Rise in C-section deliveries: Audit finds lack of confidence among specialists and sub-optimal capacity of labour room staff main contributing factors

The Hindu

26-06-2025

An audit of caesarean section (C-section) deliveries in Karnataka by a team of experts from the Health Department has found lack of confidence among specialists to take trials in moderate cases for fear of newborn morbidity and mortality and sub-optimal capacity of the labour room doctors and nurses to be the main contributing factors for a rise in the surgical deliveries.
In Karnataka, nearly one in every three deliveries is conducted through a C-section. Over the past 15 years, the C-section rate has doubled, indicating a significant shift in obstetric practices. While cesarean delivery is a lifesaving intervention when medically indicated, excessively high rates are associated with increased surgical risks, higher healthcare costs, and unnecessary strain on the health system.
Review by committee
To address this growing concern and to bring down C-section rates, the Health Department initiated a comprehensive review of C-section practices and an audit of such deliveries at the Tumkuru district hospital, where the rate is the highest in the State. The findings of the review and audit — conducted by a multi-stakeholder committee in January 2025 — were reviewed by the State Technical Committee on June 17, 2025.
According to the committee's report, every second cesarean was a repeat C-section, without trial for vaginal birth after cesarean (VBAC). Besides, non-standardised induction practices leading to poor labour progression, high referrals from taluk hospitals to the district hospital and a demand by patients and their relatives have contributed to higher C-section rates.
Harsh Gupta, principal secretary, Health and Family Welfare, told The Hindu on Thursday that regular audits of C-section cases in randomly selected public facilities will henceforth be done by the State Technical Committee..
Corrective measures
'While this audit is for Tumkuru district hospital, the contributing factors are by and large the same in all districts. Based on the findings, we have initiated corrective measures and are conducting orientation programmes for obstetricians and gynaecologists on the safety and feasibility of VBAC. Of late, C-section has become a trend with many women themselves opting for it,' he said.
'While optimisation of quality antenatal care (ANC) checks is being taken up by introducing newer tools such as 'Gestosis scoring' used to assess the risk of preeclampsia and 'Pregnancy wheels' used to calculate gestational age and estimated delivery date, the consent form for the C-section has been revised by incorporating side effects of procedure,' Mr. Gupta said.
To encourage vaginal births under the Ayushman Bharat Arogya Karnataka (AB-ArK) scheme, the department is considering a proposal for inclusion of incentives for normal delivery services at primary and secondary health care facilities. 'Apart from this, a proposal for withdrawal of team-based incentives for conducting C-sections to discourage unnecessary procedures is also under consideration,' he said.
Recommendations
To ensure evidence-based practices and reduce unnecessary cesarean sections, the committee has recommended development of State-specific guidelines for labour induction.
'Strengthening the taluk hospitals by rationalisation of posting specialists to provide assured comprehensive emergency obstetric and newborn care services round-the-clock; refresher trainings on evidence-based labour management for obstetric care teams and regular online capacity building of skills required for labour room process have also been recommended,' he said.
'Capacity building of the nursing teams incorporating the principles of midwifery initiatives such as alternative birthing positions, exercise in the antenatal period, respectful maternity care involving counselling on the labour process has also been recommended. Besides, early identification of risk factors such as anemia, uncontrolled hypertension and diabetes, Urinary tract infections in the pregnant women and early intervention and community-level awareness campaigns on the risks of unnecessary C-sections and the benefits of vaginal birth are among the other recommendations,' Mr. Gupta added.