Obstetricians in Rural area are doing only emergency Cesarean operations…

More than 70 % of deliveries are conducted

by Non obstetricians in rural area in India.

Though the percentage of deliveries at home

are rapidly decreases in Rural area…

the fact of delivery conducted by experienced persons at remote or difficult area can not be ignored.

In many times…these deliveries are conducted at home of patient or at the residence of experienced person…usually an old female lady…called suyin in Maharashtra.

The main reason behind not going to a proper health center for delivery is the fear of operative interference like cesarean section…and…Lack of money is often secondary reason for not visiting proper health centre.

Since the process of normal parturition is the natural process…needs no active intervention unless and until required…and so most of the procedures of parturitions are being conducted by Medical Practioners who may not be a obstetrician in qualification…This is not true for only in rural and even in city area also.

But the major difference is that in city most of the obstetrics is being practiced under the supervision of a qualified obstetrician…but in rural area…the condition is exactly opposite.

Most of the obstetrics is being practiced with out supervision or guidance of obstetricians…in spite of availably of obstetricians in rural area…and when the condition is beyond their limit the patient is either transferred or a obstetrician is called for help…These things are culprits for not minimizing morbidity in obstetrics…which is the thing to be considered more seriously.

 

Sensitive methods of monitoring Intra uterine condition of fetus is just wastage of time…in obstetrics in rural area in India.

Though there are highly sensitive

and effective methods like

Non Stress Test or

Continuous fetal monitoring

by using Doppler during labor…these things are not useful in Rural Obstetrics.

First most things are that the percentage of cesarean section is increased by more than 20 percent…over all…including city area. In big Institutional Set ups in city area…many cesareans are done as elective…or planned. This known fact has made relatives of patients reluctant for cesarean section.

In rural area…there are very few such elective or planned cesarean cases…due to reluctant of relatives of patients. And Obstetricians are accepting and following same old protocol of giving trail for normal vaginal delivery…in spite of…book indicated case for cesarean section.

This is the old trend to satisfy or to prepare mind of patient or her relatives for cesarean delivery…as many obstetricians in rural area…believe in such practice. And during such time…Is there anything like monitoring fetal distress so as to react fast and properly.

Rather such things gives tension to a doctor…nothing more than that…just to hear heart sound of fetus periodically is enough. Few doctors are expert in convincing the relatives…for them there are no indications for cesarean section. The common people are of common opinion that cesarean was done aiming to get money only…and doctors are culprits. Majority of doctors in rural area have to face angry unsatisfied relatives of patient…posted for cesarean. These are relatives of patient…of whom some relative had cesarean in city area…and paid maximum for it…Just like…Dogs barking on each vehicle with past memory of death of his keen by dash of some vehicle.

Well equipped set ups of obstetricians have contributed in mission of decreasing maternal and neonatal mortality drastically…

But lack of nearest Blood transfusion facility…reluctant and arrogant relatives…                                                                                                                                             are making Life of Doctors in rural area…Miserable.

Health can not be classified as Rural health and Urban health…and measures to provide health are also same…then why as approach of people towards health in rural and urban area differs a lot is the question to be answered.

.

Work on improvement on Obstetrics Under process

Obstetric Practice in Rural area is improved a lot…but there still space to improve it.

Main concerned that is Anaemia is treated by using medicines in tablets and injectable forms.

Drugs like prostagaldins helps to control or prevent post partum bleeding.

Maternal Mortality is dramatically decreased due to efforts being taken by Government…by various schemes like NRHM.

But need to update infrastructure with staff of Government set ups in rural area…as this is neglected issue of all the time since last two decades.

Though updating health facilities is constant process…the  Graph  of updating should not be flat…need upward swing which is lacking.

Recent way

Recent ways

of obstetric practice in Rural are in India…..

1. No more Home deliveries: as government has taken initiative…. the percentage of home delivery is now decreased….I am not the person to provide the data….but can predict this…as the number of case of postpartum hemorrhages brought by private maternity nursing home are now very minimal equal to nil in last five years….

2. Improved Antenatal Care: as government has taking efforts                                                                          to screen and to give routine Iron & folic acid tablets and tetanus toxoid injection…the referred patients to private nursing home are no more anemic…at least hemoglobin more than 8 %….

