ALAPPUZHA, India, May 11 2011 (IPS) – It was smooth sailing for 30-year-old Susan George throughout her pregnancy, until the day she went to give birth at the government hospital. Doctors told her they had to do a caesarean section because they could not wait for a normal delivery.
George, a fish vendor, pleaded for a natural delivery, but no one heard her. There was a rush of pregnant women, hence the C-section, said doctors at the hospital in Cherthala town in Alappuzha district in the southern Indian state of Kerala, when George was admitted on Apr. 19.

The hospital is capable of handling only six surgeries a day, and lacks maternity and newborn care facilities. Despite these limitations, the doctors took the risk of performing 22 C-sections in three days, because they were rushing to go on leave for the Easter holidays.

The incident came to light after several pregnant patients complained that the doctors forced them to show up for delivery before their due dates.

District medical officer K. M. Sirabuddin noted that the mass C-sections represented an unusual rise in the number of caesarean operations (that) had become visible and many of these surgeries were unwarranted.

The cases have prompted the State Human Rights Commission to file a case against the hospital and the doctors, news reports said.
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The World Health Organisation (WHO) states that C-sections should be done only as a life-saving measure when there is a risk of fetal or maternal death. As far back as 1985, the WHO already stated, There is no justification for any region to have CS rates higher than 10 to 15 percent.

But the Kerala Health Directorate revealed that the C-section rate in the state is as high as 30 percent, and has always been much higher than the national average of 20 percent.

The Kerala Health Department says this is because the state has nearly 100 percent institutional delivery – in other words, almost all births take place in hospitals and not at home.

Women s rights activists say forcing women to undergo C-sections violates their human rights. The group is blaming medical bodies such as the Indian Medical Association for standing by errant colleagues instead of conducting unbiased investigations into such incidents.

The activists, led by former WHO consultant and professor Dr. T. K. Sundari Raveendran, said subjecting women to C-sections when not medically necessary is a violation of women s rights to a non-interventional normal vaginal birth.

There are good reasons to be concerned about the spate of unnecessary C-sections carried out in a casual manner. Consent has been taken from women, and doctors are not giving full and complete information about the possible side effects of abdominal surgery, the activists said.

India, however, is not the only country with high C-section rates. News reports say China has a 46 percent C-section rate, while caesarean operations in the U.S. have been increasing and have reached over 31 percent.

C.R. Choudhury, a researcher at the Mumbai-based International Institute for Population Sciences, studied the rate of caesarean operations in India and found that the state of West Bengal had the highest rate, at 32.50 percent, followed by Kerala with 28.38. The north-eastern state of Mizoram has the lowest at 5.48 percent.

Women s organisations say the C-section rate is very high in urban areas. Birth India, a Mumbai-based NGO, reveals that the surgery rate in urban areas is approximately 50 percent.

In the capital New Delhi, analysts estimate that C-section rates could go as high as 65 per cent in some private hospitals. Birth India says it can climb as high as 80 percent in private hospitals.

Dr. Manjula, a health expert working in a private clinic in Kochi some 25 kilometres north of Cherthala, told IPS that 70 percent of pregnant women in Kerala give birth by C-section. In many parts of urban India, women having caesarean section deliveries seem to be the norm and those having normal deliveries almost seem to be an exception.

The mass C-section scandals in Kerala have exposed not only the growing rate of caesarean operations in the country but also doctors growing lust for money, say women s advocates.

Senior physicians admit government doctors and private hospitals prefer C-sections in view of the financial gains.

Many gynaecologists are looking for money. A caesarean delivery costs an average of 20,000 rupees (440 dollars) more than normal in private hospitals, and in a few hospitals in New Delhi a normal delivery costs 50,000 rupees (1,100 dollars) while a caesarean section costs 65,000 (1,400 dollars) plus hospital stay and room charges, an executive member of the Indian Medical Association told IPS on condition of anonymity.

Obstetricians say the convenience factor was the major potential advantage of caesarean delivery on demand, giving a woman the feeling that she has a degree of control over the birth process.

Dr. Santhi Iyer, professor at a medical university in Chennai, told IPS that freeing women from fear of delivery pain, maintaining the mother s health and quality of life, and avoiding pelvic prolapse and urinary incontinence are other benefits that persuade women to opt for a C-section.

An added reason against making women go through C-sections is that Indian government hospitals are unhygienic, health activists say. Yet the poor and lower middle classes still prefer these hospitals.

The typical government hospital is without basic facilities, and hence the patients are often compelled to occupy the floor – even those with serious illness. The victims of mass caesareans were forced to share single beds and newborns are often kept on the floor, said Gopichand, an activist from Rajasthan state.