Rise in c-section rates; an interesting perspective

[Anonymous]

I wonder what percentage of induction and augmentation with Pitocin and Cytotec have to do with rising section rates. It seems as though those drugs greatly increase the chance of fetal distress and then c sections.

I have always thought it was a mix of liability concerns and interventions, but I have no studies to back this up. On an anecdotal level, I know one woman who was bent on having a VBAC. Her uterus ruptured and she lost her baby. After all that she learned about VBACs, she still sued anyone that had anything to do with her prenatal/delivery care. A dead baby is emotional and tort reform means nothing to someone searching for someone to take responsibility for such a horrific experience.

[Anonymous]

"I agree with all PPs about the need for greater education on this issue, so that women can be their own advocates and not be "pushed" into unneeded c-sections. "

This is just not realistic. Who wants to try to argue with your doctor when they are in labor? It puts a patient in a horrible position. You may be 99% that what you are hearing is BS but you can't help but second guess yourself about the 1%. Conversly, a patient could end up refusing something that is needed.

There should be more transparancy during the initial ob/gyn selection. Ob/gyns and hospitals should be required to disclose their c-section, induction and unmedicated childbirth rates. Most women are finding out in the third trimester about whether their doctor is conservative or progressive and then in a bind about whether or not to switch.

I really wonder how elective inductions and elective c-sections get past insurance code issues. I actually support a women's right to choose elective surgery and induction if she wants but I doubt insurance carriers are up to footing the bill. Someone is messing with codes and that should be fraud. I don't understand how doctors have not gotten in trouble for this considering the money at stake.

There should be more places that support the combined mid-wife - ob/gyn practices and the nursing to patient ratio should be lower on L&D floors to provide support for women in labor.

Hospitals and doctors should be accountable for their actions. I have friends who work in medicine and everyone knows the doctor that sections before 5pm. It doesn't take a brilliant investigator to look through someone's record and pick out these patterns. If this type of doctor was ever held responsible in any way then other new doctors would not follow suit. Its amazing how little oversight doctors receive and much of what is there is watered down peer review. Doctors scream about tort reform but sadly this is the only mechanism for consequences. If something better was put in place to catch the bad apples, force adoption of evidence based practices, and deal with problems in their profession you could get tort reform.

[Anonymous]

Anonymous wrote:
This would be a valid argument if infant and maternal deaths went down as the c-section rate went up, by any proportion or measure--but the facts simply don't show that. In the last 20 years as the c-section rate has skyrocketed, maternal death rates have actually gotten WORSE, and outcomes for babies have NOT improved (although I don't believe they've actually gotten worse). So increased c-section rates are actually HIGHER risk for the mother, without saving any additional babies. THAT tells me we've gone too far in the wrong direction. No one is suggesting that we stop c-sections altogether, they ARE certainly necessary in some case, but we need to find a better equilibrium. I think it IS possible to determine, at least better than we are now, which c-sections are ACTUALLY necessary--there are way too many arbitrary measures in place now for initiating surgery when evidence has not shown it necessary (large size, past dates, length of otherwise normal labor, etc).

But people aren't suing because they had c-sections (6 of 9 reasons for suit were because they didn't perform a section earlier). Can they prove mother mortality was caused by c-section?

[Anonymous]

"But people aren't suing because they had c-sections (6 of 9 reasons for suit were because they didn't perform a section earlier). Can they prove mother mortality was caused by c-section? "

Sure, the reasons usually are infection, blood clots, or excessive bleeding but these complications are more within the accepted standard of care and risk profile for all surgery. I could be wrong but I don't think people usually win suits for catching an infection in a hospital although oddly becoming infected comes from human error where something was not sterilized or cleaned properly.

[Anonymous]

Anonymous wrote:Also in the last 20 years- woman having children 'later' in life has drastically risen.

I had a c-section and have no problem with it. I feel it was medically necessary and personally- my recovery was easy, my scar is tiny and I feel like I got great care.

I do laugh a little when I hear people talk about how bad c-sections are or how bad recovery is or how it is so bad they are on the rise. Really, your 4th degree tear and hemroids sound awesome.

Well someone had to go there, I guess. For the record, I had no tearing, no hemmorhoids. I felt great, left the hospital the morning after my birth (with doctor's blessing) and took a walk with my baby the next day. I'm sure there are loads of us on both sides who can claim the easiest and best recovery, but that's really not the point. C-sections are less healthy and overperformed. That said, if yours was truly necessary I'm glad you had one! No doubt they do save lives sometimes.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also in the last 20 years- woman having children 'later' in life has drastically risen.

