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Rise in c-section rates; an interesting perspective
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Anonymous
I don't really care whether they were, but I do kinda care about the increase in the national c-section rate b/c it also affects things like insurance premiums, women's health generally, etc. |
Anonymous
I started to have major bleeding, loss of BP, fetal distress and decreased levels of oxygen. Does this warrant a c-section or not? |
Anonymous
Dunno -- did you have pitocin? epidural? We'd need to know why you had those problems if you really want us to hazard a guess (which you probably don't, despite your challenge...) |
Anonymous
Unbelievable. Even after the PP identified four profoundly dangerous conditions that obviously militated in favor of a c-section, someone had the gall to question the medical necessity of that operation. But it gets even better, because the latest patchouli-soaked naturalist suggests that, even if the c-section was medically indicated, the PP essentially has no one to blame but herself because--heaven forfend!--she may have had an epidural. Enough is enough. Look, for those of you who are so self-satisfied with your au natural approach to birth, bravo. You're clearly the finest specimens of 12th-century orthodoxy. But it's unspeakably patronizing for you to lob anonymous natural-birthing fatwahs at women who decided to heed their doctors' orders, accede to a c-section when there were damn good reasons to do so, and, yes, even use an epidural. |
Anonymous
Dunno -- did you have pitocin? epidural? We'd need to know why you had those problems if you really want us to hazard a guess (which you probably don't, despite your challenge...) I'm a natural birth advocate and your response is asinine. A serious bleed followed by a drop in blood pressure is dangerous. To continue to labor with all the signs she listed would increase the chances of loss of life. I don't think we need anywhere close to 30% section rate, but they are sometimes necessary and save lives. Blood loss is a leading cause of maternal mortality. |
Anonymous
I'm a natural birth advocate and your response is asinine. A serious bleed followed by a drop in blood pressure is dangerous. To continue to labor with all the signs she listed would increase the chances of loss of life. I don't think we need anywhere close to 30% section rate, but they are sometimes necessary and save lives. Blood loss is a leading cause of maternal mortality. Really? so you're unwilling to acknowledge that the use of pitocin is sometimes responsible for these things? I'm not saying that her c was necessary or unnecessary. I'm saying I do not know. I have no idea how naturally her labor was allowed to progress. If she went into labor and these things happened spontaneously, yes. If she was "failing to progress" and given pitocin aggressively, then come on, there's a case to be made that this was mismanagement of labor and not something that would have otherwise led to a C section. You don't have to feel like it's your fault, because it's not. but there is still a problem with the medical model that may be at work here. |
Anonymous
I'm the poster you quoted and yes, under those scenarios I would absolutely have gotten a c-section. My point was only that a very large number of c-sections probably are *not* medically necessary. No major bleeding, not a severe drop in BP, no *real* fetal distress (other than the baby just having a long labor), etc. I'm surprised though that with your parade of horrors, you had such an easy recovery. I'd wager a guess that you are the exception b/c the women I know who had c-sections after having real complications or even long labors had VERY tough recoveries. Without a doubt they would have been better off just getting a c-section from the beginning. But you really fail to see the issue here, which is that a national c-section rate of 30% (and it is probably higher than that in DC) means that there are a lot of c-sections going on that simply aren't done for medical reasons. Nobody here is saying that a c-section is NEVER done for medical reasons, just that more often than not, it is not medically necessary. |
Anonymous
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Let's think about this from a statistics/math/economics perspective. Suppose we know that for 15% of births a c-section is necessary.
Does this mean that the c-section rate will be 15%? In a world of absolutely perfect certainty, then yes 15% of births and no more would be c-section. And because in this imaginary world there is perfect certainty, drs just tell women what type they are and we either just show up for the c-section or go into labor and have a vaginal birth. Now, add in uncertainty (but no risk). The dr does not know who will need a c-section or not. What will be the strategy? Let all women start labor and see how we do. remember there is no risk. The c-section rate will still be close to 15%. Now, add in risk along with uncertainty. What will a Dr do? If they make the wrong decision, what is the result? There are 2 potential wrong decisions: (1) c-section when vaginal birth would have been ok, the outcome is that we have in most cases a healthy mom and baby but an unnecessary surgery and potential future complications. (2) not c-section when c-section is correct or waiting too long, the outcome is injured or dead baby and/or injured or dead mom. Since the cost of not c-section is much much higher than not vaginal birth, it is easy to see why the actual observed c-section rate is much higher than 15 percent. The larger is the difference between cost of not doing a c-section when one is necessary and not having a vaginal birth when one would have been appropriate, then the higher will be the c-section rate. Would you rather have a dr that had a 15 percent c-section rate or one with a zero maternal and infant death rate? |
Anonymous
Then don't have a c-section. Easy. It is not up to you to decide when a c-section is medically necessary. There are a variety of factors that go into that decision. Also, as someone pointed out, when you are dealing with your baby, you don't want to take chances. My DD started showing some distress after a long labor (long to me, at least, over 14 hours). I was not willing to wait and risk anything further; whether that would have happened we don't know. That was the best decision for us. It likely would not have been for you, which is fine. But, frankly, I am damned sick and tired of people pontificating about what they believe is best for women in terms of childbirth. What is best is what people make at that moment and in their circumstances. Period. |
Anonymous
| My baby is measuring quite big so I asked my OB for a c-section. She explained the risks, I said I still want it, she said that's fine. Not medically necessary, I know, but my choice. |
Anonymous
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"Let's think about this from a statistics/math/economics perspective. Suppose we know that for 15% of births a c-section is necessary.
