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:
- augmentation with pit
- 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!