Are private hospitals in India doing unnecessary caesarean sections? This is a question that keeps surfacing in public discussions, news debates, and even in Netflix and CNN documentaries that highlight the rising global rates of surgical births. A caesarean delivery is truly life-saving when required, yet its growing frequency raises concerns. So, what are the genuine indications, what risks do mothers and babies face, and why does this controversy matter so deeply? Let us break this down clearly and fairly, in a way every expecting mother and family deserves to understand.
Why the Term “Normal Delivery” Is Misleading
One of the first things that needs clarification is terminology. We often hear the phrase “normal vaginal delivery”, but in reality, no delivery is “normal.” Vaginal births can be just as complicated as C-sections and can carry their own set of risks like heavy bleeding, perineal tears, shoulder dystocia, or fetal distress. Many obstetricians now suggest avoiding the term “normal delivery” altogether, as it creates false expectations.
In fact, conducting a vaginal delivery often requires far more intensive monitoring from doctors and nurses compared to a scheduled C-section. Some hospitals have already equalized fees for vaginal delivery and C-sections, and many experts argue that vaginal deliveries should actually cost more, because of the unpredictability and constant vigilance they demand. If this model is adopted widely, any financial incentive for unnecessary C-sections would disappear and so would much of the blame game surrounding them.
Why Are C-Sections Performed?
C-sections are performed when a vaginal delivery poses risks to the mother or the baby. They can be planned (elective) due to known complications before labor begins or emergency when urgent problems arise during labor. Common indications include:
● Fetal distress: Abnormal fetal heart rate patterns or reduced oxygen supply that could endanger the baby. Continuous fetal monitoring often guides this decision.
● Prolonged or obstructed labor (Dystocia): When labor does not progress despite strong contractions, often due to cephalopelvic disproportion (baby’s head too large for mother’s pelvis) or ineffective contractions.
● Placental complications:
● Placenta previa: The placenta covers the cervix, blocking the birth canal.
● Placental abruption: Premature separation of the placenta, which can cause heavy bleeding and threaten both mother and baby.
● Malpresentation and malposition:
● Breech presentation: Baby’s buttocks or feet enter the birth canal first.
● Transverse or oblique lie: Baby is positioned sideways.
● Other malpositions where vaginal delivery may be unsafe.
● Previous uterine surgery: Women with a prior classical (vertical) C-section or other uterine surgeries (like myomectomy) are at risk of uterine rupture during labor.
● Multiple pregnancies: Twins, triplets, or higher-order multiples may require C-section, especially if the leading twin is not in a head-down position.
● Maternal health conditions: Severe pre-eclampsia, eclampsia, uncontrolled diabetes, heart disease, or active infections (like untreated genital herpes) can make C-section safer than vaginal delivery.
● Fetal conditions: Large baby (macrosomia), congenital anomalies, or growth-restricted babies who may not tolerate labor stress.
● Cord prolapse: When the umbilical cord slips into the birth canal ahead of the baby, cutting off oxygen supply. This is an obstetric emergency requiring immediate C-section.
The Risks of C-Sections You Should Know
A c-section, while generally safe, is still a major abdominal surgery. Like any surgery, a C-section comes with some risks. These can include:
Medical risks:
● Infection
● Excessive bleeding (hemorrhage)
● Blood clots that can travel through the bloodstream (embolism)
● Injury to the bladder or bowel
● A uterine incision that could weaken the uterine wall
● Placental complications in future pregnancies
● Risks associated with general anesthesia
● Possible injury to the baby
Other potential disadvantages:
● Recovery usually takes longer than after a vaginal birth
● Higher chances of experiencing chronic pelvic pain
● Greater likelihood of needing a C-section in future pregnancies
● Increased risk of breathing problems for the baby
A study published in JAMA Network Open (2020) highlighted that repeat C-sections carry a significantly higher risk of complications compared to first-time procedures.
What Happens When a C-Section Is Not Done in Time?
While much of the debate focuses on the overuse of caesarean sections, it is equally important to talk about the dangers of underuse. When a C-section is delayed or not performed despite clear indications, the consequences can be devastating.
As a neurologist, I have personally seen the aftermath of obstructed labor and prolonged oxygen deprivation during childbirth. Babies who suffer hypoxia can develop epilepsy, cerebral palsy, and other lifelong neurological conditions. These are not just medical diagnoses but life-altering realities for both the child and the family, requiring constant care, rehabilitation, and emotional strength.
The Risks of Not Doing a Timely C-Section
When surgery is not performed on time despite clear medical indications, both the mother and the baby are put at serious risk. These are not rare complications, they are the very emergencies that obstetricians are trained to prevent every single day.
Risks for the Baby
● Birth asphyxia (oxygen deprivation): Prolonged or obstructed labor can cut off oxygen supply. Even a few minutes of delay may cause:
● Cerebral palsy (lifelong movement and posture disability)
● Epilepsy (seizures due to brain injury)
● Cognitive and developmental delays (learning and memory difficulties)
● Hearing or vision impairments due to brain hypoxia
● Behavioral and psychiatric issues later in life, such as ADHD or emotional disorders linked to perinatal hypoxia
● Stillbirth or neonatal death if oxygen deprivation continues unchecked.
