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Shocking New Cesarian Rates - Page 2

post #21 of 58
Quote:
Originally Posted by Storm Bride View Post
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.
post #22 of 58
Quote:
Originally Posted by MiaMama View Post
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.
post #23 of 58
Quote:
Originally Posted by scottishmommy View Post
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!!!
post #24 of 58
Quote:
Originally Posted by scottishmommy View Post
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.
post #25 of 58
Quote:
Originally Posted by MegBoz View Post

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!
post #26 of 58
Quote:
Originally Posted by MegBoz View Post

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.
post #27 of 58
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.
post #28 of 58
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...
post #29 of 58
Quote:
Originally Posted by scottishmommy View Post
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 View Post
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.
post #30 of 58
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.
post #31 of 58
Quote:
Originally Posted by scottishmommy View Post
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 View Post
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."
post #32 of 58
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.
post #33 of 58
Quote:
Originally Posted by miriam View Post
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.
post #34 of 58
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 *&^%.
post #35 of 58
Quote:
Originally Posted by Storm Bride View Post
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
post #36 of 58
Quote:
Originally Posted by MiaMama View Post
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?
post #37 of 58
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.
post #38 of 58
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).
post #39 of 58
Quote:
Originally Posted by SwanMom View Post
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!
post #40 of 58
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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