Increasing rate of caesarean section.Does that worries you?

As the delivery date starts approaching,one of the commonest question asked by the pregnant woman is,'Í have heard that in Max Hospital the incidence of caesarean is very high'.They are apprehensive and so are their partners.Very anxiously they wait for me to answer their question.

Previously I used to get defensive about the whole thing.Answers like I can't comment about others......my rate is not more than 20% for caesareans......I can assure you that if anywhere in the world you can achieve a safe vaginal delivery ,you can achieve that with my team......

Now I ask a different question.To tell me a hospital which they have heard god about and i will deliver them there.To my surprise they don't have an answer.They say that,that we don't know.Strange....isn't it.

What you read online or what you hear from your friends are half truths.Most of the time those who have good experience they get too busy with the life and don't have time for such feedbacks.Those who had an unexpected outcome or below expected outcome,they are the one's who leave strong feedbacks.They are a very small minority of people but as they are the most vocal,they scare you.

Now the question,why is the caesarean rate increasing?It is multifactorial.I will give you an example.

I work in a team with consultants and registrars etc as every person in the team has got a delegated duty and we all know that as a team we perform better.That is the whole idea of making the team that if I am busy  with one patient another patient under my care shouldn't suffer if any medical need arises.Now a patient who has come to show me for 9 months wants me to be present with them through every step,which isn't possible.How can I or any doctor be present through out if the trials are as long as 24 to 36 hours?I try my best to be present for all the vaginal deliveries.It is easy in nights or early morning as the roads are vacant,but it can be a problem during the daytime if the traffic is heavy.So at times ( once or twice in a month it so happens that by the time I reach baby has been delivered and attended by Dr Deepa Maheshwari as she lives across the hospital and has 13 years of experience in obstetrics and gynaecology.So ultimately you have a achieved a safe vaginal delivery due to our team work even if I am delayed by few minutes.

Now last week a Lady with high risk pregnancy with both Diabetes and blood pressure of pregnancy was induced at 39 weeks by me.In most likelihood they would have been offered a caesarean section had they visited anywhere else.So we started the process and followed it as per the protocol with team members including me visiting her at regular interval.All going well.At around 3 Pm she was 4 cms dilated i.e at least 6 hours to be fully dilated and then suddenly at 4 pm I was called that she had progressed very fast and is fully dilated and pushing the baby.So she travelled 6 hours journey in one hour.Totally unexpected.So I left my home and Deepa left hers.Naturally Deepa reached earlier than me and delivered the baby safely.I reached in another 5 minutes.Naturally south City 2 is farther than south city1. 

Now what I got for the patient's husband wasn't a thanks but a complaint that I didn't reach in time and no one came in between to keep the moral up of my wife by giving her false hopes that only few minutes are remaining etc.Then he went ahead to leave this feedback/complain somewhere that Dr Kaushiki Dwivedee didn't come to attend my WIVE'S delivery not mentioning that what a high risk delivery it was,how nicely my team under my supervision managed it to let his wife have a normal delivery and even a precipitate labour like hers was nicely managed because it was or team and Max Hospital.

Now if despite working so hard and ethically one gets such brickbats,is there a reason for a doctor to try 24 /36 hours of normal delivery where there is always a possibility that heavy traffic might be a problem.Isn't performing caesarean at some pretext like baby's heart beat is getting low,fluid is low,no progress of labour is a better option for the doctor?

THE BALL LIES IN YOUR COURT.DO YOU WISH THE DOCTOR TO BE HONEST AND ETHICAL WITH YOU TO TRY NORMAL DELIVERY SINCERELY WITH AN OCCASSIONAL CHANCE THAT IT WON'T BE HER BUT HER TRAINED TEAM MEMBER MIGHT ATTEND YOUR VAGINAL DELIVERY OR WOULD YOU PREFER A CAESAREAN TO BE PERFORMED BY THE MAIN GYNAECOLOGIST AT THE TIME OF HER CONVENIENCE.CHOICE IS YOURS!!

Hterotrophic Pregnancy can be tricky

Am back to my domain,where I can write to my hearts content.What I feel about and what I consider true.
I had taken a small break from blogging as well as vlogging.Needed to feel the need to communicate with the world.Need to expose my thought,which were as true as I could express but did hurt few..

