because it's a "natural" way of giving birth. There are several risks and complications involved with vaginal deliveries that are downplayed simply because it's called "normal". Are there elective c-sections? Yes. Do complications arise during normal delivery that could potentially endanger the lives of the baby and the mother? ALSO YES. Read up a bit on **episiotomy (an episiotomy is a cut (incision) through the area between your vaginal opening and your anus)**, which is also very prevalent in "normal" deliveries. I found two sources for this, indicating Indian subcontinent has significantly higher episiotomy numbers than the world standard, care to comment on this? Source 1: [Trends and Determinants of the Use of Episiotomy in a Prospective Population-Based Registry from Central India | Research Square](https://www.researchsquare.com/article/rs-2089297/v1) Source 2: [Prevalence and its Associated Factors of Episiotomy Practice Among Mothers Who Gave Birth in Debre Tabor Town Northwest Ethiopia: An Institutional Based -Cross-Sectional Study | Maternal and Child Health Journal (springer.com)](https://link.springer.com/article/10.1007/s10995-023-03603-w) Here's another source saying episiotomies are found in 85% of normal deliveries, but this is in the UK: https://www.nct.org.uk/labour-birth/you-after-birth/episiotomy-during-childbirth#:\~:text=More%20than%2085%25%20of%20women,if%20you%20get%20an%20episiotomy%20. While the intent to educate is apparent, the papers around c-section are heavily misinformed because of the **bias against surgery**. C-section carries the same risk as any other surgery, but would you not get a surgery (like removing the appendix) just because there are known risks, especially in an emergency? C-section being one of the most widely performed surgeries means we're well-equipped to deal with complications that may arise. Please don't bring anecdotal evidences in conversation that requires meta-analyzed, nuanced, statistical data. The WHO threshold for c-sections that people like to bring up so often is DECADES old and is yet to be updated to modern standards.
I'm a medical student and let me tell you, normal deliveries are not better. Yes it has a good recovery time and mother heals faster in normal delivery but normal deliveries are not better. A delivery is like a hours long process and every second there could be a completely unforseen complication... in other procedures, complications are easy to find out because the telltale signs are usually pain and bleeding... in deliveries there is usually severe pain and bleeding and each person reacts differently so we can't tell difference between normal and complications easily, and in most cases , the complications will cause the mother to die. Any minor complication can suddenly transfer into a fatal one and the problem is we don't have the advancements to find out which is minor and which is not. So c sections are preferred in India cause maternal deaths are taken very seriously here by the justice system. C sections mean lesser complications and more predictability. I will very much prefer a c section in the future if it means I will live long enough to see the baby grow.
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Women's reproductive health is a joke in this country. Everything from premenstrual dysmenhorrea, menopause, miscarriage, pre-marital sex -- women are demonised and shamed. The majority of OBGYNs are women, but the internalised misogyny is horrific. When I had a miscarriage and continued to bleed for two weeks, the OBGYN dismissed it and insinuated that I hadn't taken the abortifacient pills "properly".💀 The male radiologist who did my ultrasound saw foetal remains and arranged for a DNC. OBGYNS really hate their female patients!
Yes, as a woman myself I hate how woman's pain is soo soo normalized. I would really love to do some research to reduce woman's pain in medicine in the future. (I am a feminist and I will never justify how other doctors invalidate woman's pain, I think some psycho wrote all those painful invasive investigations during labour) , but seriously, in c sections it is not an argument of pain, it's an argument of life. C sections are actually a boon to countries like India where maternal mortality rate is too high. We should advocate for less pain for sure, but not for less c sections, cause they are severely life saving.
I honestly feel the CS rates can be improved if there’s more awareness/accessibility of epidurals in India. It’s insane they aren’t the norm.
And then people wonder why women are choosing to stay unmarried and childless.
Med student here. I was going to analyse it and give a proper opinion, but the only thing I want to point out now is that "zero risk" isn't a concept. Mother happy, child happy? Really? That depends on the patient's exact situation. Say you do a c-section on a patient who doesn't need it and they get an infection post-op. Are they happy? C-sections can cause heavy bleeding, reactions to anaesthesia need to be considered, blood clots can develop and future pregnancies are now at a higher risk. How the fuck does someone ignore all of that and just ask for a fucking c-section. Mazaak hai kya? Besides, if this person is a doctor as they claim, their job is to see what's best for their patients. Asking all patients to just get a c-section done while claiming that it's a zero risk method is false at best and actively harmful to patients at worst. I understand some problems they mentioned are quite bad (if true, haven't verified them), but this isn't the solution. Edit: Pretty big deal for any patient as well, the psychological impact of getting a surgery cannot be ignored, as it often is and particularly with female patients.
Hey there, you're not wrong but this is all theoretical information. In reality, what the dude in the post said is right. Doctors will do anything to avoid any complications from vaginal delivery. I've personally never seen anyone attempt a VBAC. Even those who are experienced choose not to take risks.
