According to a Report by BMC Public Health, in India, with the increase in institutional deliveries there has also been an increase in caesarean section (C-Section) births. Of 22,111 live births analysed, 49.2% were delivered at public sector, 31.9% at private sector and 18.9% were home deliveries.
Prevalence of C-Section births were 13.7% and 37.9% in the public and private sectors, respectively. Their findings showed that C-Section births are nearly three times more in private facilities as compared to public sector health facilities.
The higher rates of C-Section births, especially in private sector, not only increase the cost of care but may also pose unnecessary risks to women (when there is no indications for requirement of C-Section surgery).
We see this stark difference in vaginal vs C-Section births because many women are unaware of the options available to them during their pregnancy.
Many women have the misconception that if their first child was born through C-Section, their second child must also be born via C-Section surgery.
This misconception must be rectified as this may not be true in all cases.
Women in India must be educated regarding the options that available where a mother can evaluate if she is eligible for vaginal birth after C-Section (VBAC). VBAC is also called TOLAC (Trial of Labor after Cesarean).
Hospitals must provide counselling sessions to the expecting mothers about what would be the best course of actions for them.
In fact, even their husbands need to be educated regarding the same as they are involved in the decision making process.
Today, women and their doctors can work together to determine the safest option for both the mother and baby. The decision to perform a VBAC (Vaginal Birth after Caesarean) is based on a number of factors.
A few questions that most Indian women struggle with are:
How to Prepare for VBAC?
Consulting an expert gynaecologist in the field of VBAC and availing the best medical service is very important.
While choosing a hospital, a mother must lookout for expert doctors and best of facilities as not all the hospitals allow or hold much expertise in VBAC.
When Not to Opt for VBAC?
- When the baby is in a breech position
- If the Placenta is covering the cervix
- Baby's pulse rate is going down
- The baby is oversized
- Women who are low on placenta in their first delivery
What Are the Factors That Help a Doctor Decide for Vaginal Birth?
- Both the mother and child must be in good health
- 90% of women with prior C-Sections are eligible for vaginal birth delivery
What Are the Benefits of Successful VBAC?
- Faster recovery
- Less chance of injury to bladder or bowel
- No problems with future childbirths
- No anaesthetics
- No surgery is involved
- Lower infection risk and lower blood loss
- Also reduce the stress given for cesarean count
What Are the Risks?
Uterus (scar) rupture - So these patients need close monitoring.
Ideal Maternal age/weight/height during VBAC (that needs to be maintained) which most women don’t maintain because of their unhealthy lifestyle are,
1. BMI should be 30 or below
2. Women of age 35 and above may face problems, who opt for VBAC
Diet That Needs to Be Followed During Vaginal Birth
- Good nutrition is very important as it helps in a speedy healing and helps the mother gain energy.
- Eating foods that are high in protein, vitamin C, and iron.
- Protein helps the healing process and is needed for the growth of new tissue.
- Vitamin C plays an key role in healing and fighting infection.
- Iron helps the immune system and is needed for Haemoglobin, as Haemoglobin is expected to drop during pregnancy.
- It is extremely vital to drink plenty of fluids to prevent dehydration and constipation.
Adequate awareness must be made in order to ensure that pregnant women either availing public or private health facilities are well informed before choosing the method of delivery.
We also need to take measures to strengthen existing public health facilities as well as ensure that C-Sections are performed based upon medical indications and not for convenience of the healthcare facility.
(Dr Jaishree Gajaraj is a Senior Consultant, Obstetrics & Gynaecology at Motherhood Hospital, Chennai.)
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