When actor Aishwarya Rai Bachchan delivered a baby on Wednesday, she made a powerful statement: One is never too posh to push or too old for a natural delivery. The 38-year-old former Miss World won accolades from various city's doctors for her "feat" at a time when every fourth woman in Mumbai undergoes a Caesarean section delivery instead of a natural one. Among women who are over 35 years of age, this statistic gets more skewed: one survey said 60% of them opted for a surgical delivery.
"Sometimes, an older mother is not given a choice by the doctor on whether she would like to deliver normally. It is taken for granted that older women should have Caesarean deliveries," said Dr Nozer Sheriar, president of the Mumbai Obstetrics and Gynaecological Society. But he felt this could change, thanks to Aishwarya. "Now mothers-to-be will be aware of what they can and should do," he said.
Dr Kiran Coelho, who heads Lilavati's gynaecology department, felt the actor should be held up as a role model for all moms-to-be. "With adequate ante-natal preparation and motivation, most women irrespective of their age can deliver their babies naturally."
"It's a bold step on the part of two bold women," said Dr Firuza Parikh of Jaslok, adding that Dr Vinita Salvi of Seven Hills Hospital is among those excellent obstetricians who can ensure a normal delivery in most cases.
It's a generalization that has become the buzzword in medical circles: Too posh to push. Studies have shown that today's woman with her low threshold for pain is more likely than her mother to opt for a C-section.
Statistics from BMC's public health department bears out the popularity of the C-section in the private sector which the middle and upper middle classes prefer. In 2010, for instance, a little more than 1.83 lakh children were born in various public and private hospitals. Almost 17% of these births were via C-section; almost 69% were delivered in private sector hospitals and nursing homes.
In this rash of C-section deliveries, Aishwarya Rai Bachchan's natural delivery could be a trend-setter. As both the Bachchan family as well as Seven Hills Hospital have not given out specific details of the birth, it is not known whether the actor opted for an epidural (a spinal shot of painkillers) during delivery. In fact, a former supermodel who is scheduled to deliver in the next few months, too, has told her doctor that she wants a natural delivery.
Holy Family Hospital's Dr Nozer Sheriar pointed out that not all women over the age of 40 years go for the C-section. "But C-sections are more common in this age group (60-65%) mainly because the women do end up having complications with late deliveries," said Dr Sheriar.
Dr Duru Shah, who consults at Breach Candy Hospital, said that many women who opt to have children later in life have problem conceiving. "They take fertility treatment or opt for assisted reproductive processes to get pregnant. Such pregnancies are precious both from the point of view of the doctor as well as the patient. It is hence possible that many doctors advise such patients to undergo a C-section," she said.
But a doctor working in the public sector believes the soaring rate of C-sections denote an unethical trend. "The Caesarean surgery rate in India's urban areas is approximately 50% and is estimated to be as high as 80% or more in some private hospitals," the doctor said.
C-section, said Dr Sudeshna Ray, is not a function of the woman's age or her preference. Dr Rekha Daver, who heads JJ Hospital's gynaecology department, concurs: "If everything is fine during the pregnancy, then there is no reason why a mother shouldn't opt for a natural delivery-no matter what the age."
Dr Daver added that a decision to opt for a C-section can be taken only after considering the weight and maturity of the child and the mother's blood pressure and vaginal dilation.
A natural delivery has benefits for the child as well. Dr Ray said: "A child who goes through the labour process has better immunity, his\her gut is better colonized with beneficial bacteria and his\her lung mature better. "