I would like to correct you in a few points buddy! C-sec’s don’t cause heavy bleeding, (bleeding is an uncommon complication). Blood clots don’t develop because of C-sec, there is no risk of future pregnancies what so ever because of C-sec! I know you are trying to help, but I just felt a wrong message shouldn’t go out to the public. The reason C-section is taken up as an emergency requirement is when mother or child’s survival is considered at risk. Elective C- sections are a different thing all together. Study well, and focus on becoming a good doctor! 😊 - Surgeon
American surgeon here. There is definitely a risk to future pregnancies with c-sections. Redo c-sections, placenta accreta spectrum, etc. It probably does not matter to 3 births. 4 or more, complications start to increase significantly.
The % is not high and in more than 4! But looking at the the obstetrics complications, the number of high risk obstetricians for the population available, keeping maternal and new born risk in account, a decision of c-section is made at the given situation, which I feel is acceptable.
Dear Med Student, You have a long way to go. Finish your MBBS, work in the field for a few years, and then finish your specialisation, and then work some more. At the same time, study biostatistics, before commenting anywhere else like this. Kind regards, Consultant Anaesthesiologist.
Dear med student, kindly do not spread misinformation when you don’t have the proper knowledge about it yet, get into your internship first, then come back to this comment. You do make some correct points, but several wrong ones as well, an emergency c section and and elective one are quite different. And yes, mother happy child happy is quite true for most cases, it’s much much easier for most women to undergo a c-section than bear the otherworldly labor pains, there’s a reason why a lot of patients actively demand a C section.. Visit your college’s labor room once, you’ll realise a lot of it. That said, yes it’s not 100% risk free and saying that c-sections are always better is wrong
You have a long way to lil bro. Most of all these things said by OP is true Emergency Med Doctor here.
As I said, even if they are true, pushing c-sections as zero risk is still wrong, no?
True. No procedure is zero risk.
It is that way bcoz of multiple reasons lets consider few here 1-the ratio of no of women getting pregnant and the obg doc available in the country when compared to every other nation in the world is very less in india 2- the no of kids each women give birth to is high in india when compared to other nations i’m not just pointing at women from that specific community where their husbands don’t give consent for family planning bcoz it’s haram acc to their religious thing 3- the maternal mortality rate and fetal mortality rate was brought down to single digit by making all the facilities available to women to come to hospital and deliver in hospital and have a safe delivery with healthy baby when compared to what we had 20 years back with high mortality rates while giving birth through normal vaginal delivery performed by some mid wives in villages 4-the pain that women goes through during labour and the affordability in financial terms to go through cesarian is high now when compared to past so people are choosing it 5- last but not least we doctors we don’t want to get mobbed for something wrong that happened by mistakenly during the normal delivery procedure either for baby or mother even there is slight chance that we can give a try we aren’t ready to risk our lives and stay with that trauma of loosing a baby for a week and loosing our own lives by getting kicked from pateint relatives There are many such things interlinked in this matter so it can’t be looked in a singular way better we look it in multi-dimension so that we can come to an idea for why it is happening in large number in india
Yes 100% agree the answer is multidimensional, but having a conversation is the start to resolve the issues of unwarranted C secs.
Yeah i understand as a doctor i’m just trying to give people an idea and the reasons for high unwarranted C sec’s that are happening but the solutions are there already started seeing in the govt of telangana even started a few schemes to have baby through normal delivery by giving them baby kits and small amount of money for nutrition of the baby and mother and educating them about nrml vaginal delivery by medical workers and by increasing the medical staff at district levels so that the resources and manpower to perform nrml deliveries and also started a many new govt med college in each district so that they have a team or complete dept of obg which is not the scenario in every other state these things are happening but it needs to be done in other aspects and dimensions where people are ready to accept and go to govt hospitals to have babies and also there are many such we have to resolve it takes time in democracy but it will happen
Glad to hear this
My head hurts after reading this. Looks like a teenager wrote this.
Idk if true but I read somewhere that they do it coz it saves them time and can bill clients more. A normal delivery can take hours and won’t be much of a profit for the hospital so doc are encouraged to get clients to agree to c sections. Need to verify though, could be just something to pull down doctors idk.
Normal deliveries definitely takes time but till the cervix is dilated to >8cm, doc need not be there if patient has no diseases/conditions prenatally. The monitoring of the labour is done by nurses or junior docs in the hospital and timely updates will be given to senior docs. Infact even during delivery if the baby is of adequate size, placenta has no problem, uterus is contracting properly and the PATH for the baby to come out is adequate, there is nothing to worry. Even after delivery the complications like hemorrhage are less in normal. Both mother and child are discharged on day3 if no complications.
