# Shocking New Cesarian Rates



## Rosemaryluna (May 21, 2002)

I just read this article and was saddened by it. I had my second child in 1983, she was born by VBAC and was one of the first at our little country hospital. It seems such a pity that things are going the other way in other parts of the world.

http://www.msnbc.msn.com/id/34826186...lth-pregnancy/


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## isabchi (Sep 14, 2006)

Really sad!!!







.I was one of this c-section







and then a HBAC







. I still feel guilty to allow the section with my first one.


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## DoulaVallere (May 29, 2009)

Pretty well done survey, I think. Wish they would have mentioned how first world countries with the lower c/s rates have such low infant mortality rates compared to more "western" birthing nations.


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## AustinMom (Jul 16, 2008)

How arrogant of us to think that we can birth babies "better" than our maker designed. UGH!

It won't be long till the US is the highest. we're on our way.....


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## FloridaBorn (Nov 28, 2009)

This is a generalization of course, but it seems the women/OBs in these countries are equating "surgery" with "wealth."


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## emnic77 (Sep 12, 2009)

Quote:

The study did not discuss specific reasons for the high number of C-sections, but it noted that more than 60 percent of the hospitals studied were motivated by financial incentives to perform surgeries.
*ding ding ding ding*


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## MegBoz (Jul 8, 2008)

Quote:

"I think it's safer for the mother and child to have C-sections, and the relatives feel more secure because it's very simple and very common now," said a Vietnamese woman, Trang Thanh Van, 25, just days away from giving birth to her first child. "People worry that using tools to pull the baby out (in a vaginal birth) may affect their brains."
This drives me bonkers--> Comparing CS to "medically managed vaginal birth." The crazy thing is that I CAN see how CS can actually be better than medically-managed vag birth (which, too often ends in emergency CS _anyway!)_ I think this is why many OBs say they'd chose elective CS for themselves or their wives... because they're making _this_ comparison.

Truly, I personally might be tempted to chose CS for myself if I had no choices but fully medically-managed vaginal or CS. It's an awful choice to have to make.

If only there were some *better education* so people could learn the truth that truly physiological birth is by far, exponentially better for both mother & baby.


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## scottishmommy (Nov 30, 2009)

What I don't understand is how these doctors think it's necessary to do c-sections on small asian women having large babies. I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.


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## AustinMom (Jul 16, 2008)

Quote:


Originally Posted by *scottishmommy* 
What I don't understand is how these doctors think it's necessary to do c-sections on small asian women having large babies. I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.

Our Doula was telling me about a mom she worked with, she was a HBAC, 4' 11'' and had a 10lb baby.


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## Freeman (Sep 16, 2005)

Quote:


Originally Posted by *scottishmommy* 
I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.

This _is_ actually the case for some people, though. I have a friend whose pelvic opening was just too narrow to allow the baby to pass through -in her case, a c-section was truly necessary, and thank goodness it was available. Personally, I had the same experience as you - a 9+ lb. baby, delivered without any problems.

In speaking with OB's it seems the greatest motivator to perform a c-section in the U.S. is to avoid a malpractice suit. It used to be that many OB's wouldn't perform c-sections and did anything to avoid them, thinking that it would be riskier than a vaginal birth. Today, if there is any "blip" on the radar at all, a c-section is strongly encouraged in order to avoid the "risk" of a vaginal birth. The perspective on "risk" has totally shifted in the past 50 years.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Freeman* 
This _is_ actually the case for some people, though. I have a friend whose pelvic opening was just too narrow to allow the baby to pass through -in her case, a c-section was truly necessary, and thank goodness it was available.

Well, I'm sure this is indeed true _sometimes._ However, CPD (cephalo-pelvic disproportion - the diagnosis that the pelvis just can't accommodate the baby fitting through) is STILL grossly over-diagnosed in the US. In most cases, a little bit of assistance could have helped. Making sure baby was positioned properly & helping ensure OA positioning if baby is OP. & getting mama UPRIGHT & MOVING to help the pelvis open. The vast majority of American women birth in hospitals, and most of those births have mama in bed - often reclined, generally immobilized with an epidural, rarely pushing in an upright position.

So, I don't think it's fair to say "a baby can't fit through your pelvis" without _giving it a real try- with the best possible circumstances._ (Note, I'm not saying your friend did not have support, I don't know her case, just saying, I know in America it DOES happen where docs say "that baby won't fit" & they didn't do anything to HELP it fit - but rather hindered the process.)

Quote:


Originally Posted by *Freeman* 
In speaking with OB's it seems the greatest motivator to perform a c-section in the U.S. is to avoid a malpractice suit. It used to be that many OB's wouldn't perform c-sections and did anything to avoid them, thinking that it would be riskier than a vaginal birth.

Yup. Although, ya know, I think a lot of them are also beginning to believe that vaginal birth truly is so risky!! As Dr. Marsden Wagner writes, "Fish can't see the water they swim in." They see crash, emergency CS, they see awful PPH, they see a need for vacuum & forceps & the accompanying pelvic floor damage. *They see this and perceive vaginal birth as risky*! (Again, I think this is part of the reason a significant portion of OBs surveyed have said they'd chose purely elective CS for themselves of their wives.)

They simply don't KNOW, or don't realize & think about the fact that the doc's actions so often caused the problems & that vaginal birth is generally safe the majority of the time. (If you don't do dumb







to







it up, that is!)







As Dr. Wagner & others have written, docs aren't properly educated on good scientific methods for research. They often practice based on clinical experience & what they see. Heck, I've even heard docs say it themselves & read it in books written by docs, "Well, in my experience this perineal massage technique reduces tears." (I remember reading years ago in an OB's guide to pregnancy & birth.)
"Well, I've never had a patient get pregnant on Alesse." (old Gyn said to me.