Does this mean that the c-section rate will be 15%? In a world of absolutely perfect certainty, then yes 15% of births and no more would be c-section. And because in this imaginary world there is perfect certainty, drs just tell women what type they are and we either just show up for the c-section or go into labor and have a vaginal birth. Now, add in uncertainty (but no risk). The dr does not know who will need a c-section or not. What will be the strategy? Let all women start labor and see how we do. remember there is no risk. The c-section rate will still be close to 15%. Now, add in risk along with uncertainty. What will a Dr do? If they make the wrong decision, what is the result? There are 2 potential wrong decisions: (1) c-section when vaginal birth would have been ok, the outcome is that we have in most cases a healthy mom and baby but an unnecessary surgery and potential future complications. (2) not c-section when c-section is correct or waiting too long, the outcome is injured or dead baby and/or injured or dead mom. Since the cost of not c-section is much much higher than not vaginal birth, it is easy to see why the actual observed c-section rate is much higher than 15 percent. The larger is the difference between cost of not doing a c-section when one is necessary and not having a vaginal birth when one would have been appropriate, then the higher will be the c-section rate. Would you rather have a dr that had a 15 percent c-section rate or one with a zero maternal and infant death rate? " Your logic is off here. We'll use 15% but I think the actual number is much lower. Medically necessary means there are indications of need. Say 15% of all births present indications where a c-section is warranted. 15% of those births would not have resulted in infant or maternal death without one but the indicators were high enough to make this the standard of care and safest path. The doctor is only injecting more risk if she misses an indicator and fails to act within that 15%. Doubling the rate indicates that c-section are being performed for non-medical reasons (convenience, preference) or become routine as prevention. Its dangerous for these to become routine and be used as preventative if the risks and evidence studies do not support this practice. Surgeons don't perform appendectomies unless there is an indication of need. They could just perform these prevently. Its low risk surgery and you don't your appendix but you still don't see people being sent off to surgery for every tummy ache. |
Anonymous
Let's go over some basics. Pitocin is synthtics oxytocin, the hormone responsible for uterine contractions, among other things. When Pitocin causes contractions, they are usually longer and stronger than natural ones. When the uterus contracts, blood flow to the uterus and placenta are hindered. Pitocin does not cause bleeds, it is normally used to control bleeds. There is approx. enough blood flowing to the placenta to fill a soda can every minute. With that volume being lost, it does not take long to go into shock and/or cardiac arrest. An epidural can reduce blood pressure and even rarely cause a sudden drop when it is administered. A bleed followed by BP loss is very dangerous and will cause fetal distress. Please, do some reading before trying to admonish others. It makes all natural birth advocates look stupid. |
Anonymous
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There is a middle ground to the two PPs who are fighting this out. The woman who described bleeding, etc., clearly had a bad situation and we can all agree that by the time she got to that situation, a c/s was a great, possibly life-saving, plan.
I took the PP who was questioning her to be pointing out, perhaps without great tact, that sometimes a c/s is medically necessary after a bunch of interventions has led to that point but that the particular pregnancy/labor would not have medically required a c/s if left alone. Whatever is true in the case of that woman, it surely is the case that some c/s happen because, for example, pitocin has led to fetal distress caused by overly strong contractions. Doesn't mean there aren't great uses for pitocin and for c/s, just that you can't say a c/s was an inevitable medical necessity just by looking at the last stages of labor. |
Anonymous
for everyone who wanted more info- I did not have pitocin at all- I was progressing just fine and luckily, I was only having minimal discomfort for my strong contractions. Things quickly spiraled downhill and I was glad that I was in the hospital and had a very quick reacting medical team who saved myself and my baby. And, after all that- my recovery was easy and I have NO regrets/second guesses/etc... |
Anonymous
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"
Anonymous wrote: Really? so you're unwilling to acknowledge that the use of pitocin is sometimes responsible for these things? I'm not saying that her c was necessary or unnecessary. I'm saying I do not know. I have no idea how naturally her labor was allowed to progress. If she went into labor and these things happened spontaneously, yes. If she was "failing to progress" and given pitocin aggressively, then come on, there's a case to be made that this was mismanagement of labor and not something that would have otherwise led to a C section. You don't have to feel like it's your fault, because it's not. but there is still a problem with the medical model that may be at work here. Let's go over some basics. Pitocin is synthtics oxytocin, the hormone responsible for uterine contractions, among other things. When Pitocin causes contractions, they are usually longer and stronger than natural ones. When the uterus contracts, blood flow to the uterus and placenta are hindered. Pitocin does not cause bleeds, it is normally used to control bleeds. There is approx. enough blood flowing to the placenta to fill a soda can every minute. With that volume being lost, it does not take long to go into shock and/or cardiac arrest. An epidural can reduce blood pressure and even rarely cause a sudden drop when it is administered. A bleed followed by BP loss is very dangerous and will cause fetal distress. Please, do some reading before trying to admonish others. It makes all natural birth advocates look stupid. " Not a natural birth advocate but Pit absolutely can cause bleeds or abruptions. This is one of the reasons you must be continually monitored on Pit. The ob/gyn orders the range of the Pit dosage and the nurse controls how much to increase/decrease by monitoring the contractions. A slow dose may not be resulting in enough contractions so they up the dose but if they go to far..ie the nusring phrase 'Pit to Distress' you can run into problems. Pitocin is given after delivery because the contractions help stop bleeding. Pit itself does nothing to stop bleeding. Yes, an epidural can tank your BP but usually only if they do not give enough fluids. I had PE with Mag, Pit and an epidural at the end as an attempt to lower my BP which was not responding to the IV BP meds. It worked I went from sky high BP to dangerously low and almost passed out. |