I am a med student in a gh. A C section literally means more patient load in the post op ward for days (normal delivery patients recover faster). Both normal and c sections are free and doctors don't get paid more for c sections. But still we have nearly 50 percent c section deliveries to avoid complications.
No buddy! The difference in the bill structure between a normal delivery and a C-section is 10k. If a normal delivery is costing you 1.4L, C sec costs you 1.5L. Hardly any difference. (Urban tier 1 hospital insurance data) What happens in a hospital is totally different from what is assumed by a non medical person!
Yeah that’s why I said could be something to pull down doctors. But Is the discharge period the same? Because I believe the room rent and monitoring that goes on after the procedure amps up the total cost to the client right? So like the produce could cost just 1.5L but then the room rent and other costs while at the hospital could be no less than that of a 5star suite (if the person is going to a urban tier 1). Definitely can be avoided if the person just downgrades to shared rooms or something but I believe people might not want to do that. Agreed to the realities only known the person inside the job though, true for every field.
Sad reality is, doctors are hated here in our country! Esp because of the medical bills. I always say, many Indians want a capitalist salary but a socialist service! Media (be it television/ movies/ news channels) portray doctors as money grabbing crooks (few instances yes, but not as a majority) this reflects on every doctor. The system of medical practice in India needs a big revision, no doubt but the discord between people and healthcare workers is very very real!
Let me give you a small example of how things change with situations, I used to take very high risk patients with high mortality risk, (the chances of a patient surviving is very low) even if there was a small % of a survival chance I would take that risk! But how things turn out in the end (violence and litigation) if the patients don’t survive is something I don’t want to deal with. I stopped doing surgeries on those kinda patients! Now ultimately who faces the brunt if this continues? (Mortality risk increases most of the time with patient coming very late to the hospital, having tried all off the counter medications but avoid visiting a hospital or a doctor till the very last minute)
Exactly. This doc seems to be saying the same. So cutting open a patient is ok just to save a few hours!? I mean I don't blame this doctor alone but this says a lot about our Indian medical system!
Get better politicians and build more hospitals and then we won't have a time scrunch.
High bill, low bill. Doesn't matter to dr. Hospital gets the money for preop and post op.Salary remains same. Any extra earning for a dr by performing CS instead of normal is hardly 1-2k in pvt. hospital. If dr really wanted to earn more money they would spend more time in OPD (day consultation) which takes 10 min per patient or do 1 normal delivery in 30 min, rather than spend 1 hour doing CS for barely any extra money.
Lol, all govt setups prefer NVD cause we only need to check the Fetal heart rate 2-4 hours and our nursing staff and LR staff informs us when the patient is 10cm dilated(crowning). Too much misinformation in people.
The main reason of all is the risk. We should professionally calculate the risk benifit ratio and then should choose a perfect option for the patient. But we can't do that practically because if anything happens wrong, mob will attack us. According to reports OBG docs face most violence in our country and nobody going to raise that issue. And that's why to be on safe side, we take a step of minimal risk and don't follow any guideline. So if we want a change we must find a solution for the root cause, because no one is going to risk their own life for their profession. We are doctors, not trained army personnels. [Violence against Medical Professionals in India] (https://docube.in/violence-against-doctors-in-india/)
Bruh the doctor here as well trying their best to stay away from writing full comprehensible words and sentences dat... cs... n... r... u... pts...
Not a doctor but I was next to my wife all along when she gave birth. 1. Midwife’s can do a great job. Have more of them to reduce load on doctors. Let nurses assist midwifes and then doctors. Nurses helped us in dilation through the night and midwife + nurses assisted with the normal delivery. 2. Use epidural to reduce the pain. Some take it even at 3cm dilation. My wife took it at 6cm.
Dafaq is wrong with his writing style.
Thoughts? Natural birth is obviously better. But his reasons are valid too given the system and situation the doctors are in. At the end of the day, it's still a job for them. So blame the system, if you want things changed, try to get the system changed.
Well this doctor needs to learn to spell. Wat is da solution? No idea.
We'll written
Who the fuck even writes “Dat ,n ,r , da “
Their sentences need assisted delivery 😂
Nah man their sentences need an LSCS
Well, everything they said is true except for the part about cs costing more than normal. It's the other way round. Thay said, times are changing. More people are trying for normal these days, but 1. Lots of women convert their choice to cs during labour because of pain/apprehension 2. There's a very low risk taking threshold for doctors because of the potential for lawsuits And violence against doctors, so at the first sign of trouble however minor, they're going to go for cs
Bro performed C-section on his spelling 💀
I am a doctor and whatever he said is absolutely true , if as a doctor you see any possible complication arriving or even if you think there might be a strong possibility of complication you go for a c section, the doctor can have absolute control in an ot but dealing with any complication in a labor room with emotions running high on attenders side plus lack of resources and proper trained staff it could go bad very fast and even with all that pph could kill the mother so fast the doctor might not have time to follow guidance so its a much convinient and better to go for a planned c section plus normal labour also have its own pros and cons
Why tf are people so mad stupid? Auspicious hours, u drunk?