)
Um, SAMPLE SIZE, people! Your own clinical experience is NOT sufficient sample size to make such judgments!

If you see crash CS so often, it's natural that you'll come to believe birth is just plain dangerous (and, therefore, CS is preferable to "trying" vaginal birth.)


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## MiaMama (Jul 21, 2007)

The size comments make me wonder about the argument that I often hear about why the US has high surgery rates and poor outcomes. I am told that because there are only Sweedes in Sweeden







, for example, they have healthier babies, lower c-section rates, and better neonatal mortality stats. That because we have a lot of genetic diversity in the US, we therefore have more complications, like mamas growing babies too big for their bodies.

I wonder about pure-bred dogs, who tend to have WAYY more health complications than mixed-breed. In other species, I have never ever heard of genetic diversity being a bad thing. Actually, quite the opposite.

I wonder how the genetic giversity in China compares the the US.


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## AustinMom (Jul 16, 2008)

I don't think Dr really know what the diagnosis of CPD does to women and their offspring. Yes, it causes them to have repeat cs usually (because they unknowingly trust their OB) but their daughters are then brought of thinking that their moms were "too small" to birth, and struggle with that. My mom had my oldest brother by cs after not dilating past 7 or so (in a hospital, with little support, pit augmentation which led to pre-e) and the DR. said she was too small. Then all 4 of us other kids had to be cs. this was before the big sweep to vbac from acog. So me, I stuggled with that a lot when I was preg. Is it genetic? Will the same thing happen to me? I was very unprepared, and ended up with a cs with our first. It has been a lot to get through, and after interrogating my dad of what REALLY happened in their first labor (1980) I came to some more facts like the pit, no handy maneuvers to turn baby, no constant support, etc, and then realized that it was an improper diagnosis.

Women being to doubt themselves and that doubt passes on generation to generation, if not dealt with.


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## lovebug (Nov 2, 2004)




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## scottishmommy (Nov 30, 2009)

Quote:


Originally Posted by *MiaMama* 
The size comments make me wonder about the argument that I often hear about why the US has high surgery rates and poor outcomes. I am told that because there are only Sweedes in Sweeden







, for example, they have healthier babies, lower c-section rates, and better neonatal mortality stats. That because we have a lot of genetic diversity in the US, we therefore have more complications, like mamas growing babies too big for their bodies.

I wonder about pure-bred dogs, who tend to have WAYY more health complications than mixed-breed. In other species, I have never ever heard of genetic diversity being a bad thing. Actually, quite the opposite.

I wonder how the genetic giversity in China compares the the US.

I think it has more to do with economics than ethnic diversity. Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc. I believe they also have very high breastfeeding rates. In America we have a lot of under served communities, such as undocumented immigrants or teen mothers who don't have good access to prenatal care. Also, because we are so diverse, it's difficult to reach out to all mothers about the importance of prenatal care and nutrition and avoiding risky pregnancy activities such as drinking or smoking. In countries like Japan or Sweden public health officials know who their target audience is, so it's easier to educate them.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *MiaMama* 
I am told that because there are only Sweedes in Sweeden







, for example, they have healthier babies,

Dr. Wagner addresses this in his book "Born in the USA." Actually, I remember it word for word because I found it so funny, I laughed out loud! He wrote, "The American OBs' reactions to the Ducth experience [regarding safe homebirth outcomes] would be amusing if it wasn't so pathetic."







He called them "pathetic"! I love it!

He also mentioned the whole excuse that, "Well, the US has a wider genetic variety." First of all, there are 2 myths there:
1. that the Netherlands is NOT genetically variant - this is actually untrue, they've had their share of immigration as well!!
2. That genetic variance leads to higher risks, worse outcomes (i.e. unsafe HB, actual justification for higher CS rates, etc.) - this too is untrue.

But, hey, ya know we've already established that ACOG doesn't give a hoot about actually valid scientific evidence to back up their claims & policies.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *scottishmommy* 
I think it has more to do with economics than ethnic diversity. Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc. I believe they also have very high breastfeeding rates. In America we have a lot of under served communities, such as undocumented immigrants or teen mothers who don't have good access to prenatal care.

Well, I suppose lack of access to health care & education certainly may contribute to neonatal mortality.

But it does NOT explain the high CS rate in the US! Women with private insurance in private hospitals are MORE likely to have CS - NOT the poor who haven't had prenatal care.


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## mntnmom (Sep 21, 2006)

Quote:


Originally Posted by *MegBoz* 
Dr. Wagner addresses this in his book "Born in the USA." Actually, I remember it word for word because I found it so funny, I laughed out loud! He wrote, "The American OBs' reactions to the Ducth experience [regarding safe homebirth outcomes] would be amusing if it wasn't so pathetic."







He called them "pathetic"! I love it!

He also mentioned the whole excuse that, "Well, the US has a wider genetic variety." First of all, there are 2 myths there:
1. that the Netherlands is NOT genetically variant - this is actually untrue, they've had their share of immigration as well!!
2. That genetic variance leads to higher risks, worse outcomes (i.e. unsafe HB, actual justification for higher CS rates, etc.) - this too is untrue.

But, hey, ya know we've already established that ACOG doesn't give a hoot about actually valid scientific evidence to back up their claims & policies.









No kidding! The Dutch are actually quite diverse to start with. "Dutch" ancestry includes most every group present in Europe traditionally. Add to that 20-30yrs of highly liberal immigration policy, and the Dutch are probably as diverse as we are in the States. Though they are a little more culturally homogenous, making education efforts simpler. Oh, and everyone has access to prenatal care. Yeah, that could be a big factor.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *scottishmommy* 
Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc.

