Increase in elective c-sections

[LeslieB]

Heard this story on NPR this morning and thought I'd pass along the link.
http://www.npr.org/templates/story/s...toryId=5311258

Caesarean deliveries are on the rise. Nearly three in 10 babies born in the United States are now delivered by C-section. Most are performed at the discretion of doctors. But, increasingly women are requesting elective Caesareans for non-medical reasons. Some mothers want the convenience of scheduling the delivery date. Others want to prevent damage to the pelvic floor in order to preserve sexual function and bladder control.

I think the woman they interviewed is pretty uneducated on vaginal delivery. I had no bladder control issues whatsoever.

[pamamidwife]

people forget that bladder control is a result of our sedentary lifestyle and pregnancy - not to mention episiotomies. it's sad that women are being misinformed.

i think that cesareans are on the rise, but they're not really elective cesareans. i think that's the bs that ACOG is trying to present to get more women to choose cesareans. i think that many women are being told right away that they "need" a cesarean for a multitude of erroneous reasons ("big baby", "small pelvis", etc).

i have a feeling ACOG would like to see a higher cesarean rate - and have heard this from many leading OBs - of around 75%. there is a belief that the higher the cesarean rate, the lower rate of litigation.

[huggerwocky]

Poor women, I think convenience c-sections are very rare and the majority is silently bullied into them by the doctors or their own fear. I might,too, if I had to give birth in a hospital.

[OnTheFence]

I believe on the Today Show an OB said that women who were electing to have cesareans for absolutely no medical reason was very low and that it was being exagerated in the media. She also said though, that if a patient of hers wanted a csection she would spend how many number of months till it was time to deliver to convince her to have a normal, vaginal delivery and the pros and cons of having a cesarean section. She then stated that if the woman after all that still wanted a csection she would do it because she said it was about choice, and that should not be taken away from women. (this is where I agree with her completely)

This OB, her name escapes also said to the interviewer that she believed the reason there was such an increase in cesarean births was due to inductions. That more women were wanting to be induced to fit birth into their schedules before it was really time for their babies to come out. I also agree with this. I believe that if doctors would refuse to induce women (on the premise that it carries risk and more liability) than the cesarean rate would go down.

[Guest*]

Originally Posted by OnTheFence

This OB, her name escapes also said to the interviewer that she believed the reason there was such an increase in cesarean births was due to inductions. That more women were wanting to be induced to fit birth into their schedules before it was really time for their babies to come out. I also agree with this. I believe that if doctors would refuse to induce women (on the premise that it carries risk and more liability) than the cesarean rate would go down.

I agree. I can't even count the number of women I know who were induced for whatever reason before their baby was ready and end up with a c-section. The stress that a forced labor puts on the baby eventually causes so much distress that a c-section becomes necessary.

[eleven]

Originally Posted by OnTheFence

I believe on the Today Show an OB said that women who were electing to have cesareans for absolutely no medical reason was very low and that it was being exagerated in the media. She also said though, that if a patient of hers wanted a csection she would spend how many number of months till it was time to deliver to convince her to have a normal, vaginal delivery and the pros and cons of having a cesarean section. She then stated that if the woman after all that still wanted a csection she would do it because she said it was about choice, and that should not be taken away from women. (this is where I agree with her completely)

This OB, her name escapes also said to the interviewer that she believed the reason there was such an increase in cesarean births was due to inductions. That more women were wanting to be induced to fit birth into their schedules before it was really time for their babies to come out. I also agree with this. I believe that if doctors would refuse to induce women (on the premise that it carries risk and more liability) than the cesarean rate would go down.

Wow!! I am so glad that she was able to speak out! It's interesting that this was on the Today Show, considering the horrible segment they had about elective cesareans on the evening news last night.

Off to look for a link.

[Emilie]

[amygoforth]

This just kills me!

How absurd is this?!

Dr. James Nicholson of the University of Pennsylvania is...

researching the possible benefits of inducing women one week prior to their due-dates (at 39 weeks gestational age) in order to cut the rate of Caesareans. Initial data shows that this is effective, mostly because the babies are smaller.

Okay, did this little nugget send anyone else through the roof? An intervention to try to decrease the rate of another intervention? How about reseraching the probablility that induction and medically-managed birth increases the risk of c-sections?

And another thing! I stongly suspect if more women knew the real risks of c-sections, as well as the true benefits of a vaginal birth, many would think twice before choosing an elective Caesarean. Again, I blame the medical community for this lack of knowledge. It's commonly accepted among many women I know that in our medically-managed culture, c-section is a pretty safe procedure. I can think of dozens of mothers I know who were sectioned. If it's so common, it must be safe, right? And if it's so safe, then why not choose to sidestep the pain of labor, choose the date and time most convenient, and get it over with quickly? Again, this is me right now:

[Storm Bride]

I don't even get the sidestepping the pain of labour thing. Why on earth would you only want the pain to appear at the same time your new baby is handed to you? With a c-section, you don't get to try to bond with your baby at (or near) the end of the pain...you get to do that right at the beginning.