I had a c-section and have no problem with it. I feel it was medically necessary and personally- my recovery was easy, my scar is tiny and I feel like I got great care.

I do laugh a little when I hear people talk about how bad c-sections are or how bad recovery is or how it is so bad they are on the rise. Really, your 4th degree tear and hemroids sound awesome.

Well someone had to go there, I guess. For the record, I had no tearing, no hemmorhoids. I felt great, left the hospital the morning after my birth (with doctor's blessing) and took a walk with my baby the next day. I'm sure there are loads of us on both sides who can claim the easiest and best recovery, but that's really not the point. C-sections are less healthy and overperformed. That said, if yours was truly necessary I'm glad you had one! No doubt they do save lives sometimes.

Also, I had my first at 36, so surely I'm an exception according to your assumption that advanced maternal age indicates ability to have a vaginal childbirth. (insert eye rolling).

[Anonymous]

Can you point me in the direction of research that advanced maternal age has anything to do with the inability to deliver vaginally? Other complications surely attach as women advance in age, but vaginal birth ain't one of 'em.

It's this sort of so-stupid-it-practically-drools commentary that makes these boards so richly entertaining and so poorly informative. Here's a recommendation for the next time you feel like sniping at someone on these boards with your smug certainty: Try the Google. It took me all of 45 seconds to discover a piece from the Mayo Clinic that explains why advancement maternal age increases the risk of other complications that in turn--wait for it, wait for it....increase the chance that an AMA mother will need a c-section.

http://www.mayoclinic.com/health/pregnancy/PR00115

Of course, knowing how many tin-foil-hat wearers populate this board, I'm sure it won't be long before someone writes off the Mayo Clinic as body of zombie "cutters" who care only about their Friday evening dinner plans.

Cheers.

[Anonymous]

"Can you point me in the direction of research that advanced maternal age has anything to do with the inability to deliver vaginally? Other complications surely attach as women advance in age, but vaginal birth ain't one of 'em.

It's this sort of so-stupid-it-practically-drools commentary that makes these boards so richly entertaining and so poorly informative. Here's a recommendation for the next time you feel like sniping at someone on these boards with your smug certainty: Try the Google. It took me all of 45 seconds to discover a piece from the Mayo Clinic that explains why advancement maternal age increases the risk of other complications that in turn--wait for it, wait for it....increase the chance that an AMA mother will need a c-section.

http://www.mayoclinic.com/health/pregnancy/PR00115

Of course, knowing how many tin-foil-hat wearers populate this board, I'm sure it won't be long before someone writes off the Mayo Clinic as body of zombie "cutters" who care only about their Friday evening dinner plans.

Cheers. "


I'm not the PP but the advanced maternal age leads to c-section is an oversimplification. Most people do not read the underlying assumptions. Older women have a higher probablity of being overweight or obese, have begun to develop CHT or Type II diabetes which increases risk factors for GD, PE, and PTL. If you have advanced maternal age but are not overweight or have CHT then you shouldn't assume you will need a c-section.


Convenience (doctor or patient), daylight obstretics, fear of big baby and no VBACS are bigger drivers. If a higher % of primips are having c-sections and VBACS are disallowed in all circumstances at most hospitals the rate is going to soar.

[Anonymous]

Anonymous wrote:

Can you point me in the direction of research that advanced maternal age has anything to do with the inability to deliver vaginally? Other complications surely attach as women advance in age, but vaginal birth ain't one of 'em.

It's this sort of so-stupid-it-practically-drools commentary that makes these boards so richly entertaining and so poorly informative. Here's a recommendation for the next time you feel like sniping at someone on these boards with your smug certainty: Try the Google. It took me all of 45 seconds to discover a piece from the Mayo Clinic that explains why advancement maternal age increases the risk of other complications that in turn--wait for it, wait for it....increase the chance that an AMA mother will need a c-section.

http://www.mayoclinic.com/health/pregnancy/PR00115

Of course, knowing how many tin-foil-hat wearers populate this board, I'm sure it won't be long before someone writes off the Mayo Clinic as body of zombie "cutters" who care only about their Friday evening dinner plans.