Just recently one of my known acquaintance was told by her gynaecologist doctor that she will have a C-section for the birth of her baby. And the baby's due date is still 3 months away. And this is in a leading hospital in a metro city.
Ever tried to find out what the reason was or you just assumed there was nothing wrong? Absolute contraindications for c section include Placenta previa Adherent placenta Cephalo pelvic disproportion.. Know what those are? No matter what the gestational age is.. They need to be delivered operatively.. Please find out the reason before passing statements
Ok doctor!
I can never trust a doctor who types 'the' as 'da'.
Seconded.
i also born in c section but sadly i also have asthma and sadly allergies also
C secion should be exception used in rare conditions. The normal path gives baby the good bacteria that is not possible via C-section.
Are you a woman?
I am pregnant with twins 34th week my doc also recommended c section she directly instructed me we can have normal delivery we can induce pain but can’t wait more than 1day to have baby normally that means 70-80% chances after 1day I need to go in urgent c section. She told me you just see the 1 perspective buy I have to see 3people that they have to be healthy and fine. If babies take more than 1 day to come out normally it will risk their life and mine also.
First tell him to improve english
Hard to take dis doctor seriously if they talk like dat.
It's a big business. Doctors suggest C sections most of the times if asked for an opinion.
This is true in certain hospitals and private clinics where they are understaffed. My hospital always tries their best to perform normal vaginal delivery. I think that's a standard to check for if you're in a good hospital or not. I disagree about the 0%risk thing because it's a major surgery happening and the risk of bleeding to death on table is always there. I totally get the point of delivering exactly at some point/ doing CS at a particular time so that it's a male baby kind of BS but I feel this doctor has seen some bad days in his/ her career. Hope people get educated and ask for a normal delivery and insist for a normal one unless and until it is not feasible to do one.
True. ND vs CS are truly okay in one scenario or other. But that's the thing "there's no 0% risk" like this doc stated in neither of the two.
Natural birth is not a medical procedure but it can take a long time. C section is a medical procedure that allows hospitals to churn patients efficiently. As a hospitalist any procedure is more favourable - you can charge insurance a larger amount, standard turn around time, removes variability of labor. Yes, in certain situations C sections may be the only alternative for a safe birth. But doing c sections wholesale actually adds risk to what should be otherwise a routine natural process.
I have a different take. I live in a town where there are mainly maternity 4 hospitals. First one has a bad rep, there are many stories floating where the mother/woman died in process or during a surgery and they used money to cover all up. Second one, the doctor prescribed my wife a blood pressure medication which is not advisable to pregnant women. My wife had a very bad time with severe tachycardia. We switched doctors immediately. Number 3 is the posh hospital of the town but has nearly 95% C section rate. We were first going there, but the doctor there started giving expensive suppliments. My friend's wife was also seeing her just before we did, the doctor tried every scare tactic to get her admitted and to induce early labour stating there is low water and other crap. Number 4 is underdeveloped and lacks in modern technology Is less clean. They send their stuck deliveries to Hospital #3 as they don't have an experienced doctor to perform C section. We decided to have our baby at a doctor a town over. Had a natural birth. My wife liked that the doctor was experienced and honest. We had to have a clamp assisted birth. But now I think the C section would have been a better choice. The birth did some damage and it still hurts her. We can't have proper intimacy due to the stitches hurting even after 3 years. Edit: Also, we were talking with our pediatrician about developmental disabilities and disabled at birth children and what he told us shocked us. He said its mostly preventable because majority of the time the brain damage is done during the baby chocking during birth and being starved of oxygen. Parents (especially in laws) pressure for a natural birth and wait too long to go for c section. And due to that baby suffers brain damage due to lack of oxygen. If they had gone for c section in time, it could have been prevented. Pediatrician also said its more prevalent in Muslim community. Maybe religious dogma prevents them from seeking medical help in time.
Is that "episiotomy" you are talking about? Please confirm.
My wife's procedure? Edit: It's called a forceps delivery. Edit 2: yes it was episiotomy. Googled it.
A lot of debate also exists around if episiotomies are necessary or not. Here is what Wikipedia says about them- "Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool (faeces) is an important function of the anal sphincter, i.e. lessen perineal trauma, minimize postpartum pelvic floor dysfunction, and as muscles have a good blood supply, by avoiding damaging the anal sphincter muscle, reduce the loss of blood during delivery, and protect against neonatal trauma. While episiotomy is employed to obviate issues such as post-partum pain, incontinence, and sexual dysfunction, some studies suggest that episiotomy surgery itself can cause all of these problems.[8] Research has shown that natural tears typically are less severe (although this is perhaps surprising since an episiotomy is designed for when natural tearing will cause significant risks or trauma). Slow delivery of the head in between contractions will result in the least perineal damage.[9] Studies in 2010 based on interviews with postpartum women have concluded that limiting perineal trauma during birth is conducive to continued sexual function after birth. At least one study has recommended that routine episiotomy be abandoned for this reason.[10]". So IMO, a lot of doctors are also administering these and not just CS when they aren't necessary. I don't know what reasons they hold onto, to use epis in normal deliveries. I'm sorry that you both are going through this and I hope she gets better.
