No Pain, Please!

In order to bypass labor pain and get quick results, a number of mothers voluntarily opt to go under the knife. But not always it’s the mothers who get to deicide, private hospitals often call shots to make extra bucks. Saima Bhat reports  

Attendents waiting outside for their patients outside a operation theatre at a government run hospital in Srinagar. Pic: Bilal Bahadur
Attendants waiting outside for their patients outside a operation theater at a government run hospital in Srinagar.
Pic: Bilal Bahadur

Shazia, 28, a diabetic patient was excited when she conceived her first baby after a year of her marriage. But, when pregnancy started having repercussions on her health, Shazia’s excitement faded. Despite being on special medical treatment for nine complete months, Shazia had to finally deliver her baby through Caesarean section or C-section. Given her medical condition, delivery through a normal procedure was not an option.

C-section is a surgical procedure in which one or more incisions are made through a mother’s abdomen and uterus to deliver a baby. The first modern Caesarean Section was performed by German gynecologist Ferdinand Adolf Kehrer in 1881. Since then it has become one of the most widely used form of delivering babies.

Shazia, a homemaker, started developing complicacies in the sixth month of her pregnancy. Her hormone levels were fluctuating – which even happens in case of normal pregnancies – but she was worried. “I am diabetic and doctors have advised me to remain under their observation in hospital from 7th month onwards,” says Shazia. “But spending three months in a hospital in Kashmir scared me.”

Seeing the condition of health care in Kashmir, the lone tertiary care maternity hospital Lala Ded, Shazia decided to explore options outside the valley.

She says, she had some doctor friends at LD hospital, who could have helped her in getting preferential treatment but, “this hospital is one of the dirtiest I have ever seen. There is no concept of hygiene, or cleanliness. If one happens to pass through the hospital corridors at noon, there is leftovers food including rice and bones scattered all over the place.”

Shazia, says the hospitals in Kashmir look more like cheap canteens than health care institutions. “One is always at risk of catching infection in a hospital in Kashmir,” says Shazia. “How could I have stayed at such a place for three months?”

After deliberating over the issue for a while Shazia and her Husband, Mohammad Altaf, finally decided to visit Mumbai for the delivery.

Knowing that she was a diabetic, Shazia gave up the idea of natural birth. “I wanted to go through the (labor) pain to feel that happiness of motherhood. And at the same time I was skeptical about going through a C-Section surgery. I was afraid, after the surgery if I would be able to conceive again at all.”

While in Mumbai, Shazia was under observation but doctors advised her not to remain admit in the hospital. Finally she delivered a baby girl through a C- section without any complicacies. “Going to Mumbai was a right decision at the right time,” says Shazia.

But every delivery case is not as special as Shazia’s. Such patients, in need of specialized treatment are few in numbers where doctors don’t want to take any chances by making their patients wait for normal births.

Back in valley, every year thousands of children are born through C-Section surgeries. As per the directorate of health services in Kashmir, in 2013, around 30,640 babies were delivered through C-Section across different hospitals in Kashmir including LD hospital. Data for SKIMS was not available with the directorate.  And in 2014, up to October, 18,900 babies were delivered through C-Section.

The huge rush of deliveries is maintained by the lone tertiary care maternity hospital, Lal Ded (LD) Hospital.

A more than 500 bedded hospital, around 700 patient visit Lal Ded’s OPD on daily basis, while around 150 patient get admitted each day.

Besides LD, a number of private hospitals absorb rushes related to deliveries. But these privately run hospitals lack any super specialty care.

In case of emergencies, patients are shifted to either SHMS or SKIMS or sometimes they even die while reaching these hospitals.

A doctor at LD hospital, whishing not to be named says, “LD hospital is the super specialty hospital where deliveries of hypertensive, diabetic or any other problem are conducted under the guidance of specialists, but then if patients are not cooperative, what can be done! Otherwise C-Section surgeries are conducted here as well, but the hospital always remains overcrowded.”

This doctor is witness to many incidents when more than one patient has to share the bed in both IPD and casualty wards. There were many instances where new born babies were stolen. Around 100 babies get delivered in this hospital every day, 50 per cent of them through C-Sections.

