De­liv­er­ing busi­ness

What the in­crease in cae­sarean oper­a­tions world­wide tells us about the science and pol­i­tics of birthing

Down to Earth - - COLUMN -

Nlong ago, new­borns were ush­ered into OT SO the world nat­u­rally. Just as in their mam­malian cousins,both the ex­pec­tant mother and child were sub­ject to the cold logic of nat­u­ral se­lec­tion— some sur­vived,while oth­ers were not so lucky.Then,around the mid-19th cen­tury,science rigged the rules by de­liv­er­ing ba­bies through a knifed ab­domen.

The new sur­gi­cal in­ter­ven­tion (known as the cae­sarean sec­tion, or C-sec­tion for short) was meant ex­pressly for preg­nan­cies in which the life of the mother or child or both was in dan­ger. There is lit­tle dis­pute that in such cases,C-sec­tion has been a life-saver.How­ever,in low-risk preg­nan­cies, it is, by most ac­counts, an un­kind cut. Stud­ies have shown that it ren­ders the mother vul­ner­a­ble to de­bil­i­tat­ing,if rare,com­pli­ca­tions, such as haem­or­rhage, blood clots, and bowel ob­struc­tion. Lesser risks like blad­der dam­age, in­fec­tion and nag­ging pain are not un­com­mon.

There are down­sides for ba­bies too. Com­pared to nat­u­rally-born chil­dren, they are more likely to suf­fer from asthma,al­ler­gies,autism and even obe­sity. In his re­cent book,

Michel Or­dent, a mav­er­ick ob­ste­tri­cian based in Lon­don,sus­pects that th­ese anom­alies may have some­thing to do with syn­thetic oxy­tocin, anaes­thet­ics, and epidu­rals that ac­com­pany a C-sec­tion. Some re­searchers spec­u­late that it might be be­cause cae­sarean ba­bies are de­prived of the gift of im­mu­ni­ty­boost­ing mi­crobes that a vagi­nal baby comes wrapped in. Be­sides, there is a be­lief, as yet untested, that nat­u­ral birth makes for greater in­ti­macy be­tween mother and child.

This, one would imag­ine, would scare any ex­pec­tant mother away from C-sec­tion. On the con­trary, there has been a dra­matic surge in its pop­u­lar­ity around the world in re­cent decades. Cur­rently, it ranges from 12 per cent in Swe­den, 32 in the US, 41 in Iran, and a stag­ger­ing 52 in Brazil, to cite a few. Most ex­ceed the World Health Or­ga­ni­za­tion (who) rec­om­mended limit of 15 per cent. In­dia is still at mod­est nine per cent but in some states like Ker­ala and Tamil Nadu, it has as­sumed epi­demic pro­por­tions—around 60 per cent.

There are sev­eral rea­sons for this up­swing. For one, C-sec­tion costs twice of nat­u­ral birth; hence pri­vate hos­pi­tals tend to do them more.Two,C-sec­tion has be­come the de­fault op­tion for most ob­ste­tri­cians, as they are not trained in al­ter­na­tives like for­ceps de­liv­ery and ven­touse. Three, many well-off women opt for it in or­der to avoid labour pain. Be­sides, as more women are hav­ing their first child in their 30s,they don’t want to take any chances. Like many con­tro­ver­sies sur­round­ing moder­nity, the one on C-sec­tion too is couched as the “na­ture ver­sus tech­nol­ogy”ar­gu­ment. Pro-cae­sare­ans ridicule provagi­nal births as es­sen­tial­ists and, in turn, are ac­cused of tech­no­log­i­cal tri­umphal­ism.

The UK Supreme Court added a new knot to the im­broglio this March when it in­dicted a doc­tor for rec­om­mend­ing nat­u­ral birth to a woman (she lost her child) even though she de­served a C-sec­tion (she was short and di­a­betic). De­nounc­ing it as “med­i­cal pa­ter­nal­ism”, the court ruled that hence­forth, all doc­tors in the UK will have to ex­plain the pros and cons of both choices. Ideally, that might seem like the most ra­tio­nal thing to do—let the would-be-mother take the fi­nal de­ci­sion af­ter she has been in­formed of all the po­ten­tial risks of ei­ther op­tion.But in de­vel­op­ing coun­tries like In­dia and Brazil where health­care is an in­creas­ingly pri­vate (and shod­dily reg­u­lated) busi­ness,and where il­lit­er­acy abounds, it would take far more to stem the tide.

A greater ob­sta­cle per­haps, is the preva­lent cul­ture of risk that makes peo­ple trust tech­nol­ogy and pro­fes­sional ex­per­tise more than the skills of a mid­wife.Bet­ter reg­u­la­tion of nurs­ing homes and well-in­formed birth spe­cial­ists would surely help. But a sus­tained, en­light­ened pub­lic dis­course on the science and pol­i­tics of birthing might go a much longer way.

TARIQUE AZIZ / CSE

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