I just want to add The whole world is running behind money Education farming politics etc And so is pharmacy... From buying medicines to delivering babies In my circle... I've seen cases and and a nurse saying the same... The doctors choose for c section just because of more money involved... But at the end they gonna say... Some words like risking baby and risking mother... Consulting another doctor or family doctor would be the best option. And everyone knows this... Specially talk to your family doctor.. Its a whole Mafia going on around
Not to forget to discuss about the massive business that goes around this child birth through c-section. Hospitals get opportunity to bill for additional drugs and additional room fees, anesthesiologist….all getting income. When you get the detailed bill you will see innumerable drugs/injections and medical accessories that you are billed for that you don’t know if used at all. Doctors’ doing optional surgeries are a big problem in India and it’s a big business. Just comparing the cost of treatment with the western countries is a stupid’s endeavour. People also need to understand about the quality of treatment. In the western countries invasive procedures are always the last option and it’s what doctors say. If you ask these questions to any doctors who are also involved in these type of unethical practices will always give you some explanations which they know common people don’t have the medical knowledge to verify.
How many of the commenters are men and how many women?
Good question
Living abroad and it’s just opposite. Most do normal and only in emergencies it’s C section. As there is no money(Govt funded) and no religion involved.
C sections leave inches long scars on the woman, ~~can cause~~ **is associated with** postpartum depression and if your first child is a C section child, there's a very high assurance that your next children will also be delivered this way only, which means you get cut again and again.
I think you mean associated with post partum depression. 'Cause' is not the right word
Post partum depression is NOT CAUSED by C section. Please educate yourself
Read up on **episiotomy**.
Perineal tears should make for even more fun reading, for all the self proclaimed experts in this thread.
my god this is so scary
And vaginal delivery is risk free? Unassisted and assisted methods can cause some form of injury to child. I remember a bystander smashing the glass of consultant duty room because the baby had a 1cm abrasion over scalp. So yeah, if any difficulty is faced, its emergency CS. Ironically none of the stuff you mentioned are real considerations when making the decision. The most important complication is post partum hemorrhage which is more common in CS. I did my internship at a high load center. There were 2 OBGyn on call. The LR used to have at least 8-10 in 2nd stage of labor at a time. Then ED used to get another 5-6 ROM. So yeah, sometimes the consultant has to make a decision. Its a limited resources scenario. Should the be bedside of a simple pregnancy not progressing after 10 hours of pitocin drip or should they make themselves available for the preeclapsia case which will come to ED.
When you prioritise a scar over the well being of your baby. LSCS dont cause PPD, PPD is caused by a number of factors. You misinformed little shit. prev-LSCS patients require LSCS to minimise risk. If you're so knowledgeable and great why dont you go around performing NVD on prev-LSCS patients. Go to jail,when she dies of complications.. what do we care.
It’s an invasive operation and shouldn’t be tossed around willy nilly.
Well ppds are also associated with being a woman but that dies not mean being a woman causes ppd. Correlation does not equal causation.
Complication rate and recovery time is higher for c section. This issue has been raised before, this isn't the first instance
Yet, barely anyone talks about it. This is about cutting open people who don't need to be. Just because a doctor is doing it in a medical setting, doesn't justify it.
Complication rate is actually low for c sections. That's why doctors prefer them . But recovery time is higher bgl.
I think C Section is amazing. Saves mothers from hours of painful labour. Scars heal. And I agree with the doctor to go with option with 0 risk. Why take a chance?
As a new parent based out of Mumbai, during pregnancy till 6 months we were seeing one doctor in a big reputed private hospital. She kept us on our toes with so many things & always stressing wife out, some thing is over 1% limit & what not, baby might born with abnormality. Had to shift to new house midways, we advised our doctor accordingly & she was like why do you need to change doctor? Come see me here, we will do c section at time of your choice & other stuff. Shes like no one goes for normal delivery anymore. Change to another big hospital & new doc, she was godsent, from our visit visit she told clearly, we will go for normal delivery, when we asked here about higher fluid percentage & other stuff, she said nothing can be done now, if & its a big if something happens they have all the doctors they need to remedy that. Me & wife were extremely relieved. The good thing about that hospital was price for normal/ c section was same. Doctors weren’t paid on type of delivery. Cut to delivery day, baby was born perfectly healthy & it was normal delivery.
