Gynaecologists forced to adopt defensive practices as govt. sets out to curb C-sections

Hyderabad: Are gynaecologists soft targets for society? On 1 July, observed as Doctor's Day, gynaecologists said they want society to respect the science behind their decisions to opt for C-sections rather than blaming them. With gynaecologists being pulled up in the state for C-sections and maternal and child mortality, they now find themselves forced to opt for defensive practice. This, in the long run, will damage mother and child health which is the core for a healthy population.

The advances in birthing process, complications in young and middle-aged mothers, and the continuous social and political interference in a pregnant mother's delivery status have become a cause of concern.

Pregnant women are at the receiving end of delayed decisions by families in deciding the choice of birth, endangering the life of the baby. On the other end, it is the practising gynaecologist who is blamed for the death.

With the state of Telangana reporting the highest C-sections at 62%, according to state health minister Harish Rao, and with firm orders to bring down this number, doctors say the interference of collectors and data managers is not required in delivery rooms.

With the government asking district collectors to keep an eye on private and government hospitals opting for C-sections, the complicated cases have become a round of excessive counselling of family members.

This order has left gynaecologists in the government sector under high pressure as they have to wait till the last minute and provide medical reasons for opting for a C-section.

Dr. Manjula Anagani, clinical director and head of the department of Care Vatslya, opines that science differs from patient to patient, and a government order with administrative interference makes it difficult for a doctor to freely practice.

"We are seeing the onset of defensive practice by gynaecologists and if this is not stopped, it will only affect the health of women, mother, and child mortality in the country," she says.

Why are C-sections being done?

· Older age pregnancies.

· Weight of the foetus a decade ago was only 2.5 kgs and is now 3 kgs which means heavy babies.

· IVF pregnancies.

· Gestational diabetes.

· Hypertension.

· Hormonal imbalances.

Dr. Anagani says, "There is a lot of social pressure when it comes to child birth. The husband and family believe that if the first child was normal all other childbirth processes must be normal. There is no understanding of the changes in the woman's body and her age. If it can be done normally why will a doctor not opt for it? This they are not willing to understand. High-risk deliveries result in complications many times due to delays in signing the consent forms. The family is not interested in what happens to the woman's body after childbirth and the problems she faces due to the delayed C-section or longer hours of labour pain. It's a lifelong problem for women."

Childbirth is not only a doctor's concern but must be that of the whole family. The worse noted in India is the role of outsiders with political affiliations who create ruckus at the hospitals.

In all these, it is the pregnant mother who suffers the most and there is no one to voice her dilemma, including the gynaecologists who are now forced to save themselves.

Trust deficit

The bedrock of a doctor-patient relationship is trust. The gap between the trust between a doctor and a patient is reducing. Doctors are expected to do their best but a patient and their families along with miscreants are "entitled" to insult, harass, and beat the doctor.

Recent incidents across the country at nursing homes post-pandemic indicate that the problem is much deeper.

Dr. Payal Bhargava, senior gynaecologist and infertility specialist, explains, "The ability for normal deliveries in different population groups is decreasing. This factor is not understood by society. Educated and uneducated people are at the same level when it comes to child birth. Sporadic information from the internet is taken at face value but the real medical reasons are not understood. Harming doctors and behaving badly with them has become a norm and if it does not stop, it will only endanger women's health in the long run."