A retired Gynaecologist in a senior citizen meeting milieu serves as the catalyst for the discussion to veer toward problems faced by women during pregnancy and how doctors prefer to do Caesarean Section (C-Section) . Having served as an Obstetrician in Kerala Government Health services for three decades, I argue with them sharing my own clinical experience and opine that C-section rates need not be more than 15% and that only 40% of pregnant women face some problem during final stages of pregnancy. More important, pregnancy should be considered a joyful process. But melodramatic movies that depict a shrieking mother-to-be writhing in pain as well as all other women’s tales of pain makes the situation worse. As a result more women request doctors for a C-Section, not realizing that regardless of the procedure adopted, the child feels some pain in the process. Since now I am now involved the field Of Social Obstetrics, focusing on quality of care in Obstetric services, I thought it might be worthwhile to share my opinion about the concept of preparation for a child birth. Pregnancy is a normal physiological process and if any complications arise, these are usually due to some unresolved issues. The point to note is that pregnancy is not a disease.”An occasion so momentous and a marvel so beautiful has however always been shrouded in myths , old wives’ tales and also pain for all those who don’t know. What is ironic to note is that even advancements in science and increasing education levels haven’t done much to alleviate the doubts and fallacies surrounding child birth. You would be amazed that even with such high levels of education and exposure, young girls have gross misconceptions about child birth” says Dr Sushma Neharai the world record holder for delivering a 5.7 Kg baby through normal delivery. For a normal pregnancy and delivery, a regular check up is all that is required to ensure that everything is well. This can be done by an ordinary doctor or a well trained midwife. However, pregnancy complications are always unpredictable but curable if detected on time. Further, the instances of complicated pregnancies can be saved by timely referral to institutions with all required facilities. On an average 28-30 million deliveries take place annually in India. This is nearly 75000 a day across India. What is required for a routine checkup is a well trained and caring midwife doing the ante natal check and labour being arranged in a facility where 24 hour obstetric care services by a qualified well trained doctor is available. Availability of a trained doctor /midwife having patience, masterly inactivity and watchful expectancy are the requirement of a normal delivery and not star studded hospitals with intensive care units and obstetricians of repute and those with the so called kai rasi.(Kai punniyam). The misconception that all pregnancies end in C section is an offshoot of “my daughter/my wife should not experience pain during labour” syndrome. In cases where the parents /husbands do not have confidence in the doctor and if the confidence level of doctor is sub optimal, there may be instances of unnecessary C-Sections Whenever I start my lecture on Maternal Health, I always state complications in a pregnancy can arise anytime. This in spite of the reputation of the obstetrician involved, having daily check ups with all required tests etc. Even if a mother-to-be is found to be normal until the time of delivery, a complication can still occur depending on various conditions. The higher the reputation of an obstetrician ,more will be the number of pregnancies she may be forced to manage and it will be impossible to get personal attention. Sometimes, the doctor may not be available at the time of delivery and the poor woman may be seeing strangers when she requires affectionate, patient observation and masterly management at the time of child birth. Having said that, pregnancy is still a normal physiological process, and as two lives are involved there are certain common facts every pregnant woman, husbands and parents ought to be aware of . While I was practicing clinical obstetrics I used to counsel the husbands and parents on the pregnancy outcome such that all are well prepared. Stay tuned for my next post on common facts for every pregnant woman, husbands and parents. An alumnus of Trivandrum Medical College (1965-70)

Dr N S Iyer is a senior Obstetrician and Gynecologist and retired Deputy Director of Kerala Government Health Services. Post retirement he became the Project officer in UNICEF, Chennai office, in charge of the Maternal and Child Health Programme in Tamil Nadu and Kerala.