I'm Canadian. I have excellent access to health care. Prenatal "health care" translates as:

-a 5-10 minute appointment once a month to check my blood pressure and measure my abdomen (and listen to the baby's heart rate, when applicable). -blood work at the beginning of my pregnancy
-a routine ultrasound
-_five_ c-sections...two for breech, one for having had two already, one for a baby's heart that stopped beating (and I shouldn't have bothered with surgery, as he didn't make it, anyway) and one because I just gave up. I gave consent for four of them...and uncoerced consent for only one.
-assurance that if I took my prenatals, I'd be fine, but to make sure I took them, because "it's impossible to get adequate nutrition for pregnancy from food alone".

I don't have the exact numbers in front of me, but last time I looked, 28% of Canadian births were c-sections, and in my province (BC), the rate was over 30%.

"Better prenatal care" is a slippery subject, and it has nothing to do with medical professionals. I've never received any prenatal care from anyone, except dh,my mom, one birth attendant, and some from a friend and from ds1. The rest of it has come from _me_. What I've received from the "health" care system is a whole bunch of by-the-numbers prenatal _monitoring_, and information...some useful and some...not so much. Oddly enough, none of that monitoring has ever turned up any kind of problems, whatsoever (except very mild anemia). Several women I know who had difficult pregnancies, medically speaking, have never had a c-section.

I have no answers, but I don't think access to "better health care", even if you get it, is going to do much to cut US c-section rates. The one good thing about our system is that I'm at least spared the insult of receiving a big, fat bill for all this crap...that goes to the taxpayer, instead. Since so many of them seem to think that c-sections are just fabulous, I don't object that much to them footing the bill.


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## MiaMama (Jul 21, 2007)

Quote:


Originally Posted by *Storm Bride* 
"Better prenatal care" is a slippery subject, and it has nothing to do with medical professionals. I've never received any prenatal care from anyone, except dh,my mom, one birth attendant, and some from a friend and from ds1. The rest of it has come from _me_. What I've received from the "health" care system is a whole bunch of by-the-numbers prenatal _monitoring_, and information...some useful and some...not so much. Oddly enough, none of that monitoring has ever turned up any kind of problems, whatsoever (except very mild anemia). Several women I know who had difficult pregnancies, medically speaking, have never had a c-section.

I agree with this. I was having a discussion with someone about disparate outcomes for the US vs other countries (including but not limited to c-sections). I looked up Maryland's vital statistics for 2007. Over 11 percent of all births were before 37 weeks, the c-section rate was about average for the country (between 30-40%), and high rates of other problems were recorded. Interestingly, they also had the % of mothers who had early *and* regular prenatal care. It was over 80%, like 88 if I remember correctly.

The prenatal "care" I recieved was mostly useless, personally. I can weigh myself and take my BP at home. I DID have a poor outcome (low birth weight/IUGR), and they didn't even catch it until the day before I delivered. A midwife asked me today if it was possible my dates were wrong, and I realized that it is totally possible (I'd had a m/c only a few cycles before). It is entirely possible that my "care" (induction for IUGR) caused the low birth weight, because she wasn't really 38 wks yet. BTW, no doctor could ever figure out what went wrong.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *Storm Bride* 
I have no answers, but I don't think access to "better health care", even if you get it, is going to do much to cut US c-section rates.

Totally agreed. However, I do believe there is research that points to lower infant morality rates with adequate access to medical care (I _think_ some of those studies include access to prenatal care.)

But yes, as I've already posted, access to medical care, specifically private insurance (not government medicaid) & private hospitals _increases_ the CS rate for healthy women.

I have some answers, as does Dr. Marsden Wagner & others. We need many steps to improve maternity care in America, but chiefly among them:
1. a cultural shift to reduce the fear of birth
--specifically to reduce how we view it as a dangerous medical event instead of a normal, physiological process, and an acceptance that the pain _can be manageable_ (Instead of the common belief that "natural birth (without an epidural) makes as much sense as natural dentistry."
2. More midwives, fewer OBs
3. Perhaps some government oversight, or just education/ publicity on the concept of 'evidence-based care' so more people get as infuriated as me at the inanity of things like laboring women being told they cant' have food & drink & must have IV fluids.







etc.

Just some thoughts.


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## scottishmommy (Nov 30, 2009)

Quote:


Originally Posted by *MiaMama* 
The size comments make me wonder about the argument that I often hear about why the US has high surgery rates and poor outcomes. I am told that because there are only Sweedes in Sweeden







, for example, they have healthier babies, lower c-section rates, and better neonatal mortality stats. That because we have a lot of genetic diversity in the US, we therefore have more complications, like mamas growing babies too big for their bodies.

I wonder about pure-bred dogs, who tend to have WAYY more health complications than mixed-breed. In other species, I have never ever heard of genetic diversity being a bad thing. Actually, quite the opposite.

I wonder how the genetic giversity in China compares the the US.

Just to clarify: I don't think that being an ethnically diverse population causes mothers to give birth to babies who are too large for their pelvises. We aren't dogs. Dogs can weigh anywhere from 1 lbs to 300 lbs, so yes it's possible for a small dog not to be able to give birth to puppies sired by a really big dog. Pugs have been purposefully bred to have enormous heads.
I believe that one of the major reasons for the relatively infant mortality rates in the US, is because it's hard to educate and provide prenatal/pediatric care to such a diverse population. Of course you can have a healthy pregnancy without prenatal care, but it sort of depends on why you don't have it. For instance if you are a young girl from a disadvantaged background you may not have the resources or education to take care of yourself during pregnancy. You may not realize you need folic acid or extra iron. A lot of prenatal care is to educate women. Choosing not to have a medical professional look after you is different than not having access to a medical professional. I have a friend who was an ob/gyn at a hospital in a disadvantaged area of Chicago. He told me that a lot of women would come to the hospital after their babies were born if there were serious complications, like hemorrhaging. These women were having unassisted births out of necessity, not because they wanted to.
I don't know why Sweden would have a lower c-section rate. Perhaps c-sections are just more trendy in the US.


