Thread by @spinesurgeon

Thread on importance of #LSCS #Cesarean
Please read this
You can ask doubts here

Let us start with basics

What is Maternal Mortality Rate : It is the number of pregnant women who die during child birth

It depends on
Mother's Health
Plus
Availability of facilities

In ten lakh deliveries
50000 women can die
Or
10000 women can die
Or
600 women can die
Or
100 women can die

If no Cesarean is done
Out of 10 lakh pregancies
50000 women die (5 percent death and 95 percent survival)

This was the situation till 1970s When Deliveries were conducted at home by skilled birth attendants

You may know stories of home Deliveries those days

In 1970s
Facilities for doing cesarean were made widely available and the number of women dying dropped drastically

From no (or negligible) #LSCS before 1970, #cesarean rate increased to about 5 percent in the next two decades And number of deaths dropped drastically

Now look at this carefully

We did 50000 cesarean and saved 40000 women

Nice
Isn't it

Now
Question is should we be happy that 40000 women are saved EVERY YEAR
Or
Worried that 10000 die
Or
Both

What do you think ??

Obviously
We should be happy about 40000 and worry about the 10000

So
We improved facilities

In 1990
24x7x365 cesarean was available only in very few hospitals

So
We increased the number
Cesarean numbers rose higher
And
Simultaneously deaths reduced

We reached a stage where we were doing around 300000 Cesareans per year and death came to 1000 per year

Now look again
When we increased from no cesarean to 50000, death came from 50000 to 10000

But
Increase or another 250000 surgeries needed to save 9000 women

And it took another 150000 surgeries (rate of 40 %) to save another 300 women

And now
Cesarean rate is around 40 percent while maternal mortality is 0.06 percent (it was 5 percent just six decades ago)

Now
Question is

Is increasing cesarean good or bad

Is this too difficult to answer
More Cesareans = Less Mothers Dying

Not just Death of Mothers

You also look at Death of Infants . . .

When Cesarean Rate is increased, the death of Infants reduce

Not just death
Even Diseases are reduced

So
When Cesarean is giving so much benefits
Why are people against it

You would have read so many articles in media
Or
Got so many WhatsApp forwards saying that cesarean rate is high

But
Did any one of those also tell you increase in cesarean has brought down death of pregnant woman

Just think

Were you aware that this 4 lakh surgeries save 49400 woman each year

Read again
Four lakh surgeries save 49400 women each year

And
If the surgeries are to be reduced
Deaths will increase again

Now

Do you want
9500000 women saved
Or
9999400 women saved

Now
Spend time to See this infographics.economist.com/2015/c-section…

What does this say

This says that

When you increase the Number and Rate of Cesareans

The Number of Mothers dying in pregnancy drastically comes down

This is a world wide phenomenon

When Cesarean is Low
More Mothers Die
More Mother Suffer
More Children Die
More Children Suffer

When Cesarean is High
Less Mothers Die
Less Mothers Suffer
Less Children Die
Less Children Suffer

Do you still think that Low Cesarean is Good and High Cesarean is Bad

What happens when Cesarean reaches 50 %
The Death Rate Drops to 10 per Lakh
See here
timesofindia.indiatimes.com/city/chennai/P…

So
More Cesarean is actually doing good
Is there any doubt

In country A
Cesarean has increased and maternal deaths have come down
In country B cesarean has increased but maternal deaths have remained the same
In country C cesarean has increased but maternal deaths have not come down

So
Which is good and which is bad

If you concluded that B and C are bad
Please wait
In B maternal deaths have not come down but fetal death and infant mortality (child dying) has come down

So
Is B good or bad

In case of doubt, read this thread again

So
News : Cesarean increased in Countries A,B,C

Immediate reaction : All are bad
That is wrong

Now
You look at one parameter
Maternal deaths and see the news again

Now
A is good, B and C alone are bad

You look at two parameters
Maternal death and infant death
A,B are too and C is bad

Let us look at third parameter

Number of woman with Vesico Vaginal Fistula
We find that it has come down in C

Now
Is the increased Cesarean good or bad in C
It is good

So
To conclude
We need to look at many parameters
And not just one

Assume there are two cars
One at 3 lakhs and another at 4 lakhs

Do you immediately conclude one is good and another is bad based on cost alone
Or
you look at mileage, air bags etc
-
But
When it comes to Healthcare
Why are you letting yourself fooled by a media or social media headline and immediately start to spread lies and hatred

Dear Doctors
Please note
If you wait for Normal Delivery
If you delay doing #Cesarean
If the mother or child gets complications
You will be penalized

Don't be lazy
Don't be irresponsible
Please do surgery immediately when it is needed

https://twitter.com/spinesurgeon/status/1050241375193550848

You would have read so many articles in media
Or
Got so many WhatsApp forwards saying that cesarean rate is high

But
Did any one of those also tell you increase in cesarean has brought down death of pregnant woman

Just think

There are big side effects with cesarean
The mother is healthy
The child is healthy

By the way
Tell me why there is Cesarean in Government Hospital

And
If you worry about money
Why don't you use GH

Talking about cesarean only and not talking about MMR, IMR along with that is of no use

And Cesarean is maximum in Medical College and less in PHC

Do you think that PHCs give better care

Lots of people write against Cesarean. Any one or many among them willing to pay the amount in this case ? newscientist.com/article/dn2792…

Any one can check this Data
Cesarean Rate in Kerala, TN, Pondicherry, Goa is similar to America

And

Needless to add
These states have less MMR

More Cesarean --> Less Maternal Mortality
Less Cesarean --> More Maternal Mortality

https://twitter.com/spinesurgeon/status/1026306749731491840

#Decapitation was a common scenario in days when #Cesarean was not possible. today it is very very rare. When you reduce the cesarean rates all these may come back again

https://twitter.com/spinesurgeon/status/1026306749731491840

ndtv.com/india-news/raj…

Is doing #cesarean wrong or is not doing cesarean wrong ? How many of you are willing to share this fine ?

thehindu.com/news/cities/ba…

Parents want Cesarean
Doctor refuses

There is sudden fetal distress
Who will save the doctor from consumer court and media

If some one has concluded that "C SECTION ABOVE 10% DOESN'T CONTRIBUTE " He is a fool Because

Data from world infographics.economist.com/2015/c-section… clearly says that Cesarean 40 % is better than Cesarean 10 %