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Strong govt move must to stop needless c-section Experts tell consultation

Staff Correspondent
Physicians and academics want strong government monitoring at the hospitals and clinics in a bid to prevent unnecessary caesarean section (c-section) deliveries.
C-section delivery has phenomenally gone up from only 12 percent in 2010 to 31 percent in 2016, while World Health Organization (WHO) recommends it should remain between 10-15 percent of the total deliveries.
According to the Bangladesh Maternal Mortality and Healthcare Survey, of the total deliveries in private clinics, 83 percent are c-section deliveries, while it is 35 percent in the public hospitals and 39 percent in NGO facilities.
Health experts say higher demands from pregnant mothers for c-section, lack of antenatal care, irregularities by the hospital man-
agement are some of the factors that lead to a high number of c-section deliveries, but the gynaecologists are mostly blamed for this.
"What is needed, therefore, is strong monitoring by the government," said National Professor Shahla Khatun, a noted gynaecologist, at a consultation on prevention of unnecessary c-section.
Save the Children Bangladesh, Obstetrical and Gynaecological Society of Bangladesh (OGSB), James P Grant School of Public Health of Brae University, and the Centre for Women and Child Health, jointly organised the programme at the Directorate General of Health Services auditorium in the city yesterday.
Dr Shahla said Bangladesh has significantly reduced maternal and child mortality rate and c-section has played an important
role in this regard.
But in the recent years, many expecting mothers want c-section to avoid pain and risks, she said.
The lack of antenatal care and proper exercise during pregnancy also creates conditions that require c-section.
Physicians' role here is important in determining who needs c-section and who doesn't, said the gynaecologist, adding that this aspect also needed to be incorporated in medical education.
Dr Shahla said the absence of doctors in the public hospitals also prompts the pregnant women to go to the private clinics where the tendency of c-section is high.
Prof Laila Arjumand Banu, president of OGSB, said the organisation has sent directives to all its members throughout the country to use partograph and to maintain standard of procedures in child deliveries.
Partograph is a graphic record of the
progress of labour and relevant details of the mother and foetus. Maintaining the data helps determine if the delivery would be normal or c-section. Physicians say partograph is rarely used in Bangladesh.
Selina Amin, head of Midwifery Education Program at the James P Grant School of Public Health, Brae University, suggested training more midwives who can support natural child birth and help reduce the burden faced by busy doctors.
Dr Ishtiaq Mannan, deputy country director of Save the Children in Bangladesh, said while pregnant mothers have right to choose what delivery she wants, gynaecologists have an ethical role not to conduct c-section on a woman who doesn’t need it.
They need to counsel the pregnant mothers, he said.
"We are calling for better regulation of the industry, more checks and balances and greater funding for vital maternal health services," he added.