Surge in CAESAREAN Section Deliveries in Jammu and Kashmir

Discussing medical topics like Caesarean section (CS) versus normal delivery is crucial for public awareness. Including expert opinions in media reports aids informed healthcare decisions. The editorial team at reputable media outlets aims for balanced reporting, presenting diverse perspectives professionally.

But it’s important to be careful when discussing these topics, especially if experts are unsure about joining debates on questions like: Why are C-section deliveries increasing? There’s a surge in C-sections in Jammu and Kashmir. Clinical best practice guidelines (CPGs) are written, but are they followed? In this article, we want to look into the interesting case of C-sections, trends in Jammu and Kashmir, and the factors influencing C-section rates. We’ll use WHO guidelines called Ten Group Classification System (TGCS) to assess C-section trends in LMIC countries.

C-sections can save lives during childbirth, but there are worries about their increasing rates worldwide, including in India and private hospitals in Kashmir. In a media story on May 13, 2022, J&K administration admitted to the rise in C-section surgeries, promising a C-section audit. Unfortunately, the practice of following Clinical Practice Guidelines (CPG) in our state healthcare needs improvement.

In 2015, WHO suggested using TGCS as a global standard for C-section indication. This classification helps healthcare facilities identify and analyze groups of women contributing most and least to C-section rates. It compares practices in different units, considers changes, and assesses the effectiveness of strategies. CPG targets healthcare professionals and managers, with evidence suggesting that those following CPG deliver better outcomes. So, why do some hospitals or clinicians struggle to adhere to CPG?

CPGs for delivery care, whether to go for normal or C-section, rely on medical evidence, maternal and fetal health, and the pregnancy circumstances. As a clinical auditor focused on healthcare policies and standards, providing context is crucial. Guidelines may vary slightly, but their main goal is to improve patient care and outcomes. The healthcare team usually makes the final decision after considering general factors like maternal and fetal health, labor progress, and patient preferences. Patient preferences may override CPG, but the safety and well-being of both mother and baby remain a priority.

Expectant mothers should openly communicate with healthcare providers to be informed about available options. Discussions on medical topics, especially controversial ones like C-sections, may trigger strong opinions, even in senior medical professional forums. Sensitivity and an open mind are crucial, focusing on exchanging evidence-based information. In a media story on November 5, 2023, J&K’s C-section deliveries were reported as 42.7%, the second highest in the country. This rise continues in Kashmir, with official data showing 22,146 C-sections out of 42,737 deliveries in district hospitals from April 2022 to March 2023.

Experts say there are many reasons for more C-sections in Kashmir, and a big one is that some women can’t access proper maternal healthcare. In rural areas, women face challenges like no transport, not enough money, cultural barriers, and not having the right people and resources for safe childbirth and emergency care. These things make it hard for women to get the right care during pregnancy for a safe and healthy delivery.

In a medical faculty forum, senior specialists disagreed with data from a journalist. They argued that districts like Bandipora and remote places like Gurez, with fewer resources, have more normal deliveries than C-sections. Healthcare professionals try to keep things clear within their community. If they disagree, they usually express it through established channels like conferences, publications, or media columns to present different views.

Being open-minded and focusing on evidence-based medicine, even when opinions differ, is crucial. Professional forums help learn, collaborate, refine ideas, and contribute to better patient care. In these spaces, it’s important to debate with an open mind, leaving egos aside. Being authentic gives confidence to resist societal pressures.

Clinical Practice Guidelines (CPGs) play a big role in improving healthcare systems and patient outcomes. They help clinicians make the best decisions for patients based on evidence. CPGs should be written, published, and followed by all care providers. Implementing guidelines in healthcare organizations is key, ensuring positive impacts on patient outcomes. When all providers follow the same practices, it reduces variations in care and disparities, making sure patients get consistent and standardized care, no matter where they are treated.

The author is a Practising surgeon at Mubarak hospital, Certified professional in Healthcare Quality, National and international expert on Healthcare standards, policy planning and reforms.