Critical shortage of human resources force Ob-gyn specialists to play it safe

Obstetricians and gynecologists in the state are in quiet rebellion. They decided to “step back” from giving birth in public hospitals, which lack adequate human resources, facilities and infrastructure, by ensuring that obstetric emergencies are handled only at tertiary care centres.

In fact, Ob-Gyn specialists in Thiruvananthapuram district have started implementing this protocol; this is a joint decision taken in consultation with both their fraternity and the Kerala Government Medical Officers Association.

Over the past two weeks, doctors have stopped performing births and related surgeries after hours at institutions with only two obstetricians and no resident anesthesiologist.

Obstetricians say they are targeted for “medical negligence” whenever unexpected complications arise during childbirth. The incident at Nedumangad hospital (where the obstetrician was held responsible for the death of the newborn baby) was the latest in a series of incidents in which the mob attacked doctors.

Although the investigation report later revealed that the doctor complied with all protocols, the violence faced by the doctors and the indifference of the authorities seem to have prompted the doctors to take a strict stance.

N. Sunitha, president “There are various delivery points in the public sector where there are not enough number of Obstetricians, anesthetists, support staff or blood storage facilities so that we can provide obstetric care 24×7. Obstetric emergencies come out of the blue and most of the time an Obstetrician deals with these high-risk situations and sometimes it does not end well. The authorities are aware of the situation but still expect us to provide comprehensive emergency obstetric care in these institutions.” KGMOA says from Thiruvananthapuram.

Ob-Gyns have decided to no longer take unnecessary risks. There are at least four delivery points in Thiruvananthapuram (Poojappura, Fort hospital, Attingal and Parassala taluk hospitals) where the situation is not conducive to providing 24-hour service. A few places like Vithura, Neyyattinkara, Chirayinkeezhu and Varkala have two Gynecologists each, but the anesthetist on duty has to serve all departments and may not be available all the time. Dr. “We tell the patients before us that we do not have facilities to provide proper care 24×7 and they are referred to higher centres. There will be no off-hours deliveries in these institutions because doctors are no longer willing to risk their careers or lives,” says Sunitha.

Currently only in Thiruvananthapuram Ob-Gyns have taken an official position not to deliver in cases where 24×7 facilities are not available as per standard protocols. However, KGMOA has compiled a complete district-by-region list of delivery points across the State where comprehensive emergency obstetric care is impossible and Ob-Gyns work under severe stress.

“Safe motherhood is often taken for granted, but there are countless issues that can suddenly complicate what the family expects to be a ‘normal’ birth. But people are not willing to accept this fact. Doctors, especially Obstetricians, are now working under severe stress and the threat of litigation, violence and media lawsuits have forced them to play it safe,” says Subhash Mallya, Secretary, Kerala Federation of Obstetrics and Gynecology.

KFOG runs numerous public awareness programs to highlight uncertainties in the field of obstetrics, but doctors continue to be punished for anything that goes wrong.

We have now officially communicated to the Director of Health Services that obstetric emergency care can only be provided where specialists are available 24 hours a day.

One option could be to create selected delivery points in districts where such facilities and human resources can be made available 24/7 and all deliveries can be carried out safely.

They also requested that a team of experts be appointed to conduct an assessment of existing delivery points in the State to determine whether these locations are safe to provide comprehensive maternity care according to standard protocols.