KATHMANDU, Aug 18: Expressing concern over high rate of caesarean deliveries at nursing homes and private hospitals, the Family Health Division (FHD) under the Ministry of Health and Population (MoHP) has recently written to these health institutions about the problem.
The FHD wrote to the institutions upon finding that some private hospitals and medical colleges were conducting more caesarean deliveries than vaginal deliveries (normal delivery). Compared to government hospitals, private health institutions are conducting three times more caesarean deliveries, FHD said.
Officials at the ministry suspect that the private centers might have encouraged caesarean deliveries to extract more money from patients. They said private medical colleges are conducting more caesarean operations for teaching purposes. Patients have to pay between Rs 30,000 and Rs 100,000 per caesarean deliveries at private health institutions.
Despite knowing about the high incidence of caesarean deliveries at private health institutions, FHD has written only to those institutions that are implementing the government´s ´Safe Motherhood Program.´ The MoHP provides money to those institutions for the "Safe Motherhood Program" and these institutions conduct deliveries free of cost.
"We have written to some private hospitals and medical colleges about the high incidence of caesarean deliveries," Dr Silu Aryal, focal person of Safe Motherhood Program at FHD, said.
Dr Aryal, who is also a senior consultant obstetrician and gynecologist, said that only 10 to 15 percent out of total pregnancies have complications during delivery. Among them up to 5 percent require surgery. She said that private hospitals and medical colleges which do not implement ´Safe Motherhood Program´ have higher incidence of caesarean deliveries. The office said that such health institutions do not provide information to the government about their practices.
The Maternity Hospital, the only maternal referral center in the country, conducts caesarean deliveries in less than 20 percent of cases. The hospital carried out 21,245 deliveries in 11 months of the last fiscal year 2011/12 and only 4,231 were caesarean. In the fiscal year 2010/11, The previous year, the hospital had carried out 23,570 deliveries and 4,848 of them were caesarean.
The Tribhuvan University Teaching Hospital (TUTH) carried out 3,910 deliveries and women. Among them 2,549 were normal and 1,361 were complicated deliveries. Of the 1,361 caesarean sections were conducted on 1,000 women and this is only 25 percent.
According to the District Public Health Office (DPHO) Kathmandu, at Kathmandu Medical College (KMC) which also implements ´Safe Motherhood Program´, 44 percent of the total deliveries were caesarean during the last fiscal year. Likewise, 49 percent of the total deliveries at Kritipur Hospital were caesarean.
Hari Kishor Shrestha, the director of Om Hospital and Research Center, said most of the deliveries at the hospital are caesarean. "Mostly complicated cases come to our hospital, we do not want to risk miscarriages hence the high rate of caesarean section," said Shrestha. "A patient has to pay Rs 25,000-30,000 for normal caesarean section," he added.
Chief of Safe Motherhood Program, Dr Aryal said both the doctor and patients prefer surgical intervention to avoid risks. Likewise, doctors do not wait for normal deliveries, which can take hours. Women can go home early and return to work if they opt for caesarean section, she said. Dr Aryal also said more people these days request caesarean section.
"Women these days do not want to undergo labor, so they request surgery," she said. Dr Aryal however added that caesarean sections have several complications and it is unethical to conduct surgery for money, but the govenrment does not have any mechanism to check such practices.