From medical negligence to conducting procedures without their consent, pregnant Indian women are often denied autonomy.

Unwanted procedures unanswered questions What pregnant Indian women face in hospitalsImage for representation
Features Health Tuesday, January 09, 2018 - 19:31

Sharanya’s* first daughter was only six months old in January 2010 when she went to her gynaecologist to discuss contraception – she did not want to conceive for at least three years.

After Sharanya delivered Alisha*, her elder daughter, her gynaecologist suggested she start depo provera, a hormonal birth control injection which needs to be taken every three months.

After her first shot in October, she experienced irregular periods and spotting which were brushed off as side-effects of the contraceptive. When a home pregnancy test showed negative results, her gynaecologist did not conduct any further tests. 

In June, Sharanya and her husband were to move to Australia for his work, and so, she shifted from depo provera to an IUD (intrauterine device).

They had barely settled in the new country when Sharanya noticed a little bump in her stomach; her periods had stopped completely too. A call to her gynecologist back in Chennai provided little reassurance – she said Sharanya was just experiencing bloating because of the IUD, and the absence of menstruation was also a side-effect.

In July, a pregnancy test showed positive, confirming Sharanya’s suspicions. And in August, after an hour and 40 minute long scan, the doctors in Australia found that Sharanya was eight months pregnant and that the IUD was attached to her baby’s hair.

“I was based in Bengaluru, but I used to travel to Chennai every month for consultation because I wanted to continue with that gynaecologist,” Sharanya recounts. “But I haven’t spoken to her since I found out I was pregnant for the second time.”

Fortunately, despite the IUD and the risks involved, Sharanya’s second daughter was born safe and healthy. But for Sharanya and her husband, it meant a lot of unprecedented changes and stress.

Sharanya’s body did not have enough time to heal after her first pregnancy and delivery. Since her first delivery was through Caesarean section, she ran the risk of rupturing her scar the second time. Moreover, Alisha suffered a fracture a month after her younger sister’s birth, which plunged Sharanya further into post-partum depression.

“I wasn’t able to pay as much attention as I would have liked to Alisha, because there was a younger child to take care of,” Sharanya says, “But I only think of these things now. At the time, I was so glad that that my younger one was born healthy that I didn’t really have the time to feel angry at the gynaecologist.”

When Sharanya’s cousin confronted her gynaecologist back in Chennai about her folly, she casually said that every contraceptive has a failure rate and that this was one such case. “There was no acknowledgement of her oversight or the risk she put me and child through,” Sharanya says.

Like Sharanya, a number of women are made to question themselves by the medical professionals they turn to for guidance during their pregnancy. TNM spoke to five women about their experience with their gynaecologists during consultation and childbirth. While some say that their concerns are brushed off and their queries are answered with hesitation, others are prescribed procedures and put through tests without explanation, both during consultation and labour.

Unanswered queries 

What stands out prominently in these women’s experiences is the reluctance many of them face from their gynaecologists when it comes to answering their queries. However, they consider this to be very normal.

Seema* describes herself as a quiet, amicable patient and her gynaecologist as a conservative woman.

“I didn’t ask too many questions and generally trusted her. But whenever I did ask questions, she would give diplomatic, vague answers. She thought revealing too much information would make the women anxious for no reason,” says the 28-year-old Chennai-based Chartered Accountant.

While Seema was okay with this arrangement, she admits that to another woman, the lack of clarity would have the opposite effect than what her gynaecologist was hoping for.

During the labour too, the gynaecologist believed that Seema should not be told how much her cervix has dilated so as to not worry her. 

“But I overheard one of the doctors saying it and because I knew, I was not anxious,” chuckles Seema.

Abirami Rajendran, a District Revenue Officer in Trichy, had a similar experience with a gynaecologist she was consulting during the first six months of her pregnancy. The gynaecologist is a high-risk pregnancy expert and a well-known doctor in Chennai.

