How Odisha's Rising C-Section Delivery Trend Could Fuel an Urban Diabetes Crisis Among Mothers and Newborns | Special Report

Bhubaneswar: For nearly two decades, Odisha's maternal healthcare story has been one of remarkable success.

Institutional deliveries have risen sharply, maternal mortality has declined, and access to obstetric care has improved across the state. Yet, beneath this public health achievement, another trend has quietly gathered pace – one that could undo part of these gains.

Urban Odisha is witnessing two parallel developments. Private hospitals are increasingly opting for Caesarean section (C-section) deliveries, while diabetes among women of reproductive age is climbing steadily. Individually, each trend poses a challenge. Together, they create what public health experts describe as a metabolic risk cycle capable of increasing complications for mothers and newborns alike.

The concern is no longer theoretical.

National Family Health Survey (NFHS-6) data points to extraordinarily high C-section rates in Odisha's private hospitals, while the same survey records a significant rise in elevated blood sugar among urban women aged 15-49 years. Adding another dimension, the latest ICMR-INDIAB study estimates the prevalence of Gestational Diabetes Mellitus (GDM) in Odisha at around 17.9 per cent.

Odisha's 17.9% GDM Prevalence Makes the C-Section Boom More Concerning

The latest ICMR-INDIAB findings place Odisha's Gestational Diabetes Mellitus (GDM) prevalence at approximately 17.9 per cent.

In practical terms, nearly one in six pregnant women may develop diabetes during pregnancy.

The convergence of these three trends places Odisha's urban maternal healthcare at a crucial crossroads.

Private Hospitals Continue to Drive Odisha's C-Section Surge

NFHS-5 paints a striking picture.

While the World Health Organization considers population-level Caesarean rates above 10-15 per cent unlikely to improve maternal or neonatal outcomes, Odisha's private healthcare sector has moved far beyond that threshold.

Private hospitals in the state report Caesarean deliveries ranging between 70.7 per cent and 74.6 per cent, meaning nearly three out of every four births occur through surgery rather than normal delivery.

Although many C-sections are medically necessary and life-saving, public health specialists have repeatedly cautioned that unnecessary surgical deliveries expose women to avoidable operative risks and longer recovery periods.

The concern becomes far more serious when these surgeries increasingly involve women already experiencing insulin resistance or diabetes.

Urban Women Are Becoming More Diabetic During Their Reproductive Years

NFHS-6 also reveals another worrying shift.

Compared with the previous survey, the proportion of urban women aged 15-49 years with elevated blood sugar has increased, reflecting the growing burden of diabetes and pre-diabetes among women in their reproductive years.

High blood sugar among women in Odisha recently escalated from 14% to 26.2%, finds NFHS-6, the same study has also revealed that Overweight or obese women (aged 15–49) jumped from 24% to 30.7%.

This rise mirrors rapid urbanisation, sedentary lifestyles, increasing obesity and changing dietary habits.

For pregnancy, the implications are profound.

Women entering pregnancy with diabetes, or developing gestational diabetes during pregnancy, already face higher risks of complications. When surgical deliveries become the preferred mode of childbirth, these risks may multiply.

Rather than two independent health issues, rising diabetes and rising Caesarean deliveries begin interacting with each other.

How Diabetes Often Leads to Caesarean Delivery

Gestational diabetes changes fetal growth patterns.

When maternal blood glucose remains elevated, excess glucose crosses the placenta. The baby's pancreas responds by producing higher insulin levels.

Since fetal insulin acts as a growth hormone, babies often become larger than expected for their gestational age – a condition known as macrosomia.

Large babies increase the likelihood of:

• obstructed labour,
• cephalopelvic disproportion,
• shoulder dystocia,
• prolonged labour.

In such situations, obstetricians frequently have little option but to perform emergency Caesarean delivery.

Thus, diabetes itself often becomes the reason surgery is required.

When Surgery Meets Diabetes: Risks Multiply

The challenge does not end with the operation.

A Caesarean section is major abdominal surgery.

Surgical trauma activates the body's stress response, releasing hormones including cortisol, adrenaline and glucagon.

These hormones temporarily increase blood glucose levels.

For women already experiencing insulin resistance or gestational diabetes, maintaining glucose control during and after surgery becomes significantly more difficult.

The resulting glucose fluctuations complicate anaesthesia management, recovery and overall postoperative care.

Poor Wound Healing Adds Another Layer of Risk

High blood sugar directly affects tissue repair.

Persistent hyperglycaemia interferes with collagen formation, reduces blood supply to healing tissues and weakens immune cell function.

Consequently, diabetic mothers undergoing Caesarean delivery have a greater likelihood of:

• postoperative wound infection,
• wound dehiscence (splitting of the surgical incision),
• delayed healing,
• internal abscess formation,
• maternal sepsis in severe cases.

Instead of routine postoperative recovery lasting a few days, complications can extend hospitalisation and require prolonged antibiotic treatment.

The Hidden Long-Term Concern: Type 2 Diabetes

Perhaps the most overlooked consequence is what happens after childbirth.

Women recovering from Caesarean surgery often experience greater postoperative pain, reduced mobility and delayed initiation of breastfeeding.

Early exclusive breastfeeding plays an important physiological role in restoring maternal glucose metabolism after pregnancy.

When breastfeeding initiation is delayed, this natural metabolic adjustment may also be delayed.

For women with gestational diabetes, this could reduce one of the body's natural protective mechanisms during the postpartum period, underscoring the importance of timely breastfeeding support and postpartum diabetes screening.

The Newborn Also Pays the Price

The effects extend beyond mothers.

Babies born through Caesarean delivery may experience different early physiological adaptation compared with normal births.

Because they do not undergo the same compression of the chest during normal delivery, they have a higher likelihood of transient respiratory problems due to retained lung fluid.

Among babies born to diabetic mothers, another complication becomes important.

Immediately after birth, maternal glucose supply stops, but the baby's insulin levels may remain high, increasing the risk of neonatal hypoglycaemia, which often requires monitoring and, in some cases, specialised neonatal care.

Thus, maternal diabetes combined with Caesarean delivery can increase challenges for newborn care.

The Bigger Picture

Odisha's maternal healthcare system has successfully encouraged women to deliver in hospitals. The next challenge is ensuring that institutional delivery also translates into optimal long-term health.

With private-sector Caesarean rates among the highest in the country, diabetes rising among urban women of reproductive age, and nearly one in six pregnancies potentially affected by gestational diabetes, the state faces what may be called a twin metabolic trap.

Neither rising Caesarean rates nor increasing diabetes should be viewed in isolation. Together, they have the potential to reshape maternal and child health outcomes over the coming decade.

The challenge before Odisha's health system is therefore not merely increasing institutional deliveries, but ensuring that every Caesarean is medically justified, every pregnancy is screened for diabetes, and every mother receives appropriate metabolic follow-up after childbirth. 

Also Read: Critical Health Alert / NFHS-6 Drops Health Bombshell on Odisha: Young Adults Getting Trapped in Sudden Sugar, BP Spike| Exclusive Breaking