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Rise in c-section rates; an interesting perspective
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Anonymous
Actually, you have NO RIGHTS when it comes to making my medical choices, whether you think they are good, bad, unnecessary or whatever. And as for what you want to pay for, deal with it, honey. You pay for a lot of things that you prob don't want to re: health care. And, I would bet those things cost you more than elective c-sections: people who choose to smoke, are overweight, drink too much alcohol, drive w/o seatbelts, etc., etc. You obviously have an agenda as to how you think birthing (and no doubt child-rearing) should be approached. It comes through quite clearly in your post. Your post is ridiculous. |
Anonymous
This is my first post in this thread. You sound crazy and condescending, and are really misreading the other post. You are probably a sock puppet because it seems the sock puppets on this board PURPOSELY misread and then respond to other posts. Anyway, she didn't say that she had a right to make any medical decisions for you. Instead, she said that she "has a right to point out" that OBs are scheduling c/s for convenience, and that c/s lead to higher rates of maternal mortality. There is nothing to debate about these points; it is true. And you can add me to the ranks that thinks it is outrageous that we all have to pay for everyone's unnecessary cesareans. Yes, it sucks to pay for all the other stuff you mentioned, but that's not what this thread is about. This thread is about rising cesarean rates. I blame women a little bit - many couples don't inform themselves or ask any questions, they don't choose care providers who specialize in vaginal births (midwives) and many don't work to learn anything about giving birth normally. Of course, I blame doctors A LOT - because they are the ones refusing to follow evidence-based medicine, they are the one driving insurance company and hospital policies, and they are the ones scaring the bejeezus out of women without actually allowing women informed consent. |
Anonymous
This post should be frozen in amber and shipped to the Smithsonian as a classic example of the DCUM natural-birther rant. It combines unhinged high-pitched rhetoric, alarmist assertions backed only by the poster's own imagination, and, of course, an obligatory slam against doctors as an undifferentiated whole. Curators will marvel at the post's comical smugness, admiring how some anonymous hack--armed only with the urban myths that populate internet chat rooms and militantly silly anti-c-section web sites--assails trained medical professionals for "refusing to follow evidence-based medicine." And museum goers will gawk in awe at the post's near-Himalayan level of condescension, as the author tut-tuts broad swaths of the population to varying degrees -- "women" and "couples" -- for not hewing to her own idiosyncratic view of enlightened birth. Oh, and finally, the post exhibits a fierce lack of respect for logic and consistency. Those first two sentences follow the classic template: Sentence One concurs in some silly absurdist proposition put forward by another equally off-the-meds poster; Sentence Two candidly acknowledges excellent point made by subsequent poster who explained why said silly absurdist proposition is indeed a s.a.p., but then dismisses the point by protesting that "that's not what this thread is about." Logic is rarely what these threads are about. The post is right about that. |
Anonymous
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Here is one recent report from Amnesty Int'l that states that "[t]he risk of death following c-sections is three times higher than for vaginal births, and c-sections also increase risks in future pregnancies."