● Birth trauma during obstructed labor or shoulder dystocia:
● Brachial plexus injury (Erb’s palsy → weakness/paralysis of the arm)
● Clavicle or humerus fractures
● Skull or nerve injuries
● Shoulder dystocia complications: When the baby’s shoulders get stuck after the head is delivered, prolonged attempts can cause both trauma and oxygen deprivation.
Risks for the Mother
● Uterine rupture: Especially in women with a previous C-section scar, leading to catastrophic bleeding, shock, or hysterectomy.
● Severe postpartum hemorrhage (PPH): A leading cause of maternal death, often worsened by delays.
● Sepsis (life-threatening infection): More likely after prolonged, obstructed labor.
● Obstructed labor complications:
● Obstetric fistulas (abnormal connections between bladder/rectum and vagina), causing lifelong incontinence and social stigma.
● Pelvic floor damage leading to prolapse and chronic pain.
● Complications of pre-eclampsia/eclampsia: Without timely delivery, it can cause seizures, stroke, liver or kidney failure, and even death in the mother.
● Psychological trauma: Experiencing a preventable loss or life-threatening emergency can leave long-term scars in the form of postpartum depression or PTSD.
Therefore, while we must question unnecessary C-sections, we must also remember that timely surgery is sometimes the only way to prevent such irreversible harm and before mistrusting your doctor and believing what a random influencer is saying against caesarean section, you must know the risks associated with obstructed labour and not performing this life saving surgery.
How C-Sections Impact Maternal Mortality
Before the availability of safe surgical delivery, obstructed labor was a leading cause of maternal death. Of late, c-sections have transformed outcomes and significantly reduced Maternal Mortality Ratio (MMR) in many countries.
India’s MMR has dropped dramatically, from 556 deaths per 100,000 live births in 1990 to 97 in 2020, according to WHO and Sample Registration System (SRS) data. Increased access to emergency obstetric care, including timely C-sections, has been one of the biggest contributors to this improvement.
A Lancet Southeast Asia study (2024) estimated that scaling up safe C-section access in low-resource settings prevented thousands of maternal deaths.
Thus, it is important to note that while the risks exist, C-sections have played an enormous role in saving lives and bringing down maternal mortality significantly, worldwide.
The Uncertainty of Labor and Why Counseling Matters
Another critical point families must understand is that labor is unpredictable. A well-planned vaginal delivery can convert into an emergency C-section at any time. Blanket assurances that a delivery will be “normal” are misleading and harmful.
Doctors cannot and should not make such promises, because every pregnancy carries uncertainties. Proper patient counseling is essential so that families are not shocked or feel misled if a C-section becomes necessary in the labor room. Unfortunately, a large part of the mistrust comes from poor communication between doctors and patients. This gap must be closed with honesty and transparency.
The Controversy of Caesarian Sections
The C-section debate isn’t about whether they are necessary, they clearly save lives. The controversy is about overuse vs. underuse. Let’s look at some numbers that reflect the disparity:
● Global averages: Around 21% of all births are now via C-section, with huge disparities.
● India: National Family Health Survey (NFHS-5) data shows a 21.5% C-section rate (2019–21). But the story splits in two:
● Private sector: Over 47% of deliveries are by C-section.
● Public sector: Around 14%.
But, why does such a huge difference exist? To understand this, we must look at some of the many reasons that directly and indirectly contribute to this disparity.
The gap generally reflects issues of accessibility, financial incentives, and patient counseling. In many private hospitals, economic and medico-legal pressures may encourage higher surgical rates. In contrast, in public hospitals, infrastructural gaps and resource shortages may prevent timely surgical intervention when truly needed.
A widely cited paper (Peel et al., 2018) called this the “too much–too little problem”—too many C-sections where they may not be required, and too few where they are urgently needed. In fact, a CNA investigative documentary “A Million Cuts: India’s C-Section Epidemic” highlighted how private hospital rates in parts of India reach nearly 47%, far above the WHO’s suggested 10–15%. It also raised concerns that some mothers are being nudged into surgery without adequate explanation or continuous labor monitoring.
These reports project alarming statistics and cases where surgical births appear unnecessary. While these documentaries play a valuable role in raising awareness, they sometimes miss key nuances.
Not all C-sections in private hospitals are elective or financially motivated. Many are performed due to genuine medical reasons, such as maternal age, pre-existing health conditions, multiple pregnancies, or limitations in labor monitoring infrastructure. Economic and medico-legal pressures may influence decisions, but patient safety and actual clinical complexity are equally critical factors, often overlooked in simplified narratives.
Presenting “rising C-section rates” without context can unintentionally create fear and mistrust. Understanding the reasons behind these numbers rather than only the numbers themselves is essential for informed conversations about maternal health and surgical care.