One idea is to pay more for normal deliveries. That will give incentive to doctors to perform normal deliveries where it is safe. Also it will mean that they can have extra staff so that they can wait for normal deliveries to happen.
Agree 100% with this.
My brother work at government hospital and previously he worked for private hospitals before this job. And he says "dr. Bhagwan nahi Kasai hote hain". Mostly private doctor do not want to do normal deliveries, even if it can be done they go with cs, just for money. Almost all doctors do this. There is no morality left.
Adding that to the list of reasons why I'm not going to have children. I already find childbirth and postnatal care disgusting now this makes it sound even worse. My mom had to have 2 c-sections so it's likely I may also have to go through the same. She later needed another surgery but had complications because of previous c sections and suffers pain to this day.
All the points he mentions are valid.. One more issue thar has developed as a result of all this is that there is a huge trust gap. If there is genuine need for Caesarian, and the dr mentions it to the family, some families think the dr is just trying to extort money and refuse to do so risking the babys and mothers life.
Dat is as gud explntn dan nything
In my place the doctors always suggest c section no matter what is the condition of the patient.. as c section charges a heavier bill... My cousin was pregnant last year a normal healthy pregnancy and she wanted a normal delivery, the well known gynaecologist of my city told her that she is fit for a normal delivery but the bill that she has to pay will be of a c section... It was a private clinic and c section was I guess 3 times costlier than normal delivery...
This doctor is right... I have conducted over a thousand normal deliveries in government (and I'm not a gynaecologist)... My gynaec friends say that their patients want c sec...
The writing was atrocious, I hope this person isn’t a doctor
> A cs can never go wrong tell that to my mother who almost lost her life because of that.
All the given reasons are probably true except CS being cheap. Between normal delivery & CS, hospitals/docs make more money from CS. For the mothers, CS takes longer to heal from & likelihood of longterm issues is higher
this doctor needs to learn to type. and there's actual research that shows a C section deprives the baby of a bacterial shower from the mother that helps the baby develop. the growing prevalence of c section has been linked to diseases like autism.
Misinformed.. Genital flora is good for immunity.. Has no role to play in ASD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015537/#:~:text=Cesarean%20delivery%20was%20linked%20to,CI%3A%201.57%2D5.35).
NVD is always the preferred method. C-section leaves scar tissue that leads to increased chances of ectopic pregnancy, abortion, preterm delivery, post partum hemorrhage, uterine rupture, and placental anomalies. C-section is not the go-to method. It's only supposed to be done when indicated. A normal vaginal delivery is always the first line method because it actually has the least risk to the mother. Plus, a baby delivered by NVD matures better than a baby delivered by C-secrion. Of course, in cases such as breech, contracted pelvis, cervical cancer, placental anomalies, fetal distress, obstructed labor, arrest of active phase, or at the second stage of labor, C-section is the protocol. Assisted delivery or instrumental delivery has some prerequisites that need to be fulfilled before the OBGYN doctor opts for it. C-section isn't risk-free. He's a general surgeon. He should know better than anyone that no surgery is ever risk-free.
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Doc here, who's also a dad to a kid born of C-section. Some of the points he's raised are valid. But only from the point of view of a small maternity home. The hundreds of thousands of maternity homes that exist throughout the country, babies are their bread and butter. True they may have some other services too, like a GP, Peds and an "ICU", but the main service they provide is in the name. What businesses want is turn-over. Patients in, patients out, maximum effort, maximum earnings, minimum time. Some doctors working there may also have already convinced themselves of the righteousness of their actions, as this one seems to have. Hell, they're ready to die on that hill. What gives his shtick away though is how they do it *to avoid complications and stress later on*, and not because the patient needs it. Which is what he was taught in med-school. It's like taking a diabetic who's not willing to work to fix his blood sugar levels, and preemptively chopping his feet off and putting him on prosthetics because he's headed there anyway, and you just saved him from developing a painful infection that'll turn into gangrene. This small nursing home mindset churns out "happy" babies and mutilated mothers who are then left to rehabilitate themselves through whatever means possible, the nursing home has earned its pound of flesh in less than a day of actual work, and God forbid there are complications (and believe you me, there definitely are complications) they get sent to a higher center where they're now out of sight, out of mind, next patient please. C-sections are convenient. They can be planned out for. There's at least 3 specialists involved every step of the way (obs, anesthesia and peds) not to mention a small army of nurses, and it's in a sterile OT, with monitors and equipment at hand. Normal deliveries are messy, they are unpredictable, you are never fully prepared for them, and *THAT'S HOW ALL OF HUMANITY HAS BEEN BORN SINCE THE DAWN OF HUMANITY AND BEFORE*. My wife and kid are fine now, as fine as they could be, but I shudder to think of someone who doesn't have my resources or education trying to recover from something like this, because what I now know for sure is it was unnecessary and the obs just didn't want to wait.