Thanks for sharing. My research (couldn't help myself after I posed the question) points out that while this report points to rising c-section rates as a possible cause for rising maternal death rates, there is NO actual evidence of a causal link. The types of complications one expects to see from c-sections -- i.e. bleeding and blood clots -- have remained steady as causes of death over the last 30 years. And the sudden "rise in maternal deaths" reported over the last years is due primarily to better reporting of maternal deaths (for which we all should be grateful). So I think we should all debate the issue of who should pay for what and what doctors should and should not do in good faith, but leave the dubious claim that c-sections are "linked" to higher maternal death out of the equation. For the record, I have not engaged in any name -calling or reactionary responses in this thread. While I personally fall on the side of trusting doctors and erring on what I perceive to be the "safe side" of getting babies out when there is any sign of distress, I also agree that it is troubling (if it is true) that docs want to start operating at 5pm on Fridays, etc. And I don't necessarily believe that a c-section should be given "on demand." But I also don't think its as black and white as some (most) seem to think it is, and I am interested in testing some of the assumptions of those who say that they shouldn't have to pay for c-sections that are not "necessary" (or that they should not be allowed at all). To my mind, no one has adequately answered the question -- now posed several times -- of how we know which of the 33% of c-sections are "medically necessary". Let's take out any c-sections scheduled purely because the doc wants to go home, or because a woman simply does not want to try labor. Ok, no reason to think those are "necessary." But my guess is that those issues account for a very small percentage of the 33%. For arguments' sake, let's say 3%? Ok, now all the repeat c-sections out there. What do we do with those? Assume, for the sake of argument, that the original c-section meets "your" criteria for medical necessity. Does a woman have a "right" to choose a second c-section paid for by her insurance company (assume no other indicators favoring c-section), or does she have to try VBAC? Is any indication of fetal distress sufficient, or is there some level that rises to the level of "medical necessity" Does a woman's own comfort level/balancing of risk to the baby vs. risk to herself play any role? How about my case? I had a stillborn baby. No one knows why -- all tests came back with no answers. The one possible clue is one blood clotting factor that is barely out of range. Because of it, I was put on (expensive) clotting medications throughout my pregnancy, and was induced at 38.5 weeks. Labor did not work, and I ended up with a c-section. In my heart of hearts, I believe (especially in retrospect) that what happened to my stillborn child was likely a one-time fluke, unrelated to any clotting issues. But I also think there's a 5-10% chance that the medication saved my second child's life, and I was willing to do anything to not lose another child. And given my experience less than a year before, I simply wanted my DS out of my body as soon as I knew he was big and strong enough to live outside the womb. I felt, based on the evidence available to me, that he was safer outside than he was inside. And I wanted him to come under medical supervision, in case anything went wrong. I knew that c-section was a more likely outcome with induction, but I accepted that risk. Another woman under my same conditions might have felt comfortable waiting for the baby to come when he/she was ready. But that's not where my calculation landed. So I had a "medical reason" but there is some reason to believe that I may have ended up with a vaginal delivery if I had waited for labor to begin on its own. Do I "get" to have a c-section? Do I "get" to have it paid for by insurance? Mine is just one example of the myriad incredibly complicated situations that women face and make their own decisions based upon. I share it only in an effort to show that (I believe) this debate revolves much more around shades of gray than it does black and white. A c-section/induction may not have been available to me in one of the other countries with lower c-section rates. But I am so grateful that those tools were at my doctors' disposal. |
Anonymous
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"To my mind, no one has adequately answered the question -- now posed several times -- of how we know which of the 33% of c-sections are "medically necessary". Let's take out any c-sections scheduled purely because the doc wants to go home, or because a woman simply does not want to try labor. Ok, no reason to think those are "necessary." But my guess is that those issues account for a very small percentage of the 33%. For arguments' sake, let's say 3%? Ok, now all the repeat c-sections out there. What do we do with those? Assume, for the sake of argument, that the original c-section meets "your" criteria for medical necessity."
I'm just curious why you so desperately want to convince yourself that all of sudden 1/3 of all births require a c-section or mom and baby will die. Where is your basic common sense? What's up with the guessing % and why would you for your argument's sake just think c-section for convenience is so low? You probably have never worked on a L&D floor. What's up with the "your" criteria, it was peer group of physcians and researchers that defined the criteria for medically necessary not patients. If you had a c-section, wanted one or believed it was medically necessary, then great but that doesn't mean you check your common sense at the door. I had two medically necessary inductions which yes, I believe were medically necessary. This doesn't mean that I'm blind to the problems from skyrocketing induction rates and how they are performed for unnecessary reasons with adverse effects. The problems with rising c-section rates are documented by researchers. ACOG recently came out with stricter guidelines on not performing elective inductions/c-sections before 39 weeks due to high rates of NICU admissions from ob/gyns who were doing them at 37 weeks. This practice of elective induction/c-section at 37 weeks was never supported by evidence-based studies or had any science behind it. Doctors simply started adopting the practice. When the researchers completed the studies, ACOG needed to publish stronger guidelines to get behavior back in line. The March of Dimes had to push hard to get them to respond to the research. Some doctors completely ignore guidelines and evidence based studies and just do whatever they were doing in the past. |
Anonymous
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"I'm just curious why you so desperately want to convince yourself that all of sudden 1/3 of all births require a c-section or mom and baby will die. Where is your basic common sense? What's up with the guessing % and why would you for your argument's sake just think c-section for convenience is so low? You probably have never worked on a L&D floor. What's up with the "your" criteria, it was peer group of physcians and researchers that defined the criteria for medically necessary not patients."
