Unmasking Cesarean

 “Normal-a Ceasarean-a ? – A beginners guide to giving birth in Tamil Nadu”

If you are an expectant parent here is some interesting numbers for you. One in three women in Tamil Nadu have an operative birth (C-Section). This number goes up drastically, if you live in certain districts. It goes up even more, if you access Private healthcare facilities.  So if you are a pregnant woman in Tamil Nadu accessing private health facilities, you have a 54.3 percent or slightly greater than 1 in 2 women, having a C-section.

Are you curious as to how this number stacks up by district ? Here is a list. Contrary to what you might think, the percentages are much higher in smaller/rural districts as opposed to the more urbanised ones.

S.No.Indicators% C-sections conducted at Private facilities to Deliveries conducted at private facilities – 2017-18
Total_Tamil Nadu54.3
1Ariyalur74.8
2Chennai51.4
3Coimbatore52.9
4Cuddalore41.2
5Dharmapuri51.6
6Dindigul46.4
7Erode65.5
8Kancheepuram65.3
9Kanniyakumari65.2
10Karur67.1
11Krishnagiri60.7
12Madurai39.3
13Nagapattinam59.8
14Namakkal67.1
15Nilgiris24.6
16Perambalur65
17Pudukkottai64
18Ramanathapuram56.5
19Salem47.2
20Sivaganga56
21Thanjavur76.8
22Theni66.3
23Thiruvallur49.9
24Thiruvarur65
25Tiruchirappalli55.8
26Tirunelveli57.2
27Tirupur57.2
28Tiruvanamalai73.2
29Toothukudi57.1
30Vellore33.7
31Viluppuram49.4
32Virudhunagar60.8

Now, how about we look at it a slightly different way ?

S.No.Indicators% C-sections conducted at Private facilities to Deliveries conducted at private facilities – 2017-18% cases of Pregnant women with Obstetric Complications and attended to reported deliveries – 2017-18
Total_Tamil Nadu54.344.7
1Ariyalur74.842.6
2Chennai51.428
3Coimbatore52.945.4
4Cuddalore41.241.2
5Dharmapuri51.645.6
6Dindigul46.430.4
7Erode65.538.6
8Kancheepuram65.342
9Kanniyakumari65.213.1
10Karur67.148.6
11Krishnagiri60.740.5
12Madurai39.324.9
13Nagapattinam59.855.8
14Namakkal67.140.4
15Nilgiris24.663.9
16Perambalur6567
17Pudukkottai6482.5
18Ramanathapuram56.558.2
19Salem47.253.8
20Sivaganga5699.1
21Thanjavur76.874.4
22Theni66.330.1
23Thiruvallur49.941.9
24Thiruvarur6534.9
25Tiruchirappalli55.846.5
26Tirunelveli57.236.4
27Tirupur57.241.4
28Tiruvanamalai73.243.7
29Toothukudi57.139
30Vellore33.741.3
31Viluppuram49.471.8
32Virudhunagar60.858.1

It is scary to read that 44.7 percent of women have/had obstetric complications. We actually don’t know what qualifies as an obstetric complication, whether it was a pre labour event or one that showed up during labour. Furthermore, we don’t know what percentage of women chose or were given a pre-labour C-section. 

The on-ground reality is more complicated that what the numbers say, of course. We have made tremendous progress as a state in key maternity indicators, such as infant and maternal mortality. We have also institutionalised close to 100 percent of births. 

In this process though, our C-section rates have skyrocketed, while it begs the question as to whether our women are getting “sicker” at the same rate. Also it begs us to challenge the assumption that a high risk woman is better off getting a C-section. 

Some of the common things birthworkers hear from careproviders are :

  1. C-section is safe, safer than a normal birth.
  2. Normal birth is risky, for no benefit. 
  3. Normal birth will screw up your pelvic floor.
  4. Normal birth will screw up your vagina and perineum, making sex less pleasurable.
  5. There is no added benefit to a baby staying inside the mother after 37 weeks, because it can survive the outside world, possibility without NICU assistance after that period. 
  6. Why go through a trial of labour when you can control things better with a scheduled operation?
  7. There is significant risk to waiting for labour to start spontaneously after exactly 40 weeks.
  8. Most births will need to be managed through injection/drip fed synthetic oxytocin. 
  9. A women is incapable of birthing her placenta on her own without heamorraging and dying, so will need a chemical oxytocin injection as routine. 

This post is not going to go into any of these details but let me draw your attention to one fundamental approach to birth – the belief that birth is inherently risky for the mother and baby without pharmacological (synthetic tablets, injections etc.) or technical or surgical assistance.

Is that true ? Going by that line of thinking – if we eliminated vaginal births, and switched over to surgical births as a norm and standard in a population, we should easily achieve a zero percent infant mortality, as well as maternal mortality for example. But that isn’t true. We have research and data (https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/1471-0528.13592) showing us that there is a relationship between C-section rates and lives saved only when the percentage is at 10 percent. Beyond that, it doesn’t impact any mortality figures. Therefore the World Health Organisation (WHO) recommends a C-section rate of not more than 10-15 percent, whereas India has a country is fast on its way to becoming the land with most C-sections. 

Internationally, the need of the hour is to shift attitudes towards birth, and move towards more of a woman-centred model, one that puts the woman’s body and what its designed to do first, before using interventions, which the midwifery model of care is designed to. 2020 is the International Year of the Midwife. We are at the cusp of big changes in India, to bring back normality to maternity care. But in the meanwhile, what does that mean for you as a pregnant woman seeking private healthcare?

  1. Understand that private healthcare doesn’t necessarily translate to better outcomes.
  2. Understand that C-section is a major abdominal surgery – not an easy way out. Read up on the risks.
  3. Seek an independent childbirth educator, not someone being paid by your care provider or ones you pay for as a hospital package. There is a significant difference in quality of childbirth educators in India. General rule of thumb – cheaper is definitely not better, when it comes to antenatal education. 
  4. Understand the various different kinds of birth – vaginal, normal, natural, pre-labour and in-labour C-section. Understand the pros and cons of each.
  5.  You are a paying consumer. Which means shop around. Rule of thumb – If you are spending more money and time choosing your wedding makeup provider and doing “trial makeups” than visiting care providers and spending time asking questions, its time to rethink your priorities.
  6. On that note – a bump photoshoot costs anywhere between 10 and 20k Rupees. A baby shower costs 1 to 2 lacs, at the least, without including gold. A doula costs much less, and is giving you a 34 percent greater chance of having a vaginal birth. It is all about priorities, and choosing where to put your intention, time and money. 
  7. Ask every care provider to share the last 6 months’ worth of data. Ask for at least 3 references. Ask for their views on postdates, episiotomies, IVs, Upright births and everything else. 
  8. Follow your gut instinct. Who delivers your baby? Not your doctor, midwife, doula or nurse. It’s you and your baby. Own your body, own your birth.

About Me

My name is Sangeetha Parthasarathy – I am a birth doula and mother of two, I have recently relocated to Chennai after practicing as a Doula, Hypnobirthing Instructor and Childbirth Educator in the UK. My areas of interest are public health, I am a data geek, so I spend a lot of time in the national and state governments health data. My other keen interest is postpartum wellbeing – and studying our nervous systems and how they play a role in everything we do in the perinatal period – I am a student of Somatic Experiencing and pre and perinatal psychology, a Spinning Babies trained bodyworker and I integrate all these modalities in my work with couples pre-conception through to early years parenting. I am the Co-Founder of Chennai Birth Network, a not-for-profit that aims to create awareness around pregnancy and birth. Follow/ping me on FB, Insta and Twitter @worldoula, would love to chat. 


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