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## Plummeting (Dec 2, 2004)

Quote:


Originally Posted by *scottishmommy* 
JChoosing not to have a medical professional look after you is different than not having access to a medical professional.

I could not agree more!!!


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *scottishmommy* 
I don't know why Sweden would have a lower c-section rate. Perhaps c-sections are just more trendy in the US.










Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have _some_ impact, but otherwise, *it's the US approach to maternity care - medicalizing birth - that increases our CS rate.* Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:

induction
augmentation with pit
AROM
epidural
cEFM
denying mother both food & drink in labor
denying mother freedom of movement in labor
denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
routine CS for breech
routine CS for twins
routine ERCS (denying or strongly discouraging VBAC)
time limits/ CS for "failure to progress" (Failure to be patient!)
CS for "suspected fetal macrosomia" (big baby)
Having an OB instead of a MW*
birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, *it is the entire approach to the birth process that leads to the higher American CS rate*.


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## AustinMom (Jul 16, 2008)

Quote:


Originally Posted by *MegBoz* 








Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have _some_ impact, but otherwise, *it's the US approach to maternity care - medicalizing birth - that increases our CS rate.* Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:

induction
augmentation with pit
AROM
epidural
cEFM
denying mother both food & drink in labor
denying mother freedom of movement in labor
denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
routine CS for breech
routine CS for twins
routine ERCS (denying or strongly discouraging VBAC)
time limits/ CS for "failure to progress" (Failure to be patient!)
CS for "suspected fetal macrosomia" (big baby)
Having an OB instead of a MW*
birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, *it is the entire approach to the birth process that leads to the higher American CS rate*.

Totally with you on this. Oh, BTW, by denying a woman food and drink you risk two things that commonly happen, one, she becomes dehydrated and the uterus doesn't contract well, so, it's then deemed "failure to progress", Or, she is OVER hydrated, which can cause hypertension, glucose to shoot up, baby's glucose to shoot up, and then after birth, after baby isn't being given IV fluids by mom, glucose drops, and then supplements are given.

I DO think that it has to do with the way OBs/Dr look at birth. I don't think it is necessarily access to prenatal care. Yes, if a woman can't get prenatal care, her chances MAY be higher to have complications. If a woman chooses to not have prenatal care and say choose and unassisted birth her chances are lower to have complications, I'd even go so far as to say lower than the average woman receiving prenatal care through an OB.

It's the type of care that a woman is given. We all agree that MW care is better because it focus more on nutrition, exercise, emotion issues, etc. I don't think any OB focuses on those. They more so "monitor" how a mom is doing, with growth, weight, BP, US, etc. Example, a very successful ob here is Austin told a mom, "if water makes you sick to drink (as she had really bad nausea) get your hydrating from popsicles" Yeah, if you are supposed to drink 8-8oz glasses of water a day, that's A LOT of HFCS popsicles you are "drinking". They don't focus on preventing or reversing pregnancy complications (pre-e, GB, low fluid etc) they only focus on diagnosing and medicating, or delivering when they occur.

Another mom, (who LOVES her OB) had "no fluid" at 37 weeks, so had a cs that day, turns out fluid was fine, they couldn't figure it out. She said to me later "I stopped drinking water in the last trimester, I mainly drank coffee". Yeah, I bet is she was going through a typical MW, things would have been a lot different all the way around.

It's not access to care, it's getting Dr. to provide quality care to their moms. It's not just "take your prenatal and you'll be fine". There's a lot more to it Obs....get on the wagon!


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## scottishmommy (Nov 30, 2009)

Quote:


Originally Posted by *MegBoz* 








Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have _some_ impact, but otherwise, *it's the US approach to maternity care - medicalizing birth - that increases our CS rate.* Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:

induction
augmentation with pit
AROM
epidural
cEFM
denying mother both food & drink in labor
denying mother freedom of movement in labor
denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
routine CS for breech
routine CS for twins
routine ERCS (denying or strongly discouraging VBAC)
time limits/ CS for "failure to progress" (Failure to be patient!)
CS for "suspected fetal macrosomia" (big baby)
Having an OB instead of a MW*
birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, *it is the entire approach to the birth process that leads to the higher American CS rate*.

And I would argue that all of those are simply medical _trends_. No one really knows _why_ we birth this way. OBs can't do double blind studies, so they can't make choices based on hard evidence. They just follow trends.


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## scottishmommy (Nov 30, 2009)

also, I'm not arguing that lack of prenatal care increases c-section rates. I think it may possibly increase infant mortality, among underserved communities where there is little access to prenatal care.


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## Storm Bride (Mar 2, 2005)

MegBoz: Right on. Also add "denying mother the support of a doula". A sign from an OB office in the US recently made the rounds on facebook. They told women that they were all about providing good care to women, and that if expectant moms wanted a doula or birth "contract", they shouldn't even bother with that practice. So...yeah...


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *scottishmommy* 
And I would argue that all of those are simply medical _trends_. No one really knows _why_ we birth this way. OBs can't do double blind studies, so they can't make choices based on hard evidence. They just follow trends.

Well, sure, the studies are not "_double_" blind (i.e. a physician obviously can see whether or not a patient is continually hooked up to EFM, or whether or not he breaks her water.) It can't be _blind to the physician_ the way taking a pill is. But *that doesn't mean it is still not hard evidence*.

Quote:


Originally Posted by *scottishmommy* 
OBs can't do double blind studies, *so they can't make choices based on hard evidence.* They just follow trends.

(bolding mine)
This is simply not true. Any OB who would claim that is lying. Period. That sounds like a complete cop-out to me. While randomized, controlled double-blind trials are the gold-standard of medical research, that does not mean anything less is worthless! That type of study may be the ideal, but lesser types still yield good evidence! Particularly in sufficiently large sample sizes.