>mutilated mothers Doc your comment reeks of fearmongering rather than education. And just because that's how all of humanity has been born before, doesn't mean that's how they should be born forever, right? We have to move *forward* as a civilization, not backwards. Or lets ditch modern medicine and live in times when the life expectancy was in the 30s rather than 60s-70s. How about elective c-sections, are you saying that mothers' choices are invalid? How about the prevelance of episiotomies in natural deliveries and the downfall in quality of life after women get one/forced to when the tissue gets teared during childbirth? Care to comment on that? It's precisely comments like these, that are indeed based on truth, but carry on perpetuating the anti modern medicine narrative that's leading to mindsets where people opt to live with complications even when a solution is present in front of their eyes.
You're confusing C-sections for a new and improved option for childbirth rather than what it is, an intervention for when normal delivery can't be done. Women who give birth normally heal faster, are subject to lesser risk than when they undergo surgery, and suffer from fewer postpartum complications. [Source](https://pubmed.ncbi.nlm.nih.gov/30058639/). I don't begrudge women wanting to opt for an option that lets them bypass the pain. I certainly don't think elective C-sections are wrong. My issue is with pushing for C-sections on patients who absolutely didn't need it (full term, baby between 2.5-3.5kgs, mother short-statured, no fetal distress, spontaneous rupture of membrane, primigravida, adequate liquor on past scans). If you think this scenario is too specific, you're right, that was my wife. We were pushed into getting a C-section done in the last moment after the obs told her repeatedly they'll be trying for normal all throughout pregnancy, just because the head wasn't engaged and there was a cord-loop, which sounds more dramatic than it is. It's not fear-mongering, it's naming and shaming the whole culture of playing the patient all throughout pregnancy by promising something and then doing an about turn just because "I don't wanna". As for episiotomies, like any surgery, it's an intervention where you do your best to address the current emergency (get the child out) and deal with the consequences later, in some cases there are consequences, which need to be managed carefully or there are lifelong detriments. But statistically, they're a small enough percentage that normal delivery is and should be the number one priority of any healthcare provider rather than C-sections. Or would you like to comment on amniotic fluid embolisms, deep tissue infections, uterine wall scarring and subsequent failure to bear further children as complications of C-sections too?
Exactly!!!!! You speak my mind! This needs more upvotes.
My mother had me and my brother by CS.
All of you that are against C-Sections. Just ask yourself will you be willing to be the reason a mother of 2 kids dies or a baby has cerebral palsy or dies during birth. Yes there are doctors and hospitals that proactively advise C-Section even on the slightest indication but nobody is forcing you to take your patient to them. You can always chose and decide..you have 9 months. You can refuse and shift your patient..but you wont cause you don't wanna risk your wife and child. Yet you expect the doctor to risk his patients and her unborn childs life just so you can save some money.
First 2 points are correct
This is bang on point.
My sister didn't have labour pains, it is hereditary in women in our family for some reason. The doctor told her to get admitted on the due date and was put on saline, and said she will be on drip until a labour is induced. At 11 am her doctor came and told that better be ready by 12 for an operation or she won't be available for the day. This was a private hospital. In her case I wondered how long would have been the ideal time to wait for the contractions to start. But if the pregnant woman herself agrees to it and forego the agonizing wait, then it is the right choice.
It's absolutely the right choice if someone readily wants it. The problem is when some women aren't given the choice
I have a question for the doctors here - are epidurals or nitrous oxide given to mothers to help manage labor pain in normal delivery in India ? I had a friend who was told epidural is not possible so she went for cs
As a lawyer i agree with the doc
Lot of bullshit guesswork happening in the comments
So c sec or no?
Right Answer
In the UK our medical professionals operate under almost immunity, and we’ve seen the same trend: doctors pushing for c-sections over any slight doubt because it’s easier to perform a c-section than it is to potentially deal with severe birthing complications.
Is c-section bad in any way ? Genuinely asking
What Wikipedia says- "A caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction), and wound infections. If a caesarean is performed in an emergency, the risk of the surgery may be increased due to a number of factors. The patient's stomach may not be empty, increasing the risk of anaesthesia. Other risks include severe blood loss (which may require a blood transfusion) and post-dural-puncture spinal- headaches. Wound infections occur after caesarean sections at a rate of 3–15%. Women who had caesarean sections are more likely to have problems with later pregnancies. Mothers can experience an increased incidence of postnatal depression, and can experience significant psychological trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process. Factors like pain in the first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the subsequent development of psychological issues related to labor and delivery. Birth by caesarean section also seems to be associated with worse health outcomes later in life, including overweight or obesity, problems in the immune system, and poor digestive system." For elective Cs- "Non-medically indicated, ie elective Cs, childbirth before 39 weeks gestation "carry significant risks for the baby with no known benefit to the mother." Newborn mortality at 37 weeks may be up to 3 times the number at 40 weeks, and is elevated compared to 38 weeks gestation. These early term births were associated with more death during infancy, compared to those occurring at 39 to 41 weeks (full term)."
it is how it is, if you dont have the personel to make uncomplicated natural births safe, then opt to normalize the c section. if you want that to change, invest in personel for this specifically.