Few days back a you female had come to me. Hassled .She said, she have the most complex story and my exact words were, let me know how complex can it get?
Due to some gynaecological problem she was operated in past which affected her fallopian tube.She reached the IVF specialist for conception. And happily conceived twins. Then unfortunately she miscarried twins in second trimester due to incompetent cervix.

After a while she again went to the same set of doctors.This time IVF with singelton pregnancy.It was heterotrophic pregnancy this time.A pregnancy in tube and pregnancy in uterus. So now what to do? Her Gynaecologist-IVF specialist team assured her that the tubal pregnancy looked a vascular, won't rupture and thus no surgery wasn't needed.

A person knows in her heart of heart the correct answer. She knew it needed surgery to remove the fallopian tube and perform the OS tigehtinig in the same go. She came to me for second opinion and my opinion was to get rid of ectopic pregnancy surgically and tighten the mouth of the womb. Probably she didn't like my solution. After all I had suggested surgery.

I am considered "daring surgeon"which I am not.I am just practical surgeon who can see things which can happen after an year or may be 10 years.I told her that her ectopic pregnancy will rupture if she carries on.She didn't come back to me.I wished her to be operated. I felt 'point proven and sorry both. Almost 14 days later she was in the hospital with ruptured ectopic 'and blood all over in the abdomen. A team of general surgeon and 3 to 4 gynaecologist fixed her problem combined together which could have been done in one go that very day.

Yes I do feel at times : see I said so and my clinical sense isn't bad !!

Pre Pregnancy Visit

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Pap Smear

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Channel Introduction

Satisfaction???

God gives different personalities to different people.
He has made me ambitious,restless and perhaps a go getter.So it transpires into diabetes,Hypertension and heart attacks in long run.Before I have sorted one agenda ,I am ready with a new target.A challenge for myself.A lack of patience makes me a figidity person while I am waiting for the target to be achieved.
So today my brother declared ,you have stagnated.Either be happy with the tag of a good doctor with nice practice or if you wish to reach a higher level become an educationist.God,,,,,that is difficult....For a doctor who has no support in GGN /Delhi.Did all the schooling.college and PG outside Delhi/NCR and has no standing amongst the local educationists, how do you intend to make that person an educationist?Go...Present in conferences.And my answer was....they won't let me deliver a guest lecture unless I know someone from the organising committee.You know that my networking skills are zero.Other option was to do real research have few publications on some topic and then no one can stop you from a guest lecture.And it all started with the Afghan president's wife delivering at another Gurgaon hospital and not under me despite me being a better Obstetrician an knowing my subject better than that person( I know it is a rather bold statement to make).I lacked the name of being an ex professor.As of now I am feeling very low at my self esteem.
I was told,I will be a good practitioner of average masses but should not think being a stalwart.Nothing wrong in that too,But then no doubt I need to spend time on research and academics.Soon my patients will me find out of GGN  for a conference outside.Which is the next one BTW??
All said and done whether I manage to become a stalwart amongst doctors or not.......academics and research is what I am lacking in as I am too busy just doing my private practice,trying to just appease my patients by being present when they are delivering with no time for my personal growth and development.Dilemma!!

Endometriosis

Have written so many times about this condition.One of the bad ones to have and the number of women coming with endometriosis is just increasing in leaps and bounds.
Endometriosis is a condition where there is spillage of blood in the abdominal cavity during periods.And over the period of time it becomes a painful condition with painful period,painful sex,heavy periods sometime even painful passage of stool.It compromises even the fertility.
               The treatment of endometriosis is unsatisfactory or drastic.There is nothing in between.Removal of cysts or removal of adhesion means that 75% of the women will have the symptoms back in 5 years unless the ovaries as well as uterus is removed along with.
                 Medical management can be in the form of Oral contraceptive pills,Injections called Zoladex, Mirena etc All these agents either stop the periods temporarily or lighten it,But once stopped there is bound to be recurrence.
                 The surgery for endometriosis needs special skills and should be performed by expert laparoscopic surgeon as there is a possibility of a bowel or bladder injury if they are badly stuck.