The evidence is pretty clear on a lot of these things. For example, episiotomy significantly increases the risk of serious (4th degree) perineal tears & long-term pain with the only advantage being a slightly faster 2nd stage. AROM is generally bad with only slight advantages (speeding up 1st stage labor by an average of 20 min), cEFM increases the incidence of intervention WITHOUT any subsequent improvement in fetal outcomes.

*The jury is in on many of these things.* They are not up for debate. To CONTINUE to do many of the above listed things on a _purely routine_ basis is to be practicing in opposition to evidence.

I highly recommend reading "The Thinking Woman's Guide to a Better Birth" by Henci Goer. It clarifies a lot of the excellent research that has been published in OB/Gyn journals.

As for the "WHY" - Dr. Marsden Wagner has great theories on that in his book, "Born in the USA." Another great read with lots of research.


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## scottishmommy (Nov 30, 2009)

We are on the same side here. What I'm saying is that a lot of OBs follow trends. I think that the real reason OBs perform so many c-sections is because they are becoming more and more common. Even in the 50's when women were put under twilight sleep, c-sections were relatively rare because doctors avoided doing them. Today they are so common that they are no longer seen as a "big deal". The trend will only continue. I would not be surprised if rates reach 40% in the next decade. The more young residents and med students see obs performing sections, the more comfortable they will become with the procedure.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *scottishmommy* 
We are on the same side here.









Oh, OK, gotcha! I thought you were saying OBs don't have hard evidence on which to practice - which would excuse their many idiotic actions. i.e. you were AGREEING with ACOG when they say, for example, that it's impossible to establish a recommended maximum C-section rate.







(Yeah, cuz the WHO just pulled that 10-15% number out of their backsides!) Ha- sorry for the misunderstanding

Quote:


Originally Posted by *scottishmommy* 
I think that the real reason OBs perform so many c-sections is because they are becoming more and more common. ... Today they are so common that they are no longer seen as a "big deal.

I agree with you there. & actually many OBs have said as much- former ACOG president is actually quoted as saying that he thinks C-sections are _always safer than vaginal birth, in every case, for both Mama & Baby!_ I read that in "Pushed" - that one blew me away!

Actually though, it's not just a nonchalant attitude that CS is "no big deal" - it really is a belief that the CS is _so often necessary to save the baby!_ *What they don't realize is that they are "saving" the baby from stress they themselves inflicted!!!* With Pit, AROM, cEFM, etc. They simply don't realize this. They think this is the way obstetrics is done!
And because they don't see it any other way, they don't realize their involvement in causing 'failure to progress' or "fetal distress"!! Hence Dr. Wagner's analogy that "fish can't see the water they swim in."


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## member234098 (Aug 3, 2002)

Quote:

always safer than vaginal birth, in every case, for both Mama & Baby!
A local doctor said that in 1982. Doctors have had this mindset for decades.


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *miriam* 
A local doctor said that in 1982. Doctors have had this mindset for decades.

Of course they have this mindset. For one thing, the medical community, as a whole (I know there are always individual exceptions) refuses to hear anything negative about them. I've had a doctor tell me that my problems with gas post-section had nothing to do with the surgery, and were because I was eating too many carbs - but I was eating _fewer_ carbs than I had before! I was told that some bladder issues I was having and my inability to perform kegels were from the pregnancy itself, not from the surgery. Okay - you know, I'm actually bright enough to be able to tell when I can't do kegels or feel my bladder because of nerve damage. If I could do kegels all through the pregnancy, right up to the L&D room where they prepped me for surgery, why couldn't I do them from the moment the spinal wore off? If this is because ds2 was such a big baby (10lb. 8oz.), then why didn't it get any worse when I carried Aaron (10lb. 14oz.). Why can I still not feel those areas, 4.5 years later? They don't know, and they refuse to consider that it might have anything to do with the surgery.

My sister had an epi with her first. She loved it. Then, she had a backache right where the epi had gone in, and it lasted for weeks. The doctor told her that epis don't do that, and the pain was from pushing.

I have intermittent trouble with stress incontinence. IMO, this is not helped by the amount of pelvic numbness I experience. It's certainly not helped by being virtually unable to do kegels for the last 4.5 years (I can do them, kind of, now...but not properly and it's _incredibly_ difficult). They don't want to hear it, and women will still be cut, partly because "everyone knows" that c-sections protect from pelvic floor damage.

How can they possibly know what side effects occur, when they refuse to even consider the possibility that what a woman is going through post-partum and/or post-op could be related to what happened during the birth/surgery?

Ugh.


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## AustinMom (Jul 16, 2008)

I think "trends" influence new Obs when they step into practice and see tenure OBs doing them, and then they become "routines". As in, this is what I have always done, and it's what I think works. Both Bull *&^%.


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## MiaMama (Jul 21, 2007)

Quote:


Originally Posted by *Storm Bride* 
How can they possibly know what side effects occur, when they refuse to even consider the possibility that what a woman is going through post-partum and/or post-op could be related to what happened during the birth/surgery?

To be fair to OB's, most doctors have this mental block. I have been told that celiac does not cause headaches, yet, I am a celiac, and when I get glutened, I get severe headaches.

Although anecdotal evidence is not really evidence, it is observations about the world around us that prompt the best scientists to ask questions. Questions like, hmmm, "many women complain about numbness afte c-sections, could they be related?" Or "Why do so many celiacs get migraines?"

But doctors are not really scientists, they are practitioners. If they never report the anecdotal evidence to any scientists, then who is left to ask the questions?

Women on message boards, that's who. LOL


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## Storm Bride (Mar 2, 2005)

Quote:


Originally Posted by *MiaMama* 
To be fair to OB's, most doctors have this mental block. I have been told that celiac does not cause headaches, yet, I am a celiac, and when I get glutened, I get severe headaches.

