Hello I am Dr. Swati Naik and once again welcome on Emcure AICOG tv live from Bhubaneswar. I am privileged to have with me the father figure of the obstetrics and gynecology and one of my favorite teacher, professor, Dr. C. N. Purandare. I don’t think any one of us need an introduction of sir because he is so well-known not only in India, but across the globe. He is president of FIGO. Sir, thanks for joining on our studio that is Emcure AICOG tv show. Thank you so much. Sir a lot of controversies going on the obstetrics care particularly with respect to the labor in terms of how do we do the labor it is a normal labor versus cesarean section. What’s your opinion on that sir? Well, if you look at what the current scenario is that the worldwide the cesarean section rates are going up, some for good, some for not so good. If you look at the cesarean section rates in Brazil for that matter, in private practice the cesarean section are nearly 85%. In India the overall cesarean section rate is about 17.2% annually and it varies from city to city. W.H.O said that there should be between 10 and 15 to reduce maternal mortality that does not mean that cesarean can’t be done for other situations as well and the cesareans which are done in most of the places lot of times it because of various issues, if there are medico legal issues. There are issues of currently women getting pregnant at the age of 40 because of their working also by IVF and so on so the situation has changed drastically from what the 1985 thinking was today in 2018 and you have to know with the time serially what is happening, but unfortunately in the middle portion the fear of instrumental delivery causing problem to the baby through the instrumental delivery the out of the practice of new trainees of obsteric and gynecology, which would mean that either somebody who have to deliver very easily, normally or had to go to cesarean section, now since nothing is 100% safe whether you are talking about cesarean section or you are talking about instrumental delivery or even for that matter normal deliver problem do happen and they can happen at a minutes time if not something which you can predict lot of the time and they just happen and because of that the people now feel that Cesarean sections are safer than doing instrumental vaginal delivery, which is a wrong assumption and I think the time has come when the whole generation of obstetricians who went through training who have lost the art of doing instrumental delivery need to retrain themselves to make sure that the reviving the art of obstetrics but unless we do that the cesarean section rates are not going to come down and I keep on telling everybody a time will come otherwise the patient will either deliver by cesarean section or vaginally accidentally because there nobody there and just deliver and there is nothing available and just happen to deliver vaginally otherwise everybody will deliver by cesarean section so I think we need to introspect from both the sides to see whether women who are demanding cesarean section need to be educated as well and the obstetricians in the other hand really need to retrain themselves to make sure that they are able to reduce the cesarean section rate by doing various other procedure as well. We have forcep delivery, the new odon device which is now going come in to the market for delivering vaginally unless you use all these things to cut down the cesarean section rate it will keep on climbing if the women feel that no instrumental delivery should be done at all a valuable tool in the hands of the obstetrician will go out of use and that is not going to be good for the women at large because look at the cesarean section rates causing placenta accreta the complications subsequent pregnancy, not able to deliver vaginally everybody going for a repeat cesarean section. There was a time when people said once a cesarean section not always cesarean section, but the situation has come that once a cesarean section is becoming always a cesarean section which is a very disturbing trend as far as cesarean sections are concerned and I think today obstetrician need to really look at to make sure that the normal 37 week plus pregnancies, which go into spontaneous labor are delivered naturally and normally as far as possible and if that is done eventual total cesarean section rate from caesarians happening this way or even repeat cesareans will go down because the initial delivery has been a normal delivery so we need to really retrospect then study and see everything and today FIGO has put down guidelines regarding how to bring about the change in cesarean section rate and especially the 10 point Robson’s criteria, which is now accepted worldwide and it is a FIGOs recommendation to make sure that the cesarean sections rate is brought down and I would reckon that W.H.O in 2015 is also said that there is no definitive number that can put what was said in 1985. Today scenario no definitive number can be put as for cesarean section women who needs it must have it, but the question is she should be needing it those who do not need it should not be having a cesarean section that is where the bottom line is. Absolutely so the normal labor should be attempted in maximum cases and when it is in need then only the Cesarean section are justified that is what we can conclude sir. Thank you much sir a part form FIGO guideline is there something a FOGSI guideline coming up for this to erase the cesarean section rates? Well FOGSI probably will follow what W.H.O and FIGO’s guidelines have now been accepted by W.H.O. The W.H.O guidelines have also come out and as I said categorically said that women in need must has a cesarean section. There is no number unfortunately the 1985, 10-15% which was written by W.H.O is coated by everybody with the politicians and general public and women that it should be 10-15% if you bring down that to 10-15% the maternal mortality and perinatal mortality will rise that means if you look at what FOGSI did as a survey and ask the obstetrician themselves and doctor once. How many of them had cesarean section is over 50% opted for cesarean section. If you are talking about a doctor wanting a cesarean section. You are talking about a doctors wife being offered a cesarean section because there is no money here exchange. There is no money transaction. People feel that obstetrician do cesarean section because they are getting more money and there is money being exchange here because doctor’s charge, but yet the section rate is over 50% so if you think that is the right treatment to offer then it should be offered to everybody, why not that treatment we offered to public at large and whatever is needed is going to be given and that is the way one looks at it and FIGO has actually put in recommendation which I think all the obstetricians must start following that the charges for normal delivery and cesarean section the obstetrician charges should be same. Nobody should say that you are charging more fore cesarean section. Of course, the normal delivery charges will go up because of standardization that will happen, but look at it that way that if a doctor is delivering normally is there for 10 hours looking after the patient while it is only 20 minutes cesarean section is over so the charges should be same if 25% section rate is accepted by any obstetrician in his…, I am just giving arbitrary figure then the number of deliveries that the person is doing per year standardizing say, these are my charges. You can come and deliver with me, these are my charges where you like it or you do not like it. If you do not like it go to somebody else. It is like the choosing what is the best would you feel that this particular individual is giving the best service then you pay for the service. It is a professional charge that is not you pay lawyers, you pay anywhere else everybody, you don’t question that and you only question the doctors should not charge money or they suppose to leave off the beggar’s bowl on the road to collect money to eat or do social service. They have spent so many years to life in educating, learning, to be become an obstetrician. I think due respect should be given to the both situations and you cannot be saying that well as doctor you are humanitarian grounds you should not, if you look at the doctor who by and large the entire lot. They have given free service in hospital. I work for 20 years as honorary professor giving free service in government hospital. Everybody is doing that and there is no question of service being not offered, but what is they do if grudge giving the due and saying that they are doing it for the sake. I do not accept that. Absolutely sir I think in the interest of the patients and the society at a large view we all should encourage normal delivery and Cesarean section only when needed I think under your able guidance and with FOGSI and FIGO in future we would definitely get those promising change again from Cesarean section towards the normal delivery which a most physiological for the benefit of the mother as well as the baby and for the society at a large. Thank you so much sir for joining us.