The Real Reasons There Are More C-sections In Private Hospitals

Mumbai: Komal Vora Veera was expecting a normal delivery when she was due in February 2016. After all, she was active even in the ninth month of pregnancy with no complications. No wonder she was disappointed when told that she would have go for a Caesarean delivery by her gynecologist at a private hospital in Panvel, near Mumbai.

Post-delivery, Komal suffered intense backache. Her stitches hurt, and itched. “I believe I could have had a normal delivery. But of course at that time you listen to your doctor, and also, you know no better,” she told 101Reporters.

According to the World Health Organization (WHO), the number of C-section deliveries in a country should ideally be under 15%. A report published earlier in the year in Live Mint noted that a higher percentage "suggests that either women are opting for a controlled birth or that a profiteering healthcare system is pushing women into caesareans."

Compare the WHO figures with the reality in Mumbai's hospitals. Information obtained through the Right to Information (RTI) Act by OnlineRTI, a Bangalore based organisation that helps citizen file RTIs, revealed that during 2010-2015, 27.5% childbirths in Mumbai's private hospitals were by c-section. In the same period, government hospitals in the city recorded only 16.5% c-section deliveries.

“No one can deny that many doctors in private hospitals push for c-sections to make more money,” said Gargi Goel, a pediatrician who studied at a government hospital in Udaipur and is now working in the city in a private set up. By November, she will start working with a private hospital in Mumbai.

If a normal delivery costs Rs. 15,000-Rs. 20,000, a C-section could cost anywhere between Rs. 40,000 and Rs. 1 lakh, depending on the hospital selected.

Requesting anonymity, a doctor and a research fellow told 101Reporters that some hospitals actually ask their doctors to convince expectant mothers to go for a C-section delivery.

"At times even medical reports are manipulated and the radiologist is told to purge reports and say that conditions are not conducive for normal delivery," he said. “It is a fact that doctors practising in large corporate-run hospital chains are incentivised if a patient ends up paying more.

Source: Public Health Department, Municipal Corporation Of Greater Mumbai

Dr. Sumedh (who goes by his first name), a public health communication expert and an alumnus of the London School of Hygiene and Tropical Medicine, said a lot depends on the power dynamics between the doctor and the patient, which is not necessarily always balanced. As patients are not aware of the decisions to be taken, they give that power to the doctors and usually follow what the doctors recommend.

A similar trend is seen across the country. The Mint reported that across India 10% of all the childbirths at government hospitals were through C-sections, but 31% of the deliveries at private hospitals were by the surgical method.

Other Factors

Gargi Goel explains that the other reasons for a higher number of c-section deliveries in private hospitals include lifestyle factors of the patient, lack of regulatory laws, the risk of litigation (should the delivery go wrong) and unskilled staff to conduct normal deliveries.

“I have worked in rural areas for two years. Especially in primary healthcare centres, the number of C-sections is almost nil. Most deliveries happen normally. That number could go up to 2% at the district level,” said Goel. “But in private hospitals, it’s almost the opposite. According to my experience, about 60% to 80% babies are delivered through C-section, mainly because nurses are just not trained to handle complications and ensure a normal delivery.”

Another reason she cited was lack of time, and lack of patience in doctors. She said a normal delivery is a time-consuming process and the patient has to be continuously monitored. Neither the doctors nor the mothers have the patience to wait for the body to take its own time.

Over-crowded public setups, however, still record fewer c-sections.

“That’s because there are frequent health ministry inspections. Public Hospitals also double up as colleges, there insistence is on adhering to the regulations prescribed by the ministry before undergoing a C-section,” Goel said.

One of the regulations is not to induce labour as far as possible as the drug used to do so can be harmful to both mother and baby.

Dr. Sumedh said private setups do not pay much heed to prescribed regulations. The birthing guidelines mention under what conditions a C-section should be conducted, but they don't say you can’t do a C-sections if these conditions aren’t found in the patient.

“There are regulations, but no laws," he laments.

Another reason behind the high number of c-section deliveries is possibly a hospital's cautious approach to avoid litigation. Explaining this, Dr. Suhas Datray, medical director of Cloud 9 hospital said cases have been foisted on doctors for not opting for a C-section delivery when things went wrong.

“Doctors obviously do not want to take any chances," he said. “How many cases have you heard of lodged against a government setup?"

The lifestyle of the women who can afford the services of private hospitals is another factor that makes a case for C-section deliveries, Dr. Datray told 101Reporters.

Many pregnant women admitted to such hospitals are above 30 and/or suffer from diabetes/obesity or some other medical condition. In such cases, due to health complications are more and the chances of a normal delivery are less.

While explaining why private hospitals tend to see more cases of c-section deliveries, he did not refute the contention that many hospitals prefer it over normal delivery in order to make more money of each patient.

“I won’t say that the allegations are completely untrue. The malpractice, though, isn’t widespread and it is not always a money-making racket,” he said.

To ensure that such an unfair practice doesn't happen in his hospital or at his private clinic, Dr. Datray says he charges the same fee whether it's a normal delivery or a C-section delivery. A norm that will probably be a long-time coming in private hospitals across the country.

Riddhi Doshi is a Mumbai based independent journalist and a member of 101Reporters.com, a pan-India network of grassroots reporters.