Low pain threshold, parents’ demands spiking Goa’s caesarean rate: Doctors

PANAJI: At 39%, Goa’s caesarean delivery (c-section) rate, which has been much higher than the national rate of 17.5%, will need long-term, definitive and sustained measures to drop. Although the high prevalence of c-sections is blamed on late marriages and the consequent delay in motherhood, other factors have also contributed to the high rate of the medical intervention in the state.
Experts say a low pain threshold among mothers-to-be, a growing desire of parents to have a child born on a certain day or at a fixed time (muhurat), seeking that a child is born before December 31 so that a year is not wasted and admission to a desired school is assured upon six years of age, and increased incidence in assisted pregnancies have all led to a drastic rise in c-sections in India’s tiniest state.
Interestingly, the trend of c-sections has grown despite the risks involved being much higher than a vaginal delivery. Goa records 17,000-18,000 live births annually.
“Various factors are responsible, but caesarean deliveries on demand have become popular. In several cases, a woman and her family insist on it because she does not want to endure labour pains. If a doctor declines, there’s a chance that she will go to another hospital,” senior obstetrician and gynaecologist Dr Govind Kamat said.
He said that a woman who has delivered her first child through c-section, is likely to undergo the procedure for subsequent births. “A doctor, too, will likely opt for a caesarean delivery to avoid the risk of rupture of the scalp while performing a vaginal delivery of the second child,” Kamat said.
Diet, a woman’s age of attaining motherhood, and her threshold for pain are among the important factors that will decide if she will able to have a normal delivery.
Conversely, a lack of awareness and fear of pain could also push her to make the wrong choice.
“Sometimes, it’s the parents who plead for a caesarean delivery as they can’t bear to see their daughter in pain and distress. Unlike their predecessors, women today are not accustomed to hard labour,” another senior obstetrician and gynaecologist Dr Ajit Mopkar said. “At times, even women who favour vaginal births will demand a c-section once they go into labour and will not take no for an answer. In such situations, doctors are left with no option but to oblige.”
Obstetrician and gynaecologist Dr Deepti Pinto Rosario said that efforts have to be made to avoid a first c-section in every expectant mother. “Even if a woman has had a prior caesarean delivery, she can assess her chances of having a vaginal delivery the second time around,” she said.
A woman who has had her first child though c-section will have around 30 to 50% chances of a vaginal delivery subsequently, senior obstetrician and gynaecologist at the GMC Dr Ajit Nagarsenkar said.
He said that the option could be explored if the woman does not have other obstetric and medical conditions and could be a way to curtail the rising rates of c-sections in the state. “We need to be very strict about primary (first) c-section of every mother to be,” he said.
While unreasonable demands by families during childbirth are not uncommon, Mopkar said he doesn’t give in to such diktats. “A delivery through c-section will not be conducted before schedule if there is no strong medical ground to do so,” he said.
Doctors also see a significant section of women becoming mothers late and contributing to the trend of c-section. After failing to conceive naturally, their only hope of giving a birth is through in-vitro fertilisation (IVF), with increased chances of a c-section to avoid complications during childbirth.
The GMC, too, receives such cases of women becoming pregnant during their 40s through IVF and approaching the institute for delivery.
“Normally, 10% of total deliveries in any set-up have to be through c-section due to various complications. The caesarean method was introduced for a safe delivery when vaginal births became difficult, but otherwise, the emphasis has to be on delivery normal process,” Nagarsenkar said.
Rosario said education and dispelling fears around childbirth will go a long way in preparing a woman and her family for labour.
While Goa’s c-section rate is close to 40%, Nagarsenkar said that there’s still scope to reduce it by at least 10%. The GMC sees about 4,000 deliveries a year, with 35% being c-sections. “Our c-section rate is about 35% because 25 to 30% of the cases that we see are complicated and referred by other hospitals,” he said.
“Considering all factors, there will have to be awareness that a vaginal delivery is a safe delivery. After all, childbirth is a physiological process, a normal procedure, that has to be allowed without much interference provided there are no indications of complications to the mother and child,” he said.