Managed Care Magazine Article - C-Sections

[Tanibani]

I was posting on another board over elective C-secs and came across this article (since we are all sharing articles that are gonna make us sick.)

My apologies to all of you.

Most of us have read the Dr. Bergman article where she elects to have a Csec to avoid prolapse/vaginal issues.
Why I Chose an Elective Cesarean by Jennifer Bergman, MD

Well, read this:
Changing Medical Evidence Brings Shift in C-Section Stance - Managed Care Mag, January 2003

Like many, and probably most, Ob/Gyns, Flamm and Lockwood regard C-sections as major surgery with quantifiable risks and that they should be done only if medically indicated. At the same time, they acknowledge that patient choice may become the decisive factor. That scenario gained credibility in 2001 when then- ACOG president Benson Harer, MD, advocated on-demand Cesareans in his organization's newsletter.

Speaking for himself and not for ACOG, Harer argued that Cesarean delivery is less traumatic for baby and mother. This position had already been advanced by David Walters, MD, in his 1999 book,Just Take it Out: The Ethics and Economics of Cesarean Section and Hysterectomy.[/b]

"My belief is that Cesarean birth is fundamentally superior for mothers and babies," says Walters, an Ob/Gyn in Mount Vernon, Ill. "The maternal mortality rate in the United States would go down and so would long-term morbidity in terms of injury to the pelvic floor, specifically bladder prolapse, stressed urinary incontinence, fecal incontinence, and uterine prolapse -- for all of which, vaginal birth is the number one risk factor."

(Now, like many of you, I don't buy that vaginal birth itself causes pelvic floor problems. I am convinced it is medically managed birth that is the cause. Most OBs are too blind to see that they are PART of the problem, yet many are advancing a cure that may be worse! Another contributing factor to pelvic floor disorders is lack of rest postpartum. Other cultures follow a 40-day of rest rule, Westerners do not. )

Flamm expects to see an all-time high rate of Cesarean sections in the United States for 2002. Lockwood can conceive of a 50-percent rate within 10 years, but believes that natural birth eventually will come back into favor. Walters predicts that all American births will be via C-section within 20 years, not necessarily because that's what women will demand, but because of the prohibitive malpractice liability associated with vaginal delivery.

WHAT! Is that where we are headed?!?!?!?!

Isn't that the NUTTIEST thing you've ever read? I *hope* it never comes to pass.

But I have to wonder, if more and more women elect to have a C-sec, and of course, don't pay for it out of pocket (like they should) What effect will that have on health insurance/liability????

[dotcommama]

Walters predicts that all American births will be via C-section within 20 years, not necessarily because that's what women will demand, but because of the prohibitive malpractice liability associated with vaginal delivery.

That's a frightening prediction! Especially since she predicts it will be against what women will want for their bodies. I hope instead homebirth will become more popular and people will stay away from OB's unless they need a medically managed birth.

[Greaseball]

Walters predicts that all American births will be via C-section within 20 years, not necessarily because that's what women will demand, but because of the prohibitive malpractice liability associated with vaginal delivery.

I've predicted this as well. I think someday vaginal births in hospitals will happen only by accident. There are already some insurance policies that cover c/s but not vaginal birth.

And why do they think maternal mortality will decrease? Most mainstreamers know that c/s has a 4x greater chance of death for the mother.

But several years of data from VBAC trials of labor revealed substantially higher rates of fetal death due to uterine rupture. Administering oxytocin or prostaglandin gel to induce labor increased the risk even more.

At least they admit it...most people see no connection between pitocin and rupture.

ACOG now discourages the use of prostaglandin gel, and Ob/Gyns have dusted off the venerable adage of "once a Cesarean, always a Cesarean."

But they say nothing about discouraging the use of pitocin.

Many Ob/Gyns and vaginal-birth supporters aren't persuaded that vaginal delivery causes pelvic floor dysfunction, but as C-sections become more routine, more women like Berman may decide to play it safe.

So now there is a name for us? The "vaginal-birth supporters?" :LOL

"I don't think a doctor should tell us how to have a baby," said Berman at the end of her "Healthy Woman" segment on GMA. "We're able to choose whether we want laparoscopic surgery or open surgery, whether we want a boob job or a tummy tuck. Why can't we choose this?"

I agree with doctors not telling us how to have babies...unfortunately, not the way she does! If doctors didn't tell us how to have babies, we would probably see the 3-5% c/s rate that other countries have.

I don't know of any other elective surgery that is covered by insurance. If I just decided to have heart surgery today, in the absence of a medical condition, not only would insurance refuse to cover it, no doctor would perform it!

[Tanibani]

Loved your post Greaseball.

Originally Posted by Greaseball

I've predicted this as well. I think someday vaginal births in hospitals will happen only by accident. .

That's depressing!

Originally Posted by Greaseball

There are already some insurance policies that cover c/s but not vaginal birth.

Oh.... my.... God.... I never heard of that!

And weren't those VBAC deaths solely due (majority) to induction. 'Cause otherwise, it should be OK.

[Greaseball]

I once had insurance that covered either a c/s or an abortion, but not contraception or vaginal births. Some woman-hater must have made the rules there.

[Mom4tot]

I'm speechless. God(dess) help us all. And our daughters.

[Greaseball]

Has there ever been a case of maternal death that was due to VBAC? I read in Open Season that there had never been such a case, but since that was written in the early 90s, I was wondering if anything new had come up.

The book also said that most women who rupture do not have their babies die. And, of course, that most ruptures happen before labor begins.

[pamamidwife]

I know that leading Ob/Gyns are currently (right now, in today's times) pushing for an "ideal 50% cesarean rate".

I venture to think that soon, women who really want vaginal births will have to seek out care by homebirth attendants.

