ISLAMABAD, Nov 24: Saba Khan had anticipated a smooth delivery of her first baby and said no to a Caesarean section from the start.

However, after six hours in labour at a private hospital in August this year, her doctor suddenly told her how the child had gone into distress and a medical intervention was imperative. The doctor then went for a C-section.

In September, Zahra Hassan also had a C-section at another private hospital. According to her doctor, her amniotic fluid had reduced dangerously and she could lose the baby. Her first baby was also delivered through a Caesarean.

“The umbilical chord was wrapped around the baby’s neck, the baby’s heart beat had stopped and the amniotic fluid was too low,” were some of the excuses given by private practitioners to perform C-sections, according to several young mothers.

“There are examples how babies with umbilical cords double-coiled around their necks were delivered naturally,” said Dr Sitara Hassan, Assistant Registrar Pakistan Medical and Dental Council (PMDC), who had worked at the Polyclinic hospital briefly.

“Twice as many Caesareans are being performed in the private sector compared to the government hospitals,” she added. Like most young doctors, Dr Hassan conceded that normal deliveries today were as rare as C-sections used to be in the past.

Unlike government medical institutions, in private hospitals mothers were not given enough trial period or time in labour.

Most young mothers complained how their doctors performed a C-section after six to eight hours in labour. In public hospitals, the trial time lasted more than a day in some cases, giving mothers enough time to deliver naturally.

Some senior doctors in the government sector contacted for their opinion on the subject rejected or were hesitant to accept that private practitioners were performing ‘unethical’ medical procedures.

A few minutes into the argument, however, some of them conceded that private medical practitioners were only performing C-sections and in many cases against the will of the mothers.

Other senior doctors, who did not agree, were practicing medicine privately after day jobs in government institutions.

Dr Hassan explained that one of the major reasons why natural birthrate was much higher in government hospitals was because all the patients came from the lower class.

“They cannot afford an epidural injection that will set them back Rs5,000 roughly let alone pay another estimated Rs10,000 for a delivery,” she said.

Dr Fatima Mishal, a medical officer at the gynaecology department of the Federal Government Hospital, Shahzad Town, explained how her hospital had initially become infamous for performing C-sections.

“But that was because the set-up was new and the hospital did not have the necessary back-up. We used to explain to parents and their families how the hospital did not have blood bank support and if the family could arrange blood on their own only then would the doctors assist with natural deliveries.”

She also elaborated how today the government facility was performing more than twice natural deliveries compared to C-sections.

Dr Mishal added that she was now assisting mothers in eight to 10 natural delivers against three to five C-sections.

According to her, the ratio was same in other public hospitals. “Out of 35 to 40 deliveries, may be eight to 10 are C-sections at Pims.”

Some of the major reasons for C-sections were eclampsia or hypertension in mothers, foetal distress (baby who cannot take stress of labour) and abnormal position of the baby.

Another reason why Caesarean was necessary was when a mother had previous two C-sections, Dr Mishal explained.

There was, however, mixed opinion over how often these conditions occurred in mothers and medical intervention became necessary.

Some young doctors argued that hypertension was common and so was foetal distress.

Dr Rizwana Chaudhry, Professor of gynaecology and obstetrics and the head of the unit at the Holy Family Hospital Rawalpindi, believed that majority of the deliveries, whether in public or private sectors, were normal.

“Only 10 to 12 per cent cases of hypertension in mothers occur. About six to seven per cent mothers suffer from pregnancy-related diabetes which went away after birth,” said Prof Rizwana, who is also the councillor and regional director for the College of Physicians and Surgeons Pakistan.

“A doctor performing C-section without proper indications is ethically committing a wrong,” she said.

But the professor also argued that most women today were ready to pay more and avail medical services in the private sector because they did not want to experience labour pains.

“More and more girls come to us opting for C-sections because they are too finicky,” said Dr Rizwana.

“The reason we go to private practitioners and pay more is to get better health services, not be mislead and cheated,” said Sarwar Abbasi who did not enjoy the birth of his first baby because of the stress and panic that he claimed the doctors created in the last few hours before birth at a private hospital.

For some of the above mentioned reasons, parents who could afford travelled abroad for deliveries.

Myra Haider had her first born in Singapore in a natural way. Her second born was also a natural birth in Dubai.

Samiya Bukhari said she too had her first baby in the US after 31 hours in labour. And Imran Mubashir also explained how his wife had flown to the US to deliver their first born.

Two private hospitals in the city declined to share data about how many natural deliveries and C-sections they had performed last month.