CS (Caesarean Section) and Childbirth

JC Sanasam *

...who, after attaining specialized post graduate training, after spending so much of time, money and energy, would like to stay in such areas to rot away whatever I learned ?

CS (Caesarean Section) now appears to be the present trend in the management scenario of labour for child delivery in the modern hospitals. It is easily visible that this procedure of making an incision on the abdomen to open up the uterus(womb) and conducting the new born baby through this hole has gradually taken a more and more secure place, well accepted among the doctors and pregnant mothers as well.

The reason may be: with this procedure the doctors do not have to spend the fidgeting time and energy in waiting for a normal delivery and on the other hand, the mothers too would easily opt for this procedure to avoid the prolonged pain and labour, maybe more preferably to avoid the wear and tear of the reproductive tract during a normal delivery.

May it be more costly and may it require expert hands, involvement of a larger team of expertise and more manpower with more equipment and establishment, a trend is a trend.

It is always difficult to stop a trend. Through generations and civilizations the humans have been picking up things according to their needs and convenience. Skeptics, cultural activists, concept chauvinists usually loathe changes. However it is the courageous trend setters who eventually win intentionally or nationally or locally.

The results of this phenomenon of the ever increasing C S in the child delivery system are:

• All mothers, from all over the places more so in Manipur, are rushing up, for their deliveries, in the main hospitals, like RIMS, JN Hospital and modern Nursing Homes, where Specialist Obstetricians are readily available.
• There is an ever overcrowding in the maternity and post partum (post delivery) wards in these hospitals, even the corridors are thronged with full term mothers on mattresses, mats or whatever is at hand on the floor, especially during delivery seasons because marriage has its season in Manipur.
• Child delivery has become a rare scene in the Community and Primary Health Centres and Sub centres

The morbidity and mortality of CS not worse than natural or spontaneous deliveries:

One naturally would like to know the morbidity and mortality of CS. The saying goes that it is a life and death hurdle for a woman to bear a child. This still stands true CS or no CS. Moreover, this is also true that women, since time immemorial, have been delivering children ever since before the midwives and doctors emerged even.

And that is how again we are trying to mark our respect for women and mothers for playing a risky role during child births vis-a-vis for continuing our generations. Many an author has given his or her opinion that the morbidity or mortality of CS is not worse than that of the natural and spontaneous births.

Caesarean Section (CS) is a life saving surgical intervention, done when it is called for. It is the doctor or the obstetrician to decide. In fact all is not that well as one would imagine because it does have its potential hazards for the mother as well as for the baby whereas in many an instance the indication for the CS (the reason why it is called for) is to save the mother and baby both or sometimes one of them only according to the priorities of the pathological situations.

Indications for CS are manifold. Out of all, the commonly adopted one is Non-progress of Labour, although everything was normal at the onset of labour. This Non-progress of Labour is to be diagnosed during the latent phase or the second phase of the labour. Whereas a proper non CS management of slow progress of labour can reduce the imperative CS rate, a timely decision for CS, on the other hand, has had, many a time, avoided maternal and foetal morbidity and mortality.

The mortality rate on child delivery all over the world, according to the World Health Organisation (WHO), is at a staggering figure of 11 to 12 in 1000. Obstetricians at the RIMS Hospital scientifically claim that the rate, among those in their hands, inclusive of CS and non-CS, is about 10.34 in 1000, less than the average of the world over, a clear indication that obstetricians in our state are doing alright, not worse than their peers around the world.

Problems in the state on child delivery care

It goes without saying too much that it is incredible enough to find that the mortality rate in our state is not that bad yet in spite of the sheer hopelessness of communication, electricity, supply of drinking water, health care delivery centres, so on and so forth of the basic infrastructure of a modern living in the state. Grievances are many. To name a few, the main problems that erupt, off and on, in the matter of child delivery care in our state are:

• Non-availability of well trained obstetricians and their team in the far distant rural areas and interior hill areas whereas CS has become an epidemic trend. People from these areas fail to avail of the trained hands during emergencies.
• The oft repeated incidences of public up-rises against doctors when an untoward situation comes out.

A modern man today has a new brand of a life style. He requires a mobile set, a TV set, a computer or a lap top with internet coverage, maybe a car if he can afford, some good friends around, a good power supply, plenty of water and hygienic drinking water so on and so forth. Are these amenities available in our distant rural areas and interior hill areas?

It is time to be sympathetic to a doctor who raises this question: who, after attaining specialized post graduate training, after spending so much of time, money and energy, would like to stay in such areas to rot away whatever I learned? It is human nature.

Modern doctors say: gone are the days when a doctor got frustrated with real cruelties of life and decided to settle quietly in an unknown corner of the world to spend all his life in dedicated service to mankind. Modern doctors are perhaps more practical, are not escapists from frustrations; are more positive in their attitude and are resolute to melt their frustrations away, if any, in bringing out the best of what he was trained for in the best environment.

It is also a well known fact that a doctor, when posted in a distant station, has to reach his destination uncared, unattended; everything on his own. In many instances he is supposed to coax the village chief to convert the latter's house into a health centre as well as into a residential quarter of the doctor. Once he or she has joined in such an area, it is something like a situation where 'entry is easy but exit is almost impossible'.

Nobody will ever bother how you are doing in that unfriendly surrounding. For most people who have no backing it may take years and years, that too after a great deal of begging for sympathy and mercy and ultimately after bribing all those to do in the higher up, to come out of the place That is why we see many young talented doctors join in the nursing homes instead of being a victim to the irregular and conceited management of the government over the health care system.

It is also true that the centres with adequate facilities are all concentrated at Imphal and the only few at Imphal are too less in number to cater to the whole population of Manipur. Now-a-days an obstetrician has to handle too many cases at a time and then he or she hardly has time to talk to or to listen to a patient and her party.

So long the sailing goes smooth it is fine, but if something goes wrong particularly if the baby or the mother died, then all hell break loose, all because of misunderstanding and lack of communication. Of course surely there might be cases of greediness, negligence and mismanagement at the end of the doctors too.

Some measures or suggestions:

• Before posting or transferring a doctor (for that matter any government servant say teachers) in such a remote interior, it will be good to make the area reasonably inhabitable if not comfortable, in terms of a good road to reach it, electric light, drinking water, a house to live in, adequate equipment for the job or profession, preferably telephone-mobile internet TV connectivity. Once the local people of the area are in touch with these amenities of modern life, there will be a spontaneous improvement in proper hygiene, good health, standard education, growth of industries and what not.
• Introduction of a good and binding policy for transfer and posting, for example :
• Two years in such an area for a Specialist and three years for General Medical Officers
• To allow the senior doctor to chart out his own budgets and carry on the expenses. So and so forth.
• A Specialist should not handle too many cases at a time. He or she should have time and place to discuss the matter with proper understanding and adequate transparency with the patient or her party whether the patient's party seek for it or not.

Then only will be there a palpable and appreciable health care as well as overall development.

---

* JC Sanasam wrote this article for Hueiyen Lanpao (English Edition) as part of his regular column 'JC Digs'
This article was posted on August 02 2012 .

---