I know. I've also received the "that doesn't hurt" thing more times than I can count. (Thankfully, I have avoided the c-section without anesthesia, though. Apparently, women are just too stupid to know the difference between pain and pressure.) I just don't think the fact that doctors in other fields are equally arrogant and ignorant should mean OBs get a free pass.

Quote:

Although anecdotal evidence is not really evidence, it is observations about the world around us that prompt the best scientists to ask questions. Questions like, hmmm, "many women complain about numbness afte c-sections, could they be related?" Or "Why do so many celiacs get migraines?"
Yup. Most doctors, if pressed, will admit that c-section can cause "mild numbness", but they won't (ime) admit that numbness can actually have any effect on quality of life, or on bodily functions.

Quote:

But doctors are not really scientists, they are practitioners.
True. But, they don't seem to realize that, themselves, and they sure try not to let their patients figure it out. I don't expect my doctor to be a scientist, but I don't think that actually considering the possibility that a patient's post-op symptoms might be related to her surgery requires scientific training, yk?


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## Lucy Alden (Jun 15, 2009)

Doctors are paid a fee for their service (FFS). The more invasive the procedure the bigger the reimbursement. IMO higher reimbursement encourages a high c-section rate. I wonder what the c-section rate would be if OBs were paid the same regardless of whether the delivery was vaginal or a section? I just can't help but believe that money is a big motivator. But of course, no doctor in his/her right mind would admit this.


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## SwanMom (Jan 4, 2007)

C-sections are also a lot quicker and can be done at convenient times. An OB/GYN has to be at a lot of births to pay for the high malpractice insurance. He/she cannot sit around waiting for women to give birth. They have lives, too. It's the entire system that is making this happen. I thought "Pushed" by Jennifer Block spelled things out clearly yet allowed me to come to my own conclusions. (I feel very good about my choice to have another out-of-hospital birth with competent HCPs).


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## AustinMom (Jul 16, 2008)

Quote:


Originally Posted by *SwanMom* 
C-sections are also a lot quicker and can be done at convenient times. An OB/GYN has to be at a lot of births to pay for the high malpractice insurance. He/she cannot sit around waiting for women to give birth. They have lives, too. It's the entire system that is making this happen. I thought "Pushed" by Jennifer Block spelled things out clearly yet allowed me to come to my own conclusions. (I feel very good about my choice to have another out-of-hospital birth with competent HCPs).

I can't agree with you more. I LOVED Pushed and would recommend it to any mom, pregnant or not, heck, any woman in childbearing years, even dads....AND politicians! Lol!

I think that a dr. MAY be able (as I don't know a lot about medical malpractice insurance) to lower their deductible if they have a good record of successful outcomes, and work in a hospital/organization with a good record as well. I hope so. I hear in FL it's sometimes as high as $200K (according to Pushed). That's insane! Maybe Obs should become Midwives! LOL!


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## member234098 (Aug 3, 2002)

A c/sec is not quicker.

The surgical delivery is easier to predict, to schedule, and to deliver the baby, but the rest of the clean up is time consuming. And of course, for the mother, the recovery is protracted by the additional time of recovering from major abdominal surgery with all of the incumbent complications and long time side effects.

My reference for this is the book by Michelle Harrison, M.D., A Woman in Residence pubished in 1981. Ask yourselves if thing have changed much since.


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## naupakamama (Mar 26, 2005)

Quote:


Originally Posted by *MiaMama* 
The size comments make me wonder about the argument that I often hear about why the US has high surgery rates and poor outcomes. I am told that because there are only Sweedes in Sweeden







, for example, they have healthier babies, lower c-section rates, and better neonatal mortality stats. That because we have a lot of genetic diversity in the US, we therefore have more complications, like mamas growing babies too big for their bodies.

I wonder about pure-bred dogs, who tend to have WAYY more health complications than mixed-breed. In other species, I have never ever heard of genetic diversity being a bad thing. Actually, quite the opposite.

I wonder how the genetic giversity in China compares the the US.

You bring up an interesting point. I don't know the actual genetic diversity in different countries, but I can tell you as an evolutionary biologist that humans are an extremely similar group. We are a very young species. You would find far more genetic diversity in the dandelions or grass in your yard, or in chimpanzees or gorillas than you find in humans. Our genomes are all nearly identical to each other so I would imagine that the US is not that much more diverse because none of us are diverse. Besides Asians adopting a western diet are now growing much larger (all of my friends in Hawaii were much taller than their parents who grew up in Asia).

From my own experience, I had a lovely 3 hour homebirth of a 11 lb baby just 6 months ago. And my midwife told me that my baby wasn't the largest she had delivered and she regularly delivered babies even that large born to Asian women (usually with husbands of a different race). We live near Queens, NY so about as diverse an area as you can get worldwide, with every kind of racial mix, and she has not had a problem with a baby not fitting.


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## belltree (Mar 10, 2009)

Quote:


Originally Posted by *naupakamama* 
And my midwife told me that my baby wasn't the largest she had delivered and she regularly delivered babies even that large born to Asian women (usually with husbands of a different race). We live near Queens, NY so about as diverse an area as you can get worldwide, with every kind of racial mix, and she has not had a problem with a baby not fitting.

I was raised in a European country, which is definitely less diverse than the US, but it's C-Section rate has reached almost 30% in the last few years.

Maybe the latest increase in C-Sections has also to do, that more and more hospitals are banning VBACS and around here it has been getting more and more difficult for Moms to find hospitals that allow them.


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## AustinMom (Jul 16, 2008)

If anyone has seen Orgasmic Birth, there is an extras feature that talks about US cs rates compared to other countries and reasons for it. It's not to do with maternal request, that's bull, it's not all to be blames on maternal health, only a VERY small percentage. A LOT has to do with not allowing VBACs. Personally, I think that even a VBAC attempt in a hospital is a poor choice (health permitting to OOH birth) because it lowers your chances significantly, especially if certain routines are done, Pit and or other drugs are commonly used and there is no hydrotherapy. A lot of things need to change in order to lower the cs rate. Women birth at home or in birthing centers. Women take control of their VBAC birth, OBs "allow" VBAC and most importantly SUPPORT VBAC, and encourage professional labor support from a Doula/Montrice. Here's a good start for the US.