Cheers.

did you read or just google? i suspect you just googled b/c the article you posted suggests that placenta previa, the risk of which increases if you're a first time mother over 25, is the reason to prepare yourself for a c-section if you're advanced maternal age. placenta previa occurs is 0.3-2.0% of all births. now, i'm no statistician (but i sure am hell brighter than you, this i assure you) but i don't see how that statistic supports the overwhelming increase in c-sections. i'm sure you'll go back to google and offer up another report, but the fact is that being an older mom does not alone mean you have to have a c-section. if you have other medical conditions, sure, but those are not supporting a higher c-section rate. (in case you think you'll make your argument better by highlighting other conditions, GD occurs in 3-5% of pregnancies, again, not high enough to show why the c-section rate has increased.)

see, i just need to be able to read to refute your arguments. you provide the very basis to refute your reasoning. for that, i do thank you. i don't need to foolishly try to impugn a reputable medical community such as the mayo clinic. i just have to call you out on your own idiocy. simple, simple task really. you do make it too easy.

[Anonymous]

Anonymous wrote:Also in the last 20 years- woman having children 'later' in life has drastically risen.

I had a c-section and have no problem with it. I feel it was medically necessary and personally- my recovery was easy, my scar is tiny and I feel like I got great care.

I do laugh a little when I hear people talk about how bad c-sections are or how bad recovery is or how it is so bad they are on the rise. Really, your 4th degree tear and hemroids sound awesome.

Why do you feel that your c-section was medically necessary? Not trying to start something, but I geniunely want to know b/c chances are, you just were in labor a long time and the baby wasn't progressing as fast as you'd like.

You also are comparing the best outcome via c-section (easy recovery, tiny scar) with the worst outcome via vaginal birth (4th degree tear and hemorrhoids). That is like comparing apples to oranges. Instead, you should compare your easy recovery via c-section to the typical easy recovery via vaginal birth. I've had 2 vaginal deliveries. Minimal tearing that I never even noticed, no hemorrhoids, and was literally up and about within a couple of hours. My friends with c-sections - even those who recovered great - were not out and about as quickly as I was. How could they be? A c-section is MAJOR ABDONMINAL SURGERY. I'm glad your went so well, but you really shouldn't be so smug.

[Anonymous]

For those interested in comparing c-section rates among providers and hospitals in VA:

http://www.vhi.org/ob_guide/ob_intro.asp

[Anonymous]

did you read or just google? i suspect you just googled b/c the article you posted suggests that placenta previa, the risk of which increases if you're a first time mother over 25, is the reason to prepare yourself for a c-section if you're advanced maternal age. placenta previa occurs is 0.3-2.0% of all births. now, i'm no statistician (but i sure am hell brighter than you, this i assure you) but i don't see how that statistic supports the overwhelming increase in c-sections.

A jar of mayonnaise has better reading comprehension skills than you do. The article I linked to did not say that placenta previa was the *only* factor that increases the risk of c-section for AMA mothers. It says "Older mothers have a higher risk of pregnancy-related complications that may lead to a C-section delivery, such as placenta previa." You do understand what that economical phrase means, right? It means: Dear reader, I am about to introduce you to just one example of the phenomenon I have mentioned, but please rest assured there's more where that came from.

i'm sure you'll go back to google and offer up another report, but the fact is that being an older mom does not alone mean you have to have a c-section.

Yes, it's just like me to rely on "reports" filled with "facts" and "data." Life must be so blissfully simple for you, what with your ability to rely on the truthiness of your gut and the collective anti-wisdom of internet chatrooms. But just in case you develop a late-in-life interest in empirics and science, here is yet another study -- this one from ACOG -- that correlates AMA with, *among other things*, c-section.

http://prepforbirth.com/news/wp-content/uploads/2009/07/ama-morb-and-mort.pdf

i just have to call you out on your own idiocy. simple, simple task really. you do make it too easy.

Uncle! Oh, please stop! I'm not sure how much more of your savage (monosyllabic) barbs I can tolerate. You're just so obviously the third for fourth smartest person in the Western Hemisphere now that Einstein is dead. And now that you're showing off a rugged indifference to capitalization and good grammar, I completely recognize your brilliance. No, seriously. Will you tutor my children?

[Anonymous]

I don't understand why anyone on this board spends time thinking about whether a friend's c-section was 100% medically necessary.

[Anonymous]

"For those interested in comparing c-section rates among providers and hospitals in VA:

http://www.vhi.org/ob_guide/ob_intro.asp "

This is amazing. I wish they had this for DC or Maryland.

[Anonymous]

Okay, you guys are really clever and I'm sure you're both brilliant, but this amusing back and forth is actually not productive. One of the biggest problems with this board is people's inability to actually debate about issues without resorting to personal attacks about how stupid the person they're arguing must be. There are arguments on both sides. The topic if this thread is "an interesting perspective" - your back and forth snark is amusing, but not relevant or particularly interesting.