Thanks for the incredibly nasty post in response to my genuine intellectual curiosity. I should have known to expect nothing less. The whole point of my post, again, is that we DON'T KNOW which of the 1/3 of c-sections are "necessary". My point is that some percentage of them are, and that women should be permitted some range of opinion in determining what is right for them. I do NOT think that in 1/3 of labors, the woman or child will die. (That would be a black and white way of looking at things, which I was very clear in saying that I was trying to move away from.) I threw out 3% as a possible number of CLEARLY unnecessary, purely "convenience-based" c-sections, for the sake of argument. Between the (possible) 3% and the 33% is some number in which the baby MAY have died or suffered long-term effects, but we will NEVER know which of the 30%, because we don't have a way of knowing what would have happened but for the c-section -- and I was simply questioning where those who say that "unnecessary" c-sections shouldn't be permitted would draw the line. Would that rule out ONLY c-sections scheduled for convenience, or would it also take out the myriad situations in which one woman would choose not to face a small risk (based on some medical evidence) and opt for a c-section, even if another woman would chose to take that risk and opt for vaginal delivery? I also think I was careful to point out that I see that there are problems with "too many" c-sections. And if you can tell me what part of my post was lacking in common sense, I'd love to hear it. |
Anonymous
Yikes, PP -- this is "cuckoo bananas" here Even I think that reply is really mean-spirited! This woman is telling you she had a stillborn, and your reply to her is "you had a c-section, wanted one or believed it was medically necessary, then great..." I agree with what you're saying, that c-sections for convenience are way higher than 3 percent, that inductions should not generally take place at 37 weeks. But PP just told you she had a clotting disorder. That's different from inducing for supposed macrosomia or convenience or other issues. We don't know if it was necessary or not and it sounds like PP doesn't either, but I don't see how it's appropriate to be mean to someone who lost a child. JMHO, and basically I agree with you otherwise. |
Anonymous
I actually have no agenda, but how is electing a c-section any difference than having insurance pay for other unnecessary surgery (lipo, nose job, etc.). My post isn't ridiculous, you just don't like what I have to say. You can call me crazy all you want, but my views on this aren't that "out there." And your little quip about child-rearing?? Ummm...okay....I bet you can tell a LOT about my child rearing from my posts...sure...so quick to judge when somebody offers up a viewpoint you don't agree with...perhaps that says more about YOUR child rearing skills than mine. I never said you aren't entitled to your opinion. I'm just offering up a different one. I believe that many c-sections are unnecessary and you know what? The government and pretty much every unbiased medical organization agrees with me. I absolutely agree that some c-sections are necessary. What I don't agree with are the 50%+ of c-sections that are currently being done in the US that are not necessary. |
Anonymous
| Yes the c-section rate is very high, it might be too high......... BUT does anyone know of any research (real research published in a peer reviewed journal) that reviewed the charts of a sample of women that had c-sections and classified them into absolutely necessary, done without any real or clear justification, and a third category where it is ambiguous and reasonable people might disagree...... until then we are really just discussing the validity of one opinion over another, none of which are backed by any science. |
Anonymous
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"Yes the c-section rate is very high, it might be too high......... BUT does anyone know of any research (real research published in a peer reviewed journal) that reviewed the charts of a sample of women that had c-sections and classified them into absolutely necessary, done without any real or clear justification, and a third category where it is ambiguous and reasonable people might disagree...... until then we are really just discussing the validity of one opinion over another, none of which are backed by any science. "
Check out NIH or WebMD. There have been targeted studies on the safety of VBACs, elective c-sections, and c-section/maternal/infant outcomes. There was a 2006 panel by NIH where they declined to set an optimal range which differs from many other developed countries. More of the comparative data comes from comparing other developed countries. The VBAC one was interesting and found something like 75% would have successful vaginal deliveries. The recommendation though is for a hospital to have a surgeon and anesthiologist on stand by in case an emergency c-section is needed. You don't get paid for being on stand by and you make less money with a vaginal birth so there is a clear economic driver against VBACs. The other interesting stat that I have seen is that the c-section rise crosses all demographics, young, old, race, etc. |