As far as outlawing cs or surgical "births" no, it's a bad idea, for many reasons, some moms DONT take care of themselves and their babies are better off outside of them, this includes with complications during pregnancy and in labor. Some moms aslo have things arise even if they do everything right. This is no excuse for a 30%+ cs rate of course. Now, ELECTIVE SCHEDULED cesarean births, I do agree, should be outlawed. I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.


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## smeisnotapirate (Aug 24, 2007)

Quote:


Originally Posted by *AustinMom* 
I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.

Sexual assault. I have a very close friend who elected and scheduled a c-section because of the psychological trauma she was going through thinking about labor because of a previous violent sexual assault (sadly, how the baby got in there in the first place).

It comes down to women's rights. And outlawing elective c-sections will be VERY damaging towards women's rights. I think electing a c-section should be preceded by EXTENSIVE counseling and true informed consent about the risks the mother is taking upon herself (as it did in my friend's case), but this is truly about women's rights, and I support any woman who feels that she needs to have a c-section _in the absence of fearmongering_ and with knowledge of the risks.


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## AustinMom (Jul 16, 2008)

Quote:


Originally Posted by *smeisnotapirate* 
Sexual assault. I have a very close friend who elected and scheduled a c-section because of the psychological trauma she was going through thinking about labor because of a previous violent sexual assault (sadly, how the baby got in there in the first place).

It comes down to women's rights. And outlawing elective c-sections will be VERY damaging towards women's rights. I think electing a c-section should be preceded by EXTENSIVE counseling and true informed consent about the risks the mother is taking upon herself (as it did in my friend's case), but this is truly about women's rights, and I support any woman who feels that she needs to have a c-section _in the absence of fearmongering_ and with knowledge of the risks.


As a victim of sexual abuse I can see this being a true reason. Hopefully, your friend has extensive counseling before birth, not only on whether or not she wanted a cs opposed to a vaginal birth, but because she needs to heal from the trauma, regardless if pregnancy occurred from it or not.

But yes, I do see your point, and would hate for this to be denied from a woman, but, IMO, I think this is not an "elective cs" It's a medical condition that interferes with the mother's health if she has a vaginal birth. So, I don't see if elective cs were dubbed illegal that a person in her situation would have to fight for a cs.


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## Storm Bride (Mar 2, 2005)

Elective c/s isn't ever going to be illegal, as "elective" isn't used by medpros the way it's being used here.


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## MeepyCat (Oct 11, 2006)

Quote:


Originally Posted by *AustinMom* 
I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.

Placenta previa.

I had my dd at 32 weeks due to placenta previa and related hemorrhage. The doctors who performed the surgery determined that, while neither her life nor mine was immediately at risk, there was a risk that if I stayed pregnant, either the oxygen-transfer membrane in the placenta or the baby's blood supply would be compromised. She was safer out than in, but a trial of labor stood a high chance of killing us both.

But because no one's life was immediately at risk, the hospital paperwork indicates that my c-section was elective. If the hemorrhage hadn't happened, if I had simply continued to term with an unresolved previa, we'd have had a scheduled elective surgical delivery, because a trial of labor would still have probably killed us both.


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## scottishmommy (Nov 30, 2009)

Quote:


Originally Posted by *AustinMom* 
As a victim of sexual abuse I can see this being a true reason. Hopefully, your friend has extensive counseling before birth, not only on whether or not she wanted a cs opposed to a vaginal birth, but because she needs to heal from the trauma, regardless if pregnancy occurred from it or not.

But yes, I do see your point, and would hate for this to be denied from a woman, but, IMO, I think this is not an "elective cs" It's a medical condition that interferes with the mother's health if she has a vaginal birth. So, I don't see if elective cs were dubbed illegal that a person in her situation would have to fight for a cs.

Babies who are transverse and wont move into a better position need to be sectioned. Also women who have had many prior uterine surgeries. Or babies with serious birth defects such omphaloceles and the like. Sometimes labor itself can be a danger to these women or babies. I also feel like a woman should have the right to request a section. I think it's a crazy thing to do, and I don't agree with the decision, but I don't think it should be illegal. Who are we to tell someone what she can or can't do with her own body?


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## khaoskat (May 11, 2006)

IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.

Until tort reforms are made, we will continue to see an increase and rise in c/s rates, as OB/CNMs start to cover the backsides more and more. Not only will the primary rate increase, but I think as more and more hospitals face increasing malpractice costs/liabilities, we will see a decrease in the number of hospitals that allow VBAC and therefor start seeing a huge increase in RCS because of increasing number of bans.


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## AustinMom (Jul 16, 2008)

Yes, Placenta Previa is one where a cs is needed. I AGREE, I want to make that clear. It's funny that didn't come to mind to me, as I am a VBAC and placenta previa is more common. In that case, yes, I would say a scheduled cs should be done. Of course, you should not go into labor as well, as it can be dangerous, and hemorrhage is a high risk and very dangerous for the two of you.

Yes with a transverse baby, of course a cs is needed too. I highly doubt the baby could be born vaginally without turning head down or breech. I think that one should go into labor on their own in this case, as the studies show it is better for mom and baby to labor some and OR wait for onset of labor. But, yes, a cs should be done, as a vaginal birth would be next to impossible.

Woman's rights in not "allowing" elective cs can easily turn into a discussion on abortion. As I am not wanting to go down that road, as that is not what this thread is about.

