Thursday, April 24, 2014
Increasing rate of caesarean section.Does that worries you?
As the delivery date starts approaching,one of the commonest question asked by the pregnant woman is,'Í have heard that in Max Hospital the incidence of caesarean is very high'.They are apprehensive and so are their partners.Very anxiously they wait for me to answer their question.
Previously I used to get defensive about the whole thing.Answers like I can't comment about others......my rate is not more than 20% for caesareans......I can assure you that if anywhere in the world you can achieve a safe vaginal delivery ,you can achieve that with my team......
Now I ask a different question.To tell me a hospital which they have heard god about and i will deliver them there.To my surprise they don't have an answer.They say that,that we don't know.Strange....isn't it.
What you read online or what you hear from your friends are half truths.Most of the time those who have good experience they get too busy with the life and don't have time for such feedbacks.Those who had an unexpected outcome or below expected outcome,they are the one's who leave strong feedbacks.They are a very small minority of people but as they are the most vocal,they scare you.
Now the question,why is the caesarean rate increasing?It is multifactorial.I will give you an example.
I work in a team with consultants and registrars etc as every person in the team has got a delegated duty and we all know that as a team we perform better.That is the whole idea of making the team that if I am busy with one patient another patient under my care shouldn't suffer if any medical need arises.Now a patient who has come to show me for 9 months wants me to be present with them through every step,which isn't possible.How can I or any doctor be present through out if the trials are as long as 24 to 36 hours?I try my best to be present for all the vaginal deliveries.It is easy in nights or early morning as the roads are vacant,but it can be a problem during the daytime if the traffic is heavy.So at times ( once or twice in a month it so happens that by the time I reach baby has been delivered and attended by Dr Deepa Maheshwari as she lives across the hospital and has 13 years of experience in obstetrics and gynaecology.So ultimately you have a achieved a safe vaginal delivery due to our team work even if I am delayed by few minutes.
Now last week a Lady with high risk pregnancy with both Diabetes and blood pressure of pregnancy was induced at 39 weeks by me.In most likelihood they would have been offered a caesarean section had they visited anywhere else.So we started the process and followed it as per the protocol with team members including me visiting her at regular interval.All going well.At around 3 Pm she was 4 cms dilated i.e at least 6 hours to be fully dilated and then suddenly at 4 pm I was called that she had progressed very fast and is fully dilated and pushing the baby.So she travelled 6 hours journey in one hour.Totally unexpected.So I left my home and Deepa left hers.Naturally Deepa reached earlier than me and delivered the baby safely.I reached in another 5 minutes.Naturally south City 2 is farther than south city1.
Now what I got for the patient's husband wasn't a thanks but a complaint that I didn't reach in time and no one came in between to keep the moral up of my wife by giving her false hopes that only few minutes are remaining etc.Then he went ahead to leave this feedback/complain somewhere that Dr Kaushiki Dwivedee didn't come to attend my WIVE'S delivery not mentioning that what a high risk delivery it was,how nicely my team under my supervision managed it to let his wife have a normal delivery and even a precipitate labour like hers was nicely managed because it was or team and Max Hospital.
Now if despite working so hard and ethically one gets such brickbats,is there a reason for a doctor to try 24 /36 hours of normal delivery where there is always a possibility that heavy traffic might be a problem.Isn't performing caesarean at some pretext like baby's heart beat is getting low,fluid is low,no progress of labour is a better option for the doctor?
THE BALL LIES IN YOUR COURT.DO YOU WISH THE DOCTOR TO BE HONEST AND ETHICAL WITH YOU TO TRY NORMAL DELIVERY SINCERELY WITH AN OCCASSIONAL CHANCE THAT IT WON'T BE HER BUT HER TRAINED TEAM MEMBER MIGHT ATTEND YOUR VAGINAL DELIVERY OR WOULD YOU PREFER A CAESAREAN TO BE PERFORMED BY THE MAIN GYNAECOLOGIST AT THE TIME OF HER CONVENIENCE.CHOICE IS YOURS!!