Kind of to OnTheFence, but to everyone in general.
First off, I just want to say that i am really glad that you have been lucky enough to have an OB (More than one maybe, I don't know much about you) who is informative and helpful to you. Unfortunately, that doesn't mean that they all are. I am not anti-OB, I know many people who as either babies or mother were spared much pain and in some cases death by a great OB. However, due to many thing like the patient load and time constraints, etc. most OB's simply do not have the time to educate a mother who doesn't feel the need to educate herself. The rate of C-sections is Way too high and the World Health Organization as well as the American College of Obsterics will back me up 100% on that front. The truth of the matter is that nationwide, the rate of c-sections increases rather dramatically before holidays and long weekends (Labor day, Memorial Day, etc.) I refuse to believe, and challenge any logical person to even try to convince me that medical problems just naturally go up because a holiday is coming.
I certainly will not blame it all on the OB's. I think that women share just as much responsibility because they don't want to educate themselves. I frequent a "normal" pregnancy board (perhaps "mainstream" is a better word . . . ) and the general mindset is that an induction ends the "torture" of pregnancy sooner, the epidural makes everything better, and the doctor will make everything alright. There are definitely some who disagree, but this is the opinion of the majority, say 60-70%. This puts a tremendous amount of pressure on the doctors. They simply do not have time to make an in-depth study of each woman who comes into their care, so pregnancies get pushed into an assembly line type practice where all the guidlines have to fit most of the women. Unfortunately, this assembly line has become so common, that those of us who want to do it differently, have to fight against the tide. There won't be a major change until a majority of the women convince a majority of the doctors that they don't need the assembly line treatment. That they can do the studying for themselves. That they can look up their own symptoms and spend time making a plan with their doctor, not pumping him for useless information. Unlike some people here (no offense to anyone) I simply cannot believe that the problem lies more than halfway with the doctors. They give women what they have found the majority of women want. Resources are available for women who want to break out of the mold, but many women simply refuse to take the time and energy.
That being said, epidurals do lead to a greater rate of c-sections. Not because they contribute greatly in failure to progress, because if they are given late enough in labor, they often do not. But they do raise it a bit due to being given too early. However, IMO the biggest reason that epidurals are effecting the c-section rate is that women cannot move around and get into the best position to push. You simply cannot squat if your legs are totally numb. (Some women manage if their epidural wears of a bit, but in general, it just doesn't work very well.) I have seen so many labors be diagnosed as a baby too big to come out when they would probably be just fine if they could move around and find a better positon. IMO it is the pushing stage, not the first stage, that is MOST effected by the epidural.
Also, you commented on EFM being a good tool and although no (or at least very few) doctor will tell you this, about ten years ago a study was completed that covered thousands of women's labors over a period of twenty years and they compared continual EFM and intermittent Doppler monitoring. They found that there was no difference in birth defects, no difference in maternal or fetal demise, and no difference in several other safety factors. They did find, however, that the rate of c-sections was drastically higher with continual monitoring. I can't remember the exact number, but it was pretty drastic. The c-section rate was the only difference. It's not a useful tool most of the time, it is a tool that increases the rate of c-section.
I am also very supportive or women having the type of birth that they want. I don't want anyone pushing their drugs and interventions of me, so i don't have a right to push my ideas on anyone else. But unfortunately, now the opinions of the masses are limiting my ability to choose the birth that I want and that is what makes me upset. There are places where VBAC's are banned, and that number is growing every year. My only choice is to do everything I can to stay out of the hospital (where c-section rates are nearly triple the rate of my current birth center) so I can reduce my chances of having a c-section, because after a section, my chances of being able to have a VBAC in a way that is both legal and able to be covered by insurance are decreasing daily.
You are absolutely right when you talk about the things that you can refuse, but how many first time mothers know about that? (Which, I admit, can be somewhat their own fault.) And when you are faced with an entire team of nurses and a doctor telling you what you "need" to do, how many women will have the strength to say no? If you are pressured into things (and I know from many many birth stories that many women are) how is that freedom? How is that the doctor truly doing his job? How is that fair? Like i said, everyone can have their choice, but in the last year I have not heard a simgle story of a hospital birth where there was not some element that i found unacceptable, that could be directly blamed on either the team of delivery nurses or the doctor. In my opinion, that is a tragedy.
Thanks for letting me blab.
Edited For stupid spelling error.