Personally, woman who want a cs because they "don't want to labor" (for reasons other than sexual abuse, etc), or because "it's convenient" or "it's what my dr. said" should not be allowed. You risk the baby's health, your health, and you up the cost of your maternity care, which in the long run can effect us all. Now, OBs who say, "your baby is too big", "your placenta is ageing" (when it is not proven) "your pelvis is too small/misshapen" (when it is not in a case of ricketts, dwarfism, injury etc) "I'm going on vacation", "It's near the end of the year", "we don't allow VBAC", I think are all wrong for a DR to enforce, let alone even tell a mom. I think this is wrong. I think to change it, we need to educate moms better what the consequences of their actions are, good or bad. I have never felt a mom has not taken into consideration the health of her or her baby. No mom would choose a more risky procedure if it unnecessarily put her or her baby at risk.

Just as I don't think an OB should use Cytotec for induction (other than abortion) I don't think they should use a cesarean for means of non medical uses. It's sad, Pitocin is not even FDA approved for induction without medical means, but it happens ALL the time. Yes, sometimes it should be used, just like a cs, when the risks of continuing the pregnancy out weigh the risks of the procedure. But, when you take away the risks of continuing the pregnancy, and there are none (non medical ones) then you only have the risks of the procedure and it is then too risky. Sadly mom's aren't all told this, and blindly choose inductions for non medical reasons.


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## Ammaarah (May 21, 2005)

Uh, nevermind.


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *khaoskat* 
IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.

Until tort reforms are made, we will continue to see an increase and rise in c/s rates, as OB/CNMs start to cover the backsides more and more. Not only will the primary rate increase, but I think as more and more hospitals face increasing malpractice costs/liabilities, we will see a decrease in the number of hospitals that allow VBAC and therefor start seeing a huge increase in RCS because of increasing number of bans.

One notable study shows that of 1500 claims, the overwhelming majority were not frivolous. The majority were settled out of court. Plaintiffs lost 80% of the cases that made it to court. In short, doctors who practice defensively are practicing out of fear, not reality. And then they try to stick it to the consumer, whose only recourse for justice is through the courts, by demanding tort "reform." (Most consumers are not little old ladies suing over spilled hot coffee. The 800-lb gorilla in the room: There are incompetent physicians out there. They can and do kill or cause irreparable damage to patients).

The correlation just doesn't add up to bolster the case for tort caps. Mississippi, for example, has caps on both punitive and non-economic damages. Yet its cesarean rate is an astronomical 35.4%, one of the highest rates in the nation.

The real reason for the tort cap movement is to lower insurance rates (which, by the way, doesn't work).

Listening to the AMA and ACOG, you would think that putting caps on compensation was the ultimate panacea. They talk as if their hands are tied, and doctors "have" to slice women open to avoid lawsuits. Sorry, Charlie. I'm saving my sympathies.


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## AlexisT (May 6, 2007)

Quote:


Originally Posted by *AustinMom* 
If anyone has seen Orgasmic Birth, there is an extras feature that talks about US cs rates compared to other countries and reasons for it. It's not to do with maternal request, that's bull, it's not all to be blames on maternal health, only a VERY small percentage. A LOT has to do with not allowing VBACs.

I don't think the statistics bear this out. The problem is with primary CS. The VBAC rate is never 100%, and is usually not even close. In the UK, it's about 32%, which is a little more than twice the US rate. That's also what it was in the US when VBAC was at its height and OBs pushed it in the early-mid '90s. 20% of women who have already had a CS is really not statistically significant compared to all the women having primary sections.

The decline in VBAC happened to accompany certain other changes in medicine, and in the medico-legal climate (John Edwards' CP cases, for example). There was an overall change in birth that also affected VBAC.


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## JessicaS (Nov 18, 2001)

Hello!

I have removed several posts from this thread.

Please report inflammatory posts rather than responding.

Thank you.


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## MegBoz (Jul 8, 2008)

Quote:


Originally Posted by *khaoskat* 
IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.

I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.

It is the entire view that birth is dangerous and SHOULD be "managed" (whereas hands-off, medically known as "expectant management" is best in about 90% of cases!)

We need MUCH fewer inductions. We need more doulas. We need more birthing tubs & other hydrotherapy options to reduce the epidural rate. We need more & better education. We need more FSBC.

Ironically, health insurance companies stand to profit royally from reform to maternity care!!!!!!! The FEWER CS, FEWER inductions, the CHEAPER it will be for them to pay maternity health care fees!! This is one of very few situations where the cheaper option (less intervention) is the better option for BOTH mamas & babies!


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## member234098 (Aug 3, 2002)

Quote:


Originally Posted by *MeepyCat* 
Placenta previa.

Rates of placenta previa and placenta accreta have skyrocketed in part because previous surgery on the uterus, including c/secs, contributes to having scar tissue on the uterine wall and causing problems with the placenta.

Quote:


Originally Posted by *MegBoz* 
I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.

True.

The c/sec rate in Canada parallels the rate in the U.S. even though Canadian doctors get paid the same amount for the delivery. Doctors simply believe that they do better than nature.


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## smeisnotapirate (Aug 24, 2007)

Quote:


Originally Posted by *MegBoz* 
I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.

It is the entire view that birth is dangerous and SHOULD be "managed" (whereas hands-off, medically known as "expectant management" is best in about 90% of cases!)

We need MUCH fewer inductions. We need more doulas. We need more birthing tubs & other hydrotherapy options to reduce the epidural rate. We need more & better education. We need more FSBC.

Ironically, health insurance companies stand to profit royally from reform to maternity care!!!!!!! The FEWER CS, FEWER inductions, the CHEAPER it will be for them to pay maternity health care fees!! This is one of very few situations where the cheaper option (less intervention) is the better option for BOTH mamas & babies!









:


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## Turquesa (May 30, 2007)

Quote:


Originally Posted by *MegBoz* 
I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.









Marsden Wagner makes a compelling case against tort "reform."


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