I also see horrific things happening to the profession of in-hospital nurse-midwifery. Things have to change, but consumers have to demand the change. Sadly, I don't see many women wanting it to change.

[Greaseball]

I'm amazed at how women don't seem very upset by all this, except for those on this board. Women IRL tell me they "had to have a c/s, because the doctor said the baby would be 10 lbs, but really it was only 8 lbs!" and they just have this "oh, well" attitude about the whole thing! I would be livid if I found out I had been operated on for no good reason! Why is it acceptable to so many others? Another woman was talking about how her doctor left an instrument inside her when he closed her incision, and again it was the "oh well, these things happen" attitude. Why is it OK that her life was put in danger because her doctor doesn't know how to count?

[dotcommama]

When you think of it, is this so surprising?

How long ago was it that science and doctors convinced women they'd come up with a better way to feed a baby than breastmilk? Now science and doctors have a better way for us to birth our babies too. :

The foolish thing is that we never learn.

We now know that breastmilk is far better than any formula. I guarantee that if the majority of women birth their children medically we will find out that there are repercussions in the health and well being of those women and children.

[Dreaming]

I left my OB for a MW because he told me the very same things that this article says (c-sections "safer" blah, blah). I told him that more women will be opting for home births if that's the case.

I think it's more a matter of convenience than safety. Doctors can have their "schedule" and know that they won't miss their precious golf game or whatever important task they must attend to.

It will be an absolute tragedy if women are no longer "allowed" to birth normally.

[mirlee]

Personally, if I could have avoided it I would never have had one. I have what my sister calls, a "mommy flap" because of it. I think I have to come to terms with the fact that I can never have a flat tummy again without a little nip and tuck.

I hate the idea that people feel they can now schedule their child's birth when it is more convinient for them. I'll bet these are the same people who will schedule the heck out of the poor kids life and they won't know what it's like to be a kid. Whatever happened to " the baby will come when it is ready?" That's what my mom told me. My grandmother said that ds had a glimpse of the outside world and decided that he would pretend he was a groundhog and stay in for 6 more weeks when she found out that I was nearly three weeks over.

[Kiki Runs]

I am so sick of reading articles like this one - literally, they make me sick. I truly believe that my c/s was not only unwanted but UNNECESSARY!! If I could find even one tiny notation in my hospital records to back that up (or malpractice), I would be in a lawyer's office in a heartbeat. NOT b/c I think I should benefit financially from my c/s. NOT just for myself. Just b/c it is time that SOMEONE reversed the trend of "all c/s are necessary".

I know that docs are scared of being sued if they don't perform a c/s. Well, you know what? They should be scared to perform an unnecessary c/s! Can you imagine if you went into a hospital w/a sore on your toe and left w/a leg missing? "Well, it COULD have turned gangrenous and killed you - you should be glad you're still alive". Yeah, but before you cut off my leg, you COULD have tried other treatments and given me a chance to save my leg.

Sorry - that really touched a nerve. I find it completely unfair and disgusting that in any future pregnancies I will have to PUSH to even be "allowed" to "attempt" a VBAC - all b/c ONE doctor jumped to the scalpel. This bothers me even more (maybe) than the fact that I had a c/s - now ALL my future pregnancies will be suspect, "high risk", probably more medically managed. That one doc, w/one act RUINED my chances for future peaceful, natural, worry-free pregnancies and births. And I'm expected to thank him. Yeah, thanks for nothing!

[Greaseball]

I don't understand why hardly anyone is sued after a c/s, when there are much more complications that can happen! Anyone know why that is?

[pamamidwife]

Originally Posted by Greaseball

I don't understand why hardly anyone is sued after a c/s, when there are much more complications that can happen! Anyone know why that is?

Because the perception is that a cesarean is the only thing that can save a baby. The real risks of cesarean are to the mother - and courts are more sympathetic to saving the baby.

[Kiki Runs]

Well, for one thing, how can I PROVE that my c/s was unnecessary? For another, ds and I are both alive and "undamaged" - well, if you don't count the PPD/PTSD that I struggled with or the challenges I'll face w/future pregnancies.

Like I said, if I could find ONE scrap of proof.... But, in my case, even IF I found some proof AND found a lawyer to take the case, I fear it would all be in vain once folks found out how big ds was "Oh, 12 lbs? Of COURSE you had to have a c/s". Of COURSE I did - once the doc got tired of waiting....

[Greaseball]

You could compile a list of all the women who have had vaginal births with babies 12 lbs and up...but then instead of blaming the baby they would just blame your pelvis.

[Henry's_Mamma]

Kinsey ... I just wanted to pipe in and say I completely understand how you feel regarding future pregnancies. That is exactly how I feel and is exactly what I am most angry about regarding my c/s.

[Artisan]

Did anyone see this week's Newsweek? It's an issue devoted to women's health. In it is an article about "designer births", including C-section on demand and the crazy notion of "underwater birth". The article concludes with the note that most doctors think underwater birth is unsafe because the baby can aspirate water.

It wasn't all bad, but I thought the tone of the article was a little weird.
http://www.msnbc.msn.com/id/4880283/

[pamamidwife]

Originally Posted by sharonal

Did anyone see this week's Newsweek? It's an issue devoted to women's health. In it is an article about "designer births", including C-section on demand and the crazy notion of "underwater birth". The article concludes with the note that most doctors think underwater birth is unsafe because the baby can aspirate water.

It wasn't all bad, but I thought the tone of the article was a little weird.
http://www.msnbc.msn.com/id/4880283/

Well, if they took a basic neonatal anatomy class, there might be some better understanding of it. Alas, I guess I know more about the neonatal dive reflex and what initiates breathing in a neonate than they do. Sad.