“You know the feeling when your concerns and questions are made to feel inconsequential and like they were not worth anyone’s time? That’s how I felt when I raised concerns with her,” Abirami says.

Meanwhile, Lalitha*, a 36-year-old homemaker in Chennai, says that while her queries were answered during the first pregnancy, the second time was not as breezy. 

“They did not tell me why they were prescribing the blood tests and other tests. I did a PhD on preeclampsia (a condition during pregnancy characterised by high blood pressure and high protein in the urine) so I knew that some tests were not required really at certain times. But I did not protest,” she says.   

Unnecessary procedures

Kavita, a Bengaluru-based woman who runs a travel consultancy, feels lucky to have found a sensitive and patient gynaecologist when she conceived about eight years ago. But before that, the 42-year-old had had more than her share of unpleasant experiences.

Her first gynaecologist made her undergo a laparoscopy to remove some cysts from her ovaries. But the surgery was unnecessary, she says, and it was only after the surgery that she began experiencing pain.

“The radiologist would ask my why Madam (the gynaecologist) is not giving me medication and injection for the scar which was growing. But when I told her, she just brushed it off. I was paying up to Rs 15,000 a month, but without any relief," says Kavita.

Despite fertility tests of the couple being normal, the gynaecologist allegedly kept pushing Kavita for IUI (intrauterine insemination), which also did not work. Defeated, Kavita went to another gynaecologist in 2009. This gynaecologist told her to relax, not feel pressured, and try to conceive naturally. Two months later, Kavita became pregnant.

Like Kavita, Abirami too realised that she had been prescribed unnecessary scans.

“In my fifth month, the doctor at the scan centre told me that the scans I was prescribed were for high risk pregnancies, unlike mine, which was without any complications,” she says.

Abirami started going to another gynaecologist after that.

Expectant mothers are also not always informed about medical procedures that they may have to undergo before childbirth. For instance, while enema and episiotomy are not mandatory procedures, Seema was given enema before she went into labour. She was not asked if she wanted to take it.

Giving enema before labour is a standard procedure in most Indian hospitals. It is believed that enemas help ease labour and prevent the mother and baby from contacting infections in case a stool is passed during labour. However, TNM confirmed with a gynaecologist that this is not a mandatory procedure, though it is done routinely in India. On the contrary, giving an enema could ultimately result in "watery faecal soiling" during childbirth and thus, increase the risk of infections.

As for episiotomy (a surgical incision made in the area between the vagina and the anus to enlarge the opening for the baby to pass through), Seema had heard from her friends that it was the norm. So, she herself asked for a numbing injection to be given before the procedure.

These instances are examples of what women across India experience, where procedures which may be deemed unnecessary are prescribed anyway.

All the women TNM spoke to, except Seema, gave birth through Caesarean section with their consent. But this is not always the case. The word ‘emergency’ is often used to put mothers into a spot without really explaining what the emergency is.

Abirami recounts for instance, that a cousin of hers feels she was cheated out of a natural childbirth.

“Everything was going well. The baby’s head was engaged and she was ready to be in labour. However, the doctor supervising her declared an emergency and took consent for the surgery from her family, not from her,” Abirami says.

Post-operative care

After Seema’s 16-hour-long labour, the doctor was stitching up her episiotomy incision. “She (the doctor) told me irritably that all of them have had a long day and that I should cooperate so that they can finish the procedure quickly,” Seema recalls.

Others say however that they received proper post-operative care where the aspects of recovery and healing were explained well to them.

But an important aspect here is support for breastfeeding. Often, the first thing fed to newborns, while the mother is recuperating from labour or surgery, is formula. Many a time, this is done without the mother’s consent, and when it is well-known that breastfeeding within the first hour of birth helps significantly reduce infant mortality.

This happened with Seema as well. Her child was fed formula without her or her family’s knowledge.

It is worth noting that all the women TNM spoke to belong to the middle class and above. Women from lower socio-economic backgrounds have it much worse, whether it comes to privacy, sensitivity or the autonomy they are allowed to exercise over their bodies. 

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