In an era when caesarean section (C-section) rates are rising steadily across the globe, a government medical college hospital in Mumbai has demonstrated that thoughtful clinical strategies can reverse this trend. Lokmanya Tilak Municipal Medical College and General Hospital (Sion Hospital), under the leadership of Prof. Dr. Niranjan Chavan, has successfully reduced its C-section rates by 5–6% through an innovative approach known as the “Sion Model.”

The Global Challenge of Rising C-Section Rates

A C-section is a life-saving surgical procedure when medically indicated, but unnecessary use exposes mothers and newborns to avoidable risks. Recognising this, the World Health Organization recommends that C-section rates should ideally remain between 10–15%. However, modern obstetric practice, patient preferences, medico-legal concerns, and system-level pressures have pushed rates far beyond this benchmark in many regions.

Sion Hospital: A High-Volume, High-Responsibility Setting

Established in 1947, Sion Hospital has grown into a 1,400-bed tertiary care centre and serves as a major referral hub for emergencies from across Mumbai, Maharashtra, and beyond. Situated near Dharavi, Asia’s largest slum, the hospital caters largely to high-risk and socioeconomically vulnerable populations. The Department of Obstetrics and Gynaecology manages approximately 1,500–1,700 deliveries annually, making it an ideal setting to test sustainable interventions for improving maternal health outcomes.

The Birth of the “Sion Model”

Developed by Prof. Dr. Niranjan Chavan, Professor and Unit Chief in Obstetrics and Gynaecology, the Sion Model focuses on a simple yet powerful principle: prioritising safe vaginal birth whenever possible while ensuring maternal and fetal well-being. Implemented from mid-2023, the model blends mechanical and pharmacological methods for induction of labour to improve success rates of vaginal delivery.

How the Sion Model Works

The procedure uses a 24 French Foley’s catheter, inserted beyond the internal cervical os and inflated with 60 ml of normal saline. Gentle traction is applied and gradually increased every four hours. Alongside this mechanical cervical dilatation, Dinoprostone gel is applied locally. The combined approach helps ripen the cervix effectively, often leading to spontaneous expulsion of the catheter and progression of labour.

Importantly, this method relies on low-cost, widely available tools, making it particularly suitable for public hospitals and resource-limited settings.

Encouraging Results Over Two Years

Data collected between July 2023 and November 2025 shows consistent success. Among women induced using the Sion Model, 74.6% delivered vaginally, significantly reducing primary C-sections. Monthly vaginal delivery rates frequently exceeded 75%, with some months approaching 90%. The strategy also encouraged vaginal birth after one previous C-section (VBAC) in eligible women, further lowering repeat surgical deliveries.

Aligned with Global Best Practices

The Sion Model aligns closely with the California Maternal Quality Care Collaborative (CMQCC) toolkit, an internationally recognised framework for supporting vaginal birth and reducing unnecessary primary C-sections. The toolkit emphasises data-driven decision-making, improved labour management, and a culture of shared decision-making, principles that underpin the success seen at Sion Hospital.

A Call for Wider Adoption

Prof. Dr. Chavan and his team believe that the Sion Model can be replicated across India and other low- and middle-income countries. By combining evidence-based medicine, patient counselling, and simple technology, the model demonstrates that reducing C-section rates does not require expensive interventions, only commitment, training, and confidence in vaginal birth.

As obstetric practice evolves, experts warn that without deliberate action, vaginal delivery may become increasingly rare. The experience at Sion Hospital serves as a timely reminder that with the right approach, normal birth can be preserved as the norm rather than the exception, ensuring safer motherhood for generations to come.

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