Dr. Banka Soujanya on Teamwork in Labor, Risks of Muhurtam Deliveries, and More! (Part-2)

Dr. Banka Soujanya: When the patient is going into labor, especially active labor (from 6 centimeters of dilatation), we monitor the progress using a chart called a partogram. We check how much the cervix is dilating, how long it takes, and whether the baby's descent is happening. If everything is within normal limits, we wait and watch. If something crosses the borderline (called the action line), we assess whether the cervix is fully dilated.

Our labor room staff are well-prepared and inform me of every step of progress. Forceps will be ready. The midwife assisting the delivery provides emotional support. The partner is also present in the labor room and kept informed, so they can support the mother. As a gynecologist, I keep talking with them and explain what is happening, how the baby is doing based on the heartbeat.

We always use a continuous fetal heart monitoring machine in the labor room so the mother can hear the baby’s heartbeat. We explain that the baby is doing well and encourage her to push. If progress is not happening, we may need to use forceps.

So, by informing them beforehand and reassuring them that the baby is fine and the progress is good, we help them feel comfortable. The pediatricians are also ready to assist the baby once it is out. I am there in the labor room to give the patient confidence that everything is proceeding smoothly.

Dr. Banka Soujanya: When there’s an indication for an elective C-section, planning it is absolutely fine. But nowadays, patients request surgery at very specific times—early morning, at exactly 2:10 AM, for instance. That becomes a challenge. I may be available because I’ve communicated and traveled with them over the past nine months, but the pediatrician, anesthetist, OT technicians, and midwife must also be available. That’s a big challenge.

When people insist that the baby must be delivered at an exact time—like 2:10:15—we have to counsel them. We’re not gods to decide the baby’s fate. We cannot play the role of Brahma or any other deity. I provide proper counseling to prevent these muhurtam deliveries. While choosing a specific day is fine for elective cases, timing it to the minute is not practical.

For example, if a patient has completed two full-term pregnancies and reaches 39 weeks, and we plan the delivery within a four- or five-day window, scheduling a date is fine. But for emergency situations, it’s not appropriate. Some people say, “Madam, after 4 PM is not good; do a C-section.” I then explain firmly that this is not right. Decision-making should involve the husband and wife, not the extended family.

The government also emphasizes promoting normal deliveries. But patients need to understand and allow the doctor the freedom to decide what is best for them. They should not impose their beliefs on doctors. Muhurtam deliveries are a strict no. Elective C-sections are good when properly planned with a full team and all pre-checkups, including blood tests and baby monitoring.

In contrast, emergency C-sections are time-sensitive. I must deliver the baby within two minutes. A multidisciplinary team must be available 24/7: anesthetists, pediatricians for resuscitation if needed, and others. The risk of bleeding is also high because the patient is already in labor. The uterus might not contract back, leading to postpartum hemorrhage (PPH), which is a major risk.

VBAC (vaginal birth after cesarean) is a common scenario. We do give a trial, but in rare cases (0.1 to 1%), uterine rupture can occur during labor. That’s an emergency, and we must act fast to ensure safety and prevent bleeding.

So, when comparing elective vs. emergency C-sections, elective ones are clearly more beneficial. Emergency C-sections require absolute teamwork, not individual effort.

Dr. Banka Soujanya: Vaginal deliveries are a natural process that typically allows for good recovery with minimal risks. There is a common myth that cesarean sections (C-sections) are performed more frequently nowadays, which is not true. We can often attempt a vaginal birth after cesarean (VBAC). Normal deliveries come with several advantages. Firstly, the healing time for the mother is much shorter. Within 24 to 48 hours after delivery, she can resume many of her usual activities, such as holding her baby, without issues related to urination or defecation. She can also manage tasks to a reasonable degree without needing adult support, such as from her mother or a nurse. Secondly, blood loss during vaginal delivery is minimal. Additionally, the risk of placenta previa, where the placenta attaches to a previous scar, is extremely low, and there is no risk of damage to nearby organs during vaginal delivery. In contrast, C-sections carry risks such as bleeding and the potential for excessive manipulation of internal organs, which can lead to adhesions where the uterus may become attached to the urinary bladder or intestines. These adhesions can also result in hernias. If a patient undergoes a C-section and then resumes heavy activities, such as lifting weights or excessive household chores too soon, there is an increased risk of developing hernias and damaging internal organs like the bladder or intestines in subsequent pregnancies. Repeated C-sections further escalate these risks. The presence of a previous scar can lead to conditions such as placenta accreta, where the placenta attaches to the scar tissue. In these cases, excessive bleeding can occur, and surgery may require a cesarean hysterectomy after multiple pregnancies, with healing issues commonly associated with C-sections. In our country, it is interesting to note that after a C-section, patients often receive inadequate nutrition, primarily eating only milk, bread, and tea. Family members, including parents or in-laws, frequently avoid providing protein-rich food. Despite my insistence as a doctor that patients should receive proper nutrition, these food-related myths persist. In contrast, corporate hospitals provide meals like dal and rice or dal soup the day after a C-section. Protein-rich food is essential for wound healing. Unfortunately, because of the prevalence of these myths surrounding nutrition, there remains a risk of wound infection.