Anonymous
I think that part of the problem in coming up with a "number" for medically necessary c-sections, is that this surgery is intertwined with the practices associated with general management of labor. Example - a woman who has a bad reaction to pitocin-induced contractions resulting in fetal distress -- is this cause for a medically-necessary c-section? The c-section may be "necessary", but the cause of it was an adverse reaction to management of labor. A woman who has been given too large of a dose of epidural analgesia - who may not be able to push effectively. Is this c-section necessary? In my mind (and I would love to see research back this up), the cause in the rise in c-sections stems from interventions being given either at inappropriate times or at inappropriate doses. I personally favor a natural approach to childbirth when possible, but I understand that interventions like pitocin, epidurals, fetal monitoring, and ultimately surgery save lives and improve outcomes in the appropriate circumstances. Do the 81% of women who are given pitocin during labor really need it (Dr. Robbie E. Davis-Floyd, University of Texas)? I don't know what the answers to these questions are, but I do know that our current medical model for childbirth in the US is to take something that may (or may not) be progressing fine on its own and "mess" with it - introducing risks and possible side-effects into the equation. |
Anonymous
| I agree with PP to a point (and I'm one of the ones stating that I think the c-section rate is too high and results in unnecessary surgery). But I don't think the answer is to force all women to have natural childbirth. That just sounds barbaric to me. |
Anonymous
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"I agree with PP to a point (and I'm one of the ones stating that I think the c-section rate is too high and results in unnecessary surgery). But I don't think the answer is to force all women to have natural childbirth. That just sounds barbaric to me. "
I could be wrong but I think there was a study that epidurals do not create an increase in c-sections or pitocin. Pitocin increases the requests for epidural not the other way around. Epidurals can increase the need for forceps or vaccuum but that isn't what we are discussing here. I doubt many women are asking for pitocin. Pit is used for inductions and to speed up labor. I'm amazed to see that 81% of women are given pitocin, that can not be right. |
Anonymous
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The actual percentage of women given pitocin is closer to 85 percent -- you can poke around the NIH website and find the info, but I read it in a (print) magazine I have. That said,this is standard of procedure for the third stage of labor and is given to mom to help expel the placenta. I said "no thanks" and the nurse tried to push the issue but I held firm, and just said I'd have it if I needed it (I didn't, of course). I think most women don't even realize they have a choice. That said, this is a different statistic for how many women are given pitocin during or before labor to induce or augment it. I could not find that information, but it's probably fairly high as well. (Though I don't think 85 percent).
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Anonymous
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Also - epidurals can and do cause c-sections. It is a risk but it is not the same type of risk as an elective C section or an non-medically indicated, pre-term induction. An epidural is pain relief, and carries its own risks, but I don't think even the staunchest natural birth advocate (including me) would ever suggest that another woman should not be allowed the OPTION of pharmaceudical pain relief. I just think that doctors should do a better job of spelling out the risks involved ahead of time (and not when mom is laboring) and should encourage mom to have the epidural later in labor, so her body has a chance to labor without disruption and increases the chance of a vaginal delivery.
As for the risks involved, an epidural can cause a drop in BP and can cause the baby's heart rate to change. Epidurals also necessitate mom to lie down on her back (or side, sometimes) and push in an unfavorable position that reduces the chances of mom getting a baby out vaginally. If the dose is not admistered correctly, mom may not be able to feel to push. Aside from these easily documented cases, there are the shades of gray: If an epidural makes it harder for mom to push, the doctor is more likely to deem mom's labor a "failure to progress." So in this case it would be a more indirect cause of labor. |