Saturday, January 21, 2012

Too posh to push!

With Aishwarya Rai Bacchan recently giving birth to a baby girl, the natural way- no Caesarean, no chosen birth date- of her own birthday or the much sought after 11/11/11 newspapers were abuzz with this 'abnormal' mode of delivering a superstar. After all she would be ‘too posh to push’.
And reporters could no longer flog the story of the greedy and lazy gynaecologist who waits on patients with a knife, ready to do a caesarean on any woman who does not oblige by popping out her babies at a convenient time.

Here is a gyno’s end of the true story – to do or not to do … a Caesarean section.

It’s true the rates of caesarean sections have gone up all over the world. I think this is why:

1]Forewarned is forearmed: Sonography etc
Plenty of investigations like sonographies and blood tests are available to us today that can warn in advance of babies who are  growth restricted, too large, badly positioned or have loops of umbilical cord round their neck and could have problems with a vaginal birth.

2] Bigger is not better
With mothers being given tons of supplements their babies are sometimes too large for their pelvic structure and cannot be delivered ‘normally’

3]The Test-tube baby epidemic
Assisted reproduction [ test tube babies] have made it possible for women who otherwise would never have conceived, to have their own child. These are ‘precious’ babies often twins , conceived after years of trying and with slim chances of having another one and no doctor or patient in their right minds would leave anything to chance.- A planned caesarean with a team of doctors to attend on the baby is what makes the most sense.

4] No prizes just lawsuits
With women working and small family sizes, patients & doctors tend to avoid difficult vaginal births that could damage the baby’s brain causing cerebral palsies [spasticity], weakness in limbs [ paralysis] or mental retardation. Medico legal issues also force us to be liberal with caesareans.

5] Surgery made easy
With modern antibiotics, blood transfusion, good suture materials, and experience, complications from a caesarean section have become rare. It is often the better option in difficult cases. The mother could also suffer incontinence [inability to control urine or stool] or fistulae in badly done vaginal births as well as suffer severe tears, rupture her uterus and have excessive bleeding after wrongly applied forceps or other manuoevres.

6] Short is sweet where labour goes
 It is true to some extent that doctors tend to finish up and go home for the simple reason that baby outcomes are better when labour is shorter-We are taught ‘A labouring mother must not see two sunrises or sunsets’

7] The scarred uterus
With so many surgeries being done on the uterus like caesareans, fibroid removals, unification of two uteri, patients risk their uterus bursting at the scar and we cannot take chances with the life of both the baby and the mother.

So what’s really happening? Are we doing more caesareans than vaginal births?
The answer is a simple NO. Why not?  I just said its best for the baby!

1] The hen that lays golden eggs
 In India gynaecologists treat not just a patient but an entire neighbourhood. 3 generations of women from the extended family are looked after by the same doctor. A scissor happy doctor would be dropped like a hot potato. One unnecessary caesarean means a chunk of patients lost. And yes the competition is cut throat.

2] Because I can
The word ‘Obstetrics’ means to stand by. Or wait patiently while a woman delivers, gently helping her ease her baby out into the world. We are trained to wait. And in India with its huge population, a gynaecologist in training does every kind of difficult delivery multiple times. We are trained to do it. We have to do it to please the family. So really no reason for us not to do it.
3]If it’s good it’s not news
 According to the 4th estate, women demand caesareans because they don’t want to suffer the pain of childbirth or they don’t want to get ‘loose down there’. This is not true at all. In all these years, I have had only one patient – a doctor who insisted on a caesarean-though to be fair to her, she had conceived with difficulty, her baby threatened to come out early and was growth restricted. She was anxious for the baby’s well being. Most women want a ‘normal’ delivery and start crying as if they have failed in some way, when we tell them we need to do a caesarean. A well done and properly stitched delivery does not make a woman lose perineal muscle tone. And an abdominal surgery will always be more painful with longer recovery times than a vaginal birth.

4] Magic potions
With prostaglandins- a new group of drugs that make the cervix open up and oxytocin- a hormone that makes the uterus contract, deliveries can be timed and labour cut short by several hours. Added to these are excellent analgesia techniques that remove the pain and relax the muscles helping us to carry out deliveries with ease.

5] Self help
Restricting supplements to essentials, controlling a woman’s sugar levels, helping her take an appropriate diet, avoiding excess weight gain and encouraging her to exercise and be active also contributes to better vaginal birth rates. Preparing the breasts for lactation by massaging the nipples releases oxytocin and helps the baby’s head to enter the birth canal and the patient to deliver on time.

6] The art of Obstetrics.
We all have our egos. And take pride in doing a difficult job well. So delivering a baby vaginally is an art as well as a science that most of us are happy to practice-though not at the cost of the patient’s well being. This is just another reason why a doctor would prefer a vaginal delivery.

To sum it up, most Gynaecologists or rather Obstetricians will try to give a woman a natural birth, but where needed, they will not be tardy in doing a caesarean. Trust your doctor to do his or her best. No doctor would like to give you treatment that’s worse than your disease. No patient is too posh to push and no doctor too lazy to pull.