Dr. Banka Soujanya: These issues are some of the most neglected in our society today, especially regarding postpartum care. When a mother expresses feelings of sadness or low mood, it is often overlooked. People may assume she just feels this way because she isn't getting enough sleep or has no time for herself. Family members, including partners and parents, may dismiss her feelings, but it’s crucial that we need take these concerns seriously, particularly during the postpartum period.

When I conduct rounds, I emphasise to support mothers needs during this time. It's important to ensure they have time to eat and sleep, as these seemingly minor things can significantly impact both the mother's and the baby's well-being. My understanding of postpartum depression and psychosis has deepened because my husband is a psychiatrist. I often tell patients that feeling sad, irritable, or losing interest is not normal, and they need support.

If psychological support is required for postpartum depression, we can arrange a consultation for them at any time. This condition is often referred to as "postpartum blues." When mothers express these feelings, we must take them seriously, not for granted. We encourage them to consult a psychologist. We also collaborate with the nursing team to ensure about what is happening, using assessment scales to evaluate the situation.

If necessary, we will refer them to a psychiatrist to help manage postpartum blues. Conversely, postpartum psychosis is a more severe condition that requires immediate attention. Postpartum psychosis can develop within days or even weeks after delivery. We must act quickly if a patient reports hearing voices, increased irritability, a loss of interest in her child, or erratic behaviour. This condition not only poses risks to the mother but also to the baby.

We have encountered tragic scenarios where mothers, in the grip of hallucinations or delusions, harm their babies, such as by strangulation or smothering. They may believe they are acting on commands from voices in their heads. This situation requires immediate intervention. The mother and baby should be separated until the mother has been stabilised, and family members need to be informed that this is not normal.

Hormonal changes can contribute to these issues, and the mother will require treatment. During this time, the baby should be taken care by other caregivers to ensure their safety. After a course of treatment lasting two to six weeks, the mother can fully recover, allowing for a healthy bond between her and her baby. These matters must never be neglected.

Dr. Banka Soujanya: Yes, this is called EPDS, Edinburgh Post Depression scale. It is a self reported questionnaire where the patient answers based on their feelings from past week. Each question will have four options: 0 1 2 3. There are three options.

0: No, not at all

1: Yes, some of the time.

2: Occasionally.

3: Most often

So according to that, the patient will tick an answer that help to reflect their experience and analyze her situation in the last one week. The analysis involves a total of 10 questions, each question will be having zero to three points. Once the responses are gathered the scores are added from each question together.

If total score is more than 13, there are mild possibilities that patient might be experiencing a postpartum depression. If total score is more than 15 then patient further needs evaluation. One crucial question in the questionnaire addresses any recent thoughts of suicide, which is the most important thing? If the score is less than 5 and patient answers yes and having thoughts about suicides, it signifies a serious concern where the treatment is needed. Any continuous thoughts to have a suicide in postpartum period.

A scoring system of EPDS as follows:

If a total score is maximum of 13: A score less than 13, no cause for concern; only reassessment may be required later.

A score of 13 to 15 suggests the need for treatment.

A score of more than 15, signifies a definitive treatment is necessary This is just a self reported question.

In a follow up visit after delivery, patient comes after 10 days for follow-up, we ask how are you feeling, how is your sleep cycle? How is your appetite?. Also we ask the attenders whether she is feeling sad or did you see her crying with no reason or displays irritability.

This additional input can be crucial as some patient will not express their feelings completely so some information we have to collect from the partner.

In the post Natal follow-ups, it is important for family members to engage with the patient individually to discuss about her concerns, and we also ask the attenders or the family members just to stay outside and we talk with her personally such as what is bothering her, whether she's landing into that scale, whether she's going through all these things fitting into the postpartum depression or psychosis that allows us to recommend appropriate treatment

Dr. Banka Soujanya: While this may have been the case in the past, it is not true now. Currently, government protocols and guidelines require every hospital to aim for at least 80% normal deliveries. In my practice, I have never encountered a gynecologist who performs a C-section without a valid medical indication.

Sometimes, cesarean sections are performed due to pressure from the patient or their family, or even due to auspicious timings known as "Muhurtham Pressure". Why is all the responsibility placed just on gynecologists and obstetricians? When a mother, early in her pregnancy, states that she is not capable of a normal delivery and requests a C-section, who are we to make that decision for her? The effectiveness of delivery methods can shift based on individual needs.

It is important to note that there are no gynecologists like who do the C-section for money. In many corporate hospitals, the pricing packages are the same for normal delivery and cesarean sections. Nowadays, the term has changed and also approach has changed; we now have to charge a bit high for normal deliveries because in the case of normal delivery, the gynecologist must sit and stay until the delivery is complete.

In contrast, a C-section can be done within 1 hour, but the post-operative complications will be bit high.

Now the government protocol set to have around 80% of normal deliveries and 20% of C sections, we have to face all the audits to justify our decisions. How? Why, when? With what indication did we do the cesarean section? We must provide specific documentation adhering to a criteria called Ropsons criteria, which mentions the indication for a cesarian section.

Maintaining these statistics while being ethically professional and responsive to patients' needs is quite challenging. No hospital performs a cesarean section the instant a patient enters the examination room unless there is clear evidence necessitating it. If the baby is not in a head-down position or is lying transversely, I must inform the patient that a normal delivery isn’t possible and that surgery is required. If I lack the expertise in such cases, I would suggest consulting another doctor who specialises in delivering babies in such positions.

In summary, there isn’t a doctor who performs cesarean sections solely for monetary reasons.