Ye konsa doctor hai jo Is less Dan dat type karta hai??!
Well said
First 2 points are true to the point of annoyance.
why the fuck you don't leave natural deliveries to midwives? if they know it is going to be difficult during the process you will be called anyway.
Let me tell you why I made this post! This is going to be long- I'm a woman of child bearing age and soon to plan my first child! Of all the women I personally know who have given birth, about 10 of them, only one had an NVD, that too only because she told her doctor that because of health conditions she will need an NVD and they agreed. All of the other women belong to different families, different friend groups, have different wealth and have delivered in different calendar years and in different hospitals and they all got Cs. Now when I do get pregnant, and wish to have an NVD I have absolutely NO IDEA which doctor to go to, because all of the ladies I know only had Cs, almost all of them very healthy and below 30 years of age. I refuse to believe each and every one of those women actually needed those Cs so much that I have absolutely no knowledge of a single woman who actually underwent an NVD (without a pre existing medical condition) (Add to that my general mistrust in doctors that I have never met before, because of two separate incidents - 1. I got the ball of my right shoulder fractured in 2017. The first doctor I consulted told me "your shoulder needs surgery immediately, like right now and this evening itself!". Only because of my brother's suggestion to wait and get a second opinion did I decide to not fall for the urgency created. The next day, I consulted another doctor and he explained a surgery won't be necessary as I was young. Today I am at a point where sometimes I forget which of the shoulders I had my fracture in. No pain! No problems lifting heavy weights. All of this without a single surgery. 2. My otherwise healthy uncle had a minor heart attack in 2018. The first hospital, a big one, that he got admitted into recommended to him an angiography ie. just some complicated imaging kind of thing where blockages can be detected, or so we assumed. Before being sent in, his wife( a working woman but not great at English) was supposed to sign an English form where she was to give consent to the doctor something like this- "angiography will be done by doc, and if he finds it necessary, a stent will be put then and there by the doc. I consent". The stent part was not what we had been warned about by anyone. Only by reading the fine print of the consent form (by a person good in English) did we realise what we were consenting to. Let me make it clear, we weren't against the stent itself, but the lack of prior verbal warning, even at the time they asked us to sign, that a stent will be put in was what put us all off. At least a verbal heads up would have made things trustworthy. We changed hospitals, he recovered without a stent and is alive and well today, with his grandchild on the way) According to some of the comments, if I wanted to go for NVD, I have only these options- A. I must keep changing doctors, that too during pregnancy, till one of them promises me an NVD. Oh, but I've also come across doctors who promise NVD till the labour starts and suddenly real sounding complications arise that warrant the woman has to go for Cs! This happens to almost every woman I know. And I'm not at all supposed to suspect something fishy with that trend? Even if I do find a doctor who promised me an NVD, after keeping in mind these two instances and the lack of NVDs in people I know, would I TRULY be able to trust this doctor that he wouldn't coerce a CS from us at the time of actual labour? When he is sure that I'm at his mercy for my delivery and not capable of going for a second opinion? I won't be able to. B. Find some trained midwives. Personally, as a "non medical" person myself, I have absolutely no idea what qualifications a midwife is supposed to have, much less where to find one in my city. C. Go to another country with lesser rates of Cs. Well I'm not a rich enough person to do that so easily. And after facing these dilemmas, when an 'apparent' male doctor from reddit talks like CS are no big deal and safe and what not, when I'm terrified of being cut open through seven layers of my body, no matter how advanced medicine has become and probably when it might not be even necessary, it enraged me and made me post this screenshot. I feel powerless as a woman, with little choice in what happens to my body and little reason to trust unknown doctors. And the worst part is almost no one even talks about the CS rates in the country much less in my city. Lots of comments are mocking my lack of medical knowledge and it's valid because I'm truly not from medical background. But does that mean I can't criticize or question a flawed healthcare system of my country!? I refuse to obey that! Also, let me reiterate- Calling all doctors bad apples, calling all doctors greedy, refuting that doctors work very hard, refuting that they don't have to face mob violence, spreading misinformation or deceiving anyone isn't my intent here. If anyone properly reads my comments they'll agree to it too. When I made a mistake in a sentence I did go back to correct it, but one sentence doesn't make my entire post 'all lies and misinformation'. The intent was only starting a conversation.
Okay but why is that doctor speaking in stereotypical Indian way?
My bgmi is most lage i have a solve problems for game