In Kashmir C-Section is preferred over the natural birth for being quick.  The patients don’t have to undergo the labor pain, which can last for up to 36 hours. But there are some cases where C-Section is the only option to save the life of baby and the mother.

Tasleema, a mother of three children, has delivered all her children through C-Section. Tasleema was medically normal when she was expecting her first child. But her gynecologist at a private hospital decided to go for C-Section instead of waiting for a normal surgery.

“Nobody dares to ask the doctor why she decided to go for a surgery. But when I was gaining my senses back after the surgery, I asked her for the same. And you won’t believe what her reply was. She said I couldn’t have tolerated that pain. I mean why?” asks Tasleema.

Tasleema is not the only case where gynecologists themselves decide to go for caesarian section for their patients to make some quick bucks. There are a number of cases where doctors at private hospitals have taken liberty in deciding on patients behalf. “Besides one-time surgery costs, expecting mothers are money minting machines for many gynecologists,” says Tasleema. “I have done more than 12 USG’s (ultrasonography) during my nine months of pregnancy. Each costing me between Rs 600 and 800, while level 2 costs around Rs 1200,” says Tasleema.

Tasleems was told that if the first baby is delivered through C-Section, then the following deliveries too have to be carried in the same fashion.

Dr Lubna Nazir, a gynecologist says, “Ultra sound waves are not harmful but only two are recommended in case of normal fetus. First one done in the first trimester (first three months) and the second in the 7th month, and one more can be done at level 2 to check congenital anomaly.”

She also says if first and second babies were delivered through C-section that means third has to get delivered through C-section only. And patients are recommended to get only three C-sections.

Dr Lubna says C-section is recommended only when normal delivery might pose a risk to the mother and/or baby. C-sections are also carried out for personal preference but this is not recommended. And if done, it should not be done before 39 weeks gestational age, unless there is a medical reason to do so.

All private hospitals charge around Rs 15000 per C-sections in Kashmir, plus an additional Rs 10,000 for medicine and other items. On an average a private hospitals conducts between 50 and 100 surgeries a months.

In C-Sections the death rate is 13 per 100,000 and for normal deliveries it is 3.5 per 100,000 in the developed world. The UK National Health Service gives the risk of death for the mother as three times more than that in a normal delivery.

Besides that, a C-Section surgery can cause complicacies like: risks of postoperative adhesions, hernias and wound infections. Sometimes the situation may get worse and a patient may get infections in the uterus or in other pelvic organs such as the bladder, hemorrhage or increased blood loss, injury to organs (bowel or bladder),  adhesions which may cause blockage or  pain in pelvic region. In some cases it may lead to future pregnancy complications.

Caesarean section always means an extended hospital stay which leads to the infection to mother and baby and extended recovery time, says Dr Lubna. But it also means extra income for the hospital as well.

She also says that in case of babies, the risk also increases like premature birth which will be associated with low weight, breathing problems, fetal injury, low APGAR scores (effect of anesthesia), fetal distress before the delivery or lack of stimulation during delivery. Babies born by cesarean are 50 per cent more likely to have lower APGAR scores than those born through normal birth.

Tawkeed Bhat, manager Florence hospital, says he has seen a number of cases in hospital’s five year history, where patients themselves opt for C-Section surgeries.

As per the hospital records, 50 caesarean babies get delivered every month, but this year, post floods, around 100 babies a month were delivered in this hospital.

Bhat says rarely one baby on an average gets delivered through normal birth in a month in his hospital.

All private hospitals in Kashmir lack the facility of intensive care units for new born babies, and in case of emergencies they are referred to the GB Panth hospital.

In 2005, privately Ahmad’s hospital, located at Nowgam byepass, was shut after the death of a would-be-mother. Baby was delivered through C-Section but patient died, which led to the protests in the area. Ultimately hospital was shut and the gynecologist had to move outside the state. Even if a formal complaint was lodged, the hospital started functioning again after a year, and that doctor involved also came back to Kashmir and is practicing now.

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