If you’re searching for the best gynecologist in Delhi for delivery, chances are that you have recently become pregnant and don’t have a strong word-of-mouth reference to a doctor. And perhaps that is a good thing, because relying only on friends and family members to select a doctor might not be wise.
I am the chief executive of a non-profit hospital in South Delhi that at one time had many of the city’s “best gynaecologists”. Women delivering under these gynecologists were very satisfied and strongly recommended them to others. Yet, collectively these gynecologists had a very undesirable outcome – a 79% caesarean rate!
Risks of caesarean sections
Caesarean section is a major surgery and like all surgery carries risk. Recently the American College of Obstetricians and Gynecologists issued a statement that “pregnant women [should] plan for vaginal birth unless there is a medical reason for a cesarean.” They pointed out that caesarean delivery can increase the risk for infections, bladder and bowel injuries, and serious complications in future pregnancies. They noted that babies born vaginally have fewer respiratory problems.
Gynaecologists lack proper support
So why do some of the best gynaecologists in Delhi have high caesarean rates?
Part of the rates of some gynaecologists may be explained by their case mix that includes a high proportion of women with 2 or more caesarean sections, twin pregnancies, or preterm labour (<36 weeks).
But the primary reason behind the high caesarean rates of even the best gynaecologists in Delhi is that they are caught in a system that leaves them unsupported.
Solo consultant practice
As gynecologists become established in practice, their workload increases, often exceeding 15 deliveries in a month. In absence of a norm for shared practice, most gynecologists work alone – running home clinics and delivering at one or more hospitals. The pressures of running a busy outpatient clinic, commuting in Delhi’s traffic, and managing family and social commitments, makes it very challenging for them to give the time and attention that labouring women need.
No junior doctors or skilled nurses for labour support
Compounding the time pressures on a gynecologist is the fact that she may work in a hospital that doesn’t provide 24-hour support from a junior doctor. Sometimes, even when a junior doctor is available, that doctor may not have the skills required for attending to emergencies.
Skilled and empathetic nurses, who should provide continuous one-to-one support to every first time mother in labour, are typically in short supply.
Without such support, the gynecologist tends to be very anxious about leaving a woman in labour for long – lacking confidence that she will be alerted in time in case of a complication.
Inadequate hospital facilities
Some hospitals don’t have the facilities to conduct an emergency caesarean at night – even if they have an operating theatre, they may not have a 24-hour on-site anesthesiologist; or experienced neonatologists to attend to high risk deliveries. In such cases, the gynaecologist is sometimes forced to take an early decision for a caesarean, rather than wait for a normal delivery and risk an emergency situation in the middle of the night.
Women may also demand caesareans
Because of the lack of well-trained ancillary health professionals, most gynaecologists find it difficult to have childbirth educators or offer antenatal classes at their clinics. Without proper antenatal education, women often feel unprepared for labour and may not fully appreciate the risks of a caesarean section. Undoubtedly this largely explains the phenomenon of demand caesareans in Delhi.
Is it sufficient to identify the best gynecologist in Delhi?
Even the best gynecologist needs to be part of a team to deliver high quality care during pregnancy, labour and delivery.
During pregnancy, she needs to work with antenatal educators who can answer the myriad questions that a woman has when she first becomes pregnant. During labour and delivery, which can take up to 24 hours for first-time mothers, she needs good junior doctor and nursing support, and a hospital with round-the-clock facilities and specialists. She also needs other consultant gynecologists who can step in when she might be occupied elsewhere.
88% normal delivery rate at Sitaram Bhartia
Upon discovering our high caesarean rate in 2001, we committed ourselves to changing the situation and achieving a medically justifiable rate.
We trained childbirth educators to address questions related to diet, exercise and other changes during pregnancy. We started antenatal classes in which we educated women and their husbands about what they could expect during labour and delivery; and we trained the husbands to provide emotional and physical support to their wives during labour.
We recruited full-time salaried gynecologists, who worked only at our hospital, to form a staff unit. These gynecologists practiced using common protocols and introduced each other to all women during the antenatal period. Over time they evolved a group practice in which they attended deliveries by rotation. As a result, we no longer had situations in which a consultant had to manage a woman in labour while she was busy in an OPD, or was tired because she had been up the previous night, or needed to rush for a social engagement.
We employed junior consultants who had post-graduate specialisation in obstetrics and gynecology. We began to regularly train our nurses to provide skilled and empathetic support to labouring women. We ran a fully functional operating theatre and had a consultant paediatrician stationed in the hospital around the clock – thus giving confidence to the gynecologists about handling emergencies in the night.
These changes produced results that exceeded our expectations. The caesarean rate in our staff unit progressively fell and reached 18% in 2016. Even better, first-birth low-risk* moms had an 88% normal delivery** rate! These rates are undoubtedly among the lowest in Delhi’s private hospitals!
Choose a team not just a gynecologist
So ask not “Who is the best gynecologist in Delhi?” Instead enquire about the team of gynecologists and the hospital that can deliver unhurried and supportive care to help you have a memorable childbirth experience.
*mothers who have a single baby in the correct head down position and cross 37 weeks of gestation
** Normal delivery includes all vaginal deliveries