3. Secured Obstetricians: as HIV is done of all the                                                                                        ANC patients by government                                                                                   health department….                                                                                            Private doctors are safely follow                                                                                                                                     the norm while treating HIV                                                               positive or negative patient…                                                                   rather he is not in confused                                                        state…

4. All basuc Investigation are also  done in Primary health Centers.

5. As use of Medical Abortion Pills has increased….may be the                                                                                           illegal abortions and related complications                                                         are decreased….here also                                                                                            I have no data to comment in confident way…but I can pretend as number of cases coming for termination of pregnancy to private Obstetrician has decreased rapidly in last three years….

Changing Norms

Changing Norms of Obstetric Practice in Rural Area….

1. No Forceps: delivery by using outlet or mid cavity forceps are not as if outdated…..reason may be as the fetal morbidity and mortality is more with forceps…and rural people are also….not in mentality to loose their offspring by taking un necessary risk….rather they prefer safe option of cesarean…..and so doctors also….

2. Ventous: I was totally forgotten the way the delivery can be done by applying negating suction pressure over scalp of fetus ….and puling it can help baby to come out…before I saw …Three Idiots…. In My practice since last 18 yeas I have delivered  only three babies by this way…..but it was before 1993…the reason is same increased morbidity and mortality….as experience while doing post graduation….

3. No Planned Cesarean: Indications of planned cesareans are mentioned in books…but I have performed only three planned cesarean out nearly 1500 cesarean cases in my 18 years of practice….indication of which were…..two for precious child…..and one for…Postdated Pregnancy….

4. Decision for cesarean : standard books in obstetric have mentioned indications for planned ,elective and emergency cesarean section….but like in Institutional hospital it is not easy to inform the relatives regarding decision or necessity of cesarean section….they are not in mood to accept you…or trust you…..it becomes challenging to keep close eye on progress of labor and likely fetal distress…..and after say one or two hours or after five sox hours…the relative….realizes the necessity of cesarean….they changes or makes their mind for cesarean….So ultimately …relatives are the persons ….to tell when to take patient for cesarean….doctor has as such no role in this…..

Private Doctor’s setup improving

Is Obstetric Practice in Rural area in Private Doctor’s setup improving?….

Answer to this is Yes…

What may be the reasons?

1.Incresed awareness in society….

2.Government’s active contribution…

3.Chaning Norms of practicing by Obstetricians…

4.Obstetricians are keen to update & upgrade their knowledge and setups…

4.New drugs like Prostaglandins…and other…

5.Early reference to Institutional hospitals…as improve transportation…

6.Recent new trend of group practice…

challenges

What are the challenges of

Obstetric Practice

in Rural area….

1.Main concern…is No Blood bank nearby and …as obstetrics is the only branch in medical field…in which no body can tell you when patient will require blood transfusion and how much?….

Though same in accidental bleeding case…but in obstetric case ………blood required in case of obstetric emergency becomes the responsibility of obstetrician….as he is in charge of the patient… ….so always….think of likely required blood ….big tension all the time on head of obstetrician…

2.Conviencing the Patient for cesarean….challenging task….if you are doing practice ethically…then it is big challenging to convince the relative….reason one of may be poor socio-economical sate of patient’s relative….but the real cause is …decreasing faith on obstetricians …..not only obstetricians but…on whole medical profession….

No faith or minimal faith or decreasing faith on medical Profession is of big concerned…..but the most who are sufferers are obstetricians….what I feel personally….

3.To take your charges: this problem is far greater than treatment part of patient…it is not the question….whether they afford or not….the point is the mentality of relatives…not to pay….as charged….they themselves now started to decide what should be the amount…..they are suppose to pay.

And these people expense more or equal amount of money on ceremony called ‘pachavi’ of ‘Barase’… ‘Namkaranvishi’.So there is no question of affordability….

These people’s some patients was charged twice or up to five timed more than the charges told by rural obstetrician…and had no complaint on it….rather precious issue for them to tell other….

4. Harassment of Obstetrician: As there can not be restrictions to accompanied relative and visitors….it is the general habit of concerned and non concerned relatives of  patient to ask repeatedly about status of patient….

5.Oversmart Relative

& patients:

These are some of

the way by which

the patient or relative

wants to prove themselves over smart…

a) Delay to visit

b) Refusing responsibility…by telling let ..xyz may come…

c) Repeatedly assuring ….is everything id fine?…or will you  able to handle             it?...

Thanks…

Thanks to  WordPress.com.

This is my first sincere effort to create  a blog!