Unnecessary caesareans for sake of belief continue to happen in Tamil Nadu, say medicos

Superstitious beliefs such as avoiding delivery during Chithirai (April) month and rushing delivery on certain dates needs to be discouraged, say experts.
A pregnant woman
A pregnant woman
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Several medical experts and doctors in Tamil Nadu have welcomed Health Minister Subramanian’s statement urging pregnant women and their families to not demand caesarean delivery on desired dates according to beliefs. The minister requested expecting couples to prefer a natural delivery for the well-being of both the babies and mothers. The minister said, “As a trend these days, pregnant women and their families insist that the doctors perform caesarean delivery on the desired dates. Though a natural delivery is feasible, there are many requests for caesarean delivery for religious, sentimental and astrological reasons.”

“In the past, caesareans were conducted only in the case of complications. However, these days, caesareans have increased. This is not ideal for the health of either the baby or the mother," said the minister. The minister also said that the doctors, obstetricians in particular, have been asked to counsel the pregnant women and families for a natural delivery. The minister held a video conference with doctors in western districts of the state in this regard on June 27. "The government will soon release an order to ensure reducing unwanted caesarean delivery on the desired dates in the state,” said the minister.

When TNM spoke to several medical experts and obstetricians to understand this trend among expecting couples, it was found that such requests are often received in private hospitals more than government hospitals. A Shanmugakani, Joint Director of Health Services, Villupuram and Kallakurichi districts, told TNM, “In government hospitals, pregnant women or families do not place any such demands. The focus is on the health of the mother and baby. Hence we are able to make thorough medical judgments.”

Shanmugakani further said that if the baby is delivered before it is full-term, it is considered to be a premature baby who will require constant monitoring from pediatricians. Full-term is 40 weeks and a baby who is born before 37 weeks is considered to be a premature baby. As the baby may not be fully developed when operated during pre-term, complications such as hypothermia, feeding difficulty and low weight among other concerns may arise. Hence pre-term delivery is generally avoided except when necessary.

Welcoming the Health Minister's statement, JD Shanmugakani added, “Caesareans must be conducted only for medical reasons approved by obstetricians and not because the patient or the family insists on it. Also, in caesarean operations, side effects can arise due to added medications and avoidable surgery among others.”

Subsequently, pointing out reasons for caesareans on certain dates, Revathi Manibalan, a senior assistant surgeon at Primary Health Centre (PHC), Kullanchavadi, said, “The requests for caesarean on certain dates mostly come from people of upper middle-class to high class backgrounds. They insist on the delivery of the baby on a certain date so that it aligns with a certain nakshatram (star) in Hindu astrology.”

Quoting such an example, Revathi added, “One of my relatives wanted the baby to be born in Bharani nakshatram and had a caesarean. However, the baby developed many health conditions within days of the delivery.”

“Many doctors and Indian Medical Association officials have expressed their support for the minister's statement. Superstitious beliefs such as avoiding delivery during Chithirai (April) month and rushing delivery on certain dates need to be discouraged,” said Revathi.

To prevent unwanted caesareans, Padmapriya Vivek, Head of Department, OBG (obstetrician-gynecologist), Gleneagles Global Hospital, Chennai said, “Counseling, sharing experiences from other pregnant women have helped us in reducing unwanted caesareans.”

“We often get such requests. However, we counsel the patients and families about the process and side effects due to it. We also have a WhatsApp group where new mothers share their experience of natural delivery with pregnant women to ease their stress," she added.

“The statement from the Health Minister is welcome because it is rarely discussed. Although the doctors should counsel the patients, the first responsibility lies with every patient and family to not insist on cesarean delivery,” added Padmapriya

Further, Padmapriya said that 80% of the deliveries at her hospital were natural deliveries and that the remaining 20% were caesarean deliveries that were necessary procedures. She attributes this to timely counseling.

Health Minister M Subramanian recently said that in Tamil Nadu, in a year, about 10 lakh deliveries take place. Of them, 61% deliveries happen in government hospitals while the remaining 39% are in private hospitals.

The Minister also said that the government will begin yoga and breathing exercise sessions for the well-being of pregnant women in the state.

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