Unfortunately, some social media influencers further oversimplify the issue, calling all private hospitals “money-making machines” and accusing doctors of looting. Such blanket statements are dangerous because they can mislead families into rejecting C-sections even when truly needed, which, as discussed, may have lifelong consequences for the baby. Hence, the key message is not to generalise but to seek clarity, transparency, and shared decision-making.
So, Why Are C-Sections Higher in Private Hospitals?
C-section rates in private hospitals are consistently higher than in public hospitals, and multiple factors explain this trend. Studies from India and internationally have highlighted both medical and non-medical reasons.
Medical factors include increases in maternal age, higher body mass index, multiple pregnancies, and changes in obstetric practice and technology. These factors can make C-sections more likely even when there is no immediate emergency
Non-medical factors play a significant role, particularly in private healthcare settings. These include:
● Maternal request: Some women prefer C-sections due to fear of labor pain, convenience, or scheduling preferences.
● Fear of litigation: Obstetricians may opt for C-sections to reduce the risk of legal consequences in case of complications
● Socio-cultural factors: Higher-income or more educated patients may prefer surgical delivery for perceived safety or convenience.
● Convenience and staffing patterns: Private facilities often allow more predictable scheduling for doctors, reducing the need for prolonged labor monitoring.
In public hospitals, the opposite factors can limit C-section availability: resource constraints, fewer specialists, and infrastructure limitations can prevent timely surgery even when medically necessary.
Therefore, higher rates in private hospitals are not simply due to unnecessary surgeries or just financial gains. They reflect a mix of patient demographics, system incentives, medico-legal concerns, actual medical complexity, and sometimes limitations in monitoring facilities. Considering these factors makes it clear why C-section rates differ so much between public and private hospitals and why it’s important to make decisions based on evidence and the patient’s needs.
Guidelines and Best Practices for C-sections
Several leading health organizations have laid out guidelines that the doctors are required to follow, to ensure C-sections are done safely and only when truly necessary. FIGO (International Federation of Gynecology and Obstetrics) emphasises evidence-based decision-making, avoiding non-medically indicated procedures.
The Role of Patient Trust in Surgical Decision-Making
In surgery, including C-sections, nothing is ever black and white. Doctors make decisions based on established guidelines, the patient’s profile, and the clinical scenario. A minority may misuse the system for incentives, but painting the entire medical fraternity as corrupt is not just unfair, it is outright dangerous.
When patients lose trust, delayed decisions can cost lives. The media and influencers must be held accountable for their statements. Oversimplification and misinformation may grab attention, but they harm public interest. Hence, I believe that organisations must take a clear stand, defend patient rights, and call out misleading narratives.
Final Word
C-sections are both a medical triumph and a public health challenge. They have played an important role in reducing maternal mortality, especially in countries like India where MMR has dropped significantly in the past three decades.
That said, it would be incorrect to assume that all private hospitals are overusing C-sections. Only a minority of doctors or institutions may push for caesarean surgery, which may seem unnecessary while many others recommend it based on genuine medical complexity. Moreover, some hospitals may simply not be equipped for safe prolonged labor monitoring, and that must also be factored in. Patients should maintain trust in their doctors, while also feeling empowered to ask questions and seek second opinions. A strong doctor–patient relationship built on transparency and trust is the best way forward, for safe deliveries and a healthier future.
Frequently Asked Questions (FAQs)
Is C-section safer than vaginal delivery?
Not always. Vaginal delivery remains safer for most women when no complications exist. C-sections are life-saving when indicated, but not free of risks.
Can I have a normal delivery after a C-section?
Yes, many women can attempt VBAC (Vaginal Birth After Caesarean) depending on their medical history and current pregnancy profile. Your doctor will give the right advice depending on your condition.
Why are private hospitals doing more C-sections?
Data suggests financial incentives, fear of litigation, convenience for scheduling, and at times, patient preference play a role. But as discussed, not every case is unnecessary—sometimes infrastructure limitations and genuine medical complexities are responsible.
Do C-sections affect future pregnancies?
Yes, they increase risks like abnormal placentation and uterine rupture in subsequent pregnancies.
How HealthPil Can Help
At HealthPil, we stand with the right kind of health guidance and awareness. We make sure you understand all the complexities, nuances, and realities of procedures like C-sections. We do not promote oversimplified or “cringe” content—only clear, compassionate, and evidence-based information.
We provide:
● Direct access to obstetricians and gynecologists for trusted second opinions.
● Counseling on delivery options, so you know when a C-section is truly necessary, and when vaginal birth is safe.
● Support for high-risk pregnancies, ensuring you make informed choices backed by guidelines and medical expertise.
● A free Q&A platform where you can clear doubts openly, without judgment or pressure.
Disclaimer
This article is meant for general awareness only. It does not replace medical advice, diagnosis, or treatment. Every pregnancy is unique, and decisions about caesarean section or mode of delivery should always be made in consultation with a qualified obstetrician or healthcare provider who understands your specific health condition.