[tinyshoes]

Originally Posted by Storm Bride

I don't even get the sidestepping the pain of labour thing.

People are dumb...no wait, maybe they're smart. Women are choosing abdominal surgical assault rather than endless vaginal exams, possible episiotomy, and being yelled to PUSHPUSHPUSH by strangers in a room with their pants off and legs spread. I think that's the agony women want to sidestep.

We live in a culture that endorses surgical recovory pain for cosmetic reasons, like facelifts, boob jobs, and the like. A c-sec is just another surgery.

And "everyone" has a c-sec now; our favorite movie stars and celebs, and as the stats show, every 3rd or 4th mama you meet had one....or "had" to have one.

[Emilie]

this sickens me....
Lets brainstorm some ideas on how to get the TRUTH out there to pg and to be pg moms...

[OnTheFence]

Originally Posted by Storm Bride

I don't even get the sidestepping the pain of labour thing. Why on earth would you only want the pain to appear at the same time your new baby is handed to you? With a c-section, you don't get to try to bond with your baby at (or near) the end of the pain...you get to do that right at the beginning.

This might be the case with you, but for many of us this was not the case at all. Also there are plenty of women who have horrible vaginal births that are in a lot of pain afterwards.

[tinyshoes]

Originally Posted by Storm Bride

With a c-section, you don't get to try to bond with your baby at (or near) the end of the pain...you get to do that right at the beginning.

In general, during a vaginal birth, the contracting uterus and emerging head--the causes of the pain of childbirth, are over once the fetus emerges from the womb.

In general, during a c-sec birth, the recovery pain from the surgical procedure begins once the surgical procedure is completed.

Certainly, all women will experience different births and different pain levels during all parts of the entire babymaking process, from conception through birth (transabdominally or vaginally) and during the post-partum period, but I think you make a good point, Storm Bride.

[DreamsInDigital]

I just do not like the turn this country is taking in regards to birth. In some states homebirth is ILLEGAL. How the hell is this helping?

[Emilie]

Yes- it is sad and scary.

[crazyeight]

Drastic Action

Drs are more and more going out of business because of malpractice and sueing, this is mostly because of misdiagnosis and SURGERY!!!

Our countrys population is HUGE and exploding. I am not sure of the statistics but I am sure 90%+ hospital births are medicated therefore at higher risk for mom to not know what is even going on in her body therefore something goes wrong therefore SURGERY!!

hmmmm lets solve all the problems. NO drugs for vaginal labor and NO elective c-sec (i agree women should have a choice but this wasn't a choice that long ago). I feel that so many people take advantage of drugs to just "do something", like a child isn't a huge decision, responsibility, and change in life. Oh i can get drugs and it won't hurt and I'll go home with my perfect baby and nothing in my life will be different but we can keep up with the jones.

If you can't go through the pain of labor then you can't deal with the "pain" of rearing a child. I know that children are a joy but its not always joyful. Real mammas know that you watch them make mistakes, break their hearts, hurt themselves even and that you stand by to make sure they are ok but still have to restrain yourself. Birth is the easy part!!! Plus the pain is an honor and its miniscule when that child is placed in your arms, awake, bright eyed and so are you.

No more c-sec!!! (unless you/baby are going to die)

[Emilie]

yeah that

[DreamsInDigital]

Me too.

[amyro]

This is just media spin to blame the increasing c/s rate on women by framing it as a "patient choice" issue instead of taking a long, close look at our system. THere's no evidence that elective cesareans are requested by women and there IS evidence that docs are pressuring women to have cesareans. Also, the "dangers" of vaginal birth are primarily the result of care practices in labor that are not evidence-based: routine episiotomy, continunous monitoring, coached pushing, having women birth flat on their backs, etc. I've been working on this issue with the recent NIH conference. Here are some good resources from Lamaze, Childbirth Connection (formerly MCA) and ACNM.

Elective Cesarean versus Planned Vaginal Birth: What are the Consequences

The Problem with "Maternal Request" Cesarean

Alerts and Responses on the NIH Cesarean Meeting from Childbirth Connection

The Giving Birth with Confidence Blog, with several recent posts about the NIH meeting.

The REDUCE Campaign from ACNM

[USAmma]

In India where my SIL lives, most women who are middle and upper class choose c-sections because they don't want to go through natural childbirth. From what I hear of their options, it would be a tough choice for a woman to give birth naturally. Most go to a birth center where they all labor in one room and then are moved to a delivery room, like an assembly line. Or they go to a hospital and have a private room but are pressured to give birth within hours or they get a section. There is no epidural available for pain control, only for scheduled csections. Emergency sections they put you to sleep.

My SIL is very bravely going to educate herself and try to do it naturally but the odds are stacked against her.

I know of several women who chose not to do vbac because it's more convenient to know the date, and they know what to expect after a previous section. I know very few women who have done vbac.