Fernandez Hospital accepts the initiative to display its Caesarean section rates (CSR)
In a recent petition to the Ministry for Child Development, Ms. Subarna Ghosh has collected nearly a lakh of supporters who want to make it mandatory for all doctors and hospitals to declare the percentage of Caesarean delivery rates to patients.
Ms. Ghosh felt that the C section that she personally underwent was "misleading and manipulated and her choice was overridden". According to Ms. Ghosh, to discourage the trend of indiscriminate conducting of C sections, women need to be made aware of C section rates of different hospitals and maternity homes so they can choose their hospital carefully.
Caesarean Section Rates (CSR) have increased exponentially worldwide. India, with its varied levels of maternity services, is also facing an epidemic of CSRs. We, at Fernandez Hospital have tried to maintain an appropriate CSR ratio.
We are a tertiary referral perinatal centre accredited for training postgraduates and post doctoral fellows. While this increases our patient volumes it also brings in a variety of challenges, some of which are:
- Advanced maternal age with medical complications
- Increasing incidence of morbid obesity with co-morbidities
- Assisted reproductive techniques with couples not open to vaginal births
- Maternal request for ‘Muhurtham’ C Section
Our data represents an institutional cohort with a bigger proportion of high risk mothers. People come from varied distances, some from neighbouring states.
We initiated an audit on CSR in 2002 using Robson Classification. This is an ongoing audit where data is displayed in the hospital.
In 2001, Michael Robson proposed a system that classifies women into 10 groups, based on their obstetric characteristics (parity, previous CS, gestational age, onset of labour, fetal presentation and the number of fetuses). Since the system can be applied prospectively and its categories are totally inclusive and mutually exclusive, every woman that is admitted for delivery can be immediately classified based on these few basic characteristics which are usually routinely collected worldwide in obstetric wards. In 2015, WHO2 suggested Robson classification to be used worldwide as an audit tool.
The litmus test for any hospital would be group 1. This group encompasses the woman with a singleton baby with head down position, uncomplicated pregnancy and who sets into labour spontaneously. A CSR in this group is vital as it impacts the woman’s future obstetric career. We at Fernandez Hospital focus on the first four groups of Robson as these women have never had a Caesarean before. The distribution of our deliveries into the specific 10 groups is shown below.
- Blue represents Group 1 - 5 : term, cephalic population
- Grey represents Group 6 and 7 : breech
- Green represents Group 8 : multifetal pregnancy
- Brown represents Group 9 : abnormal lie, where vaginal delivery is not possible
- Orange represents Group 10 : preterm cephalic births
Fernandez Hospital Data December 2016 : Total Deliveries – 738
We have tried to maintain a strict control on the induction of labour. Our data clearly shows that it increases the risk of a C section in this group of women.
Our professional midwives (introduced in August 2011) offering intrapartum support to low risk women have helped reduce unnecessary interventions. The incidence of epidural analgesia has decreased from an initial 66% in 2011 to 41% in 2016. The hospital is committed to promoting natural birth. With overwhelming volumes we are making every effort to humanize birth, offer midwifery support and work towards reducing the primary Caesarean in every birthing woman.