"they only do caesareans when they're necessary" - UPDATE

[Celery]

and

"they don't rush to c-sections for breech... they try and turn them first"

Excerpts from my conversation with a friend just now regarding where she's planning to give birth Not so much for the hospital's policies, but her naivete!

Yes, my copy of Henci Goer's book is going to be on its way to her tomorrow. I have 29 weeks to educate her on evidence based medicine in obstetrics. And she starts her med school OB rotation next week.

Wish me luck!

UPDATE POST #35

[weliveintheforest]

Hopefully she is a reader and it helps her to make good decisions that she is happy with.
I read a lot during my pregnancy but it was all fluff, I wish someone had given me Goer's book

[wifeandmom]

Originally Posted by Celery

regarding where she's planning to give birth

It is at least a *remote* possibility that this *might* be true if she was speaking ONLY in terms of where SHE is giving birth.

I know the same things could have been said with complete accuracy for the first hospital I delivered at. They LOATHED doing sections, had a less than 10% OVERALL section rate (a good deal lower for first time moms), and most assuredly pushed for external version with breech babies. They'd try version twice before scheduling a section and had some of the most leniant rules for trying that I've ever seen as well (as far as baby's estimated size, weeks gestation, fluid levels, etc).

However, *in general*, I'd say you'd be hard pressed to find a hospital that would even come close to meeting those criteria. You could always look at the section rate though, as that would give you a snapshot very quickly of just how many sections they are doing and whether or not they could justify their percentages.

[MsElle07]

A lot of OBs have stopped doing external versions -- they are seen as too risky now. I know two women who had primary C-sections for breech presentation, and their OBs were unwilling to try versions. I haven't read up on the stats, but that seems to be the current climate.

[huggerwocky]

Then let her explain the discrepancy between the WHO recommendation and the true numbers of c-sections.

[wifeandmom]

Originally Posted by huggerwocky

Then let her explain the discrepancy between the WHO recommendation and the true numbers of c-sections.

That only applies if the hospital in which SHE intends to deliver has much higher numbers than the WHO recommends.

In the hospital I delivered my twins in, their c-section rate was actually LOWER than what the WHO recommends.

*Perhaps* this particular woman is delivering at a hospital with reasonable numbers. It's not common to find such a place, but they DO exist.

[sapphire_chan]

Probably they'd exist more often if there were only people like your dh and the other MDC medical folks working at them.

[wifeandmom]

Originally Posted by sapphire_chan

Probably they'd exist more often if there were only people like your dh and the other MDC medical folks working at them.

To be fair, my own husband has nothing to do with the c-section rate. His job is strictly administering anesthesia when needed/requested. I will say he certainly is MORE than happy for mom to labor and deliver WITHOUT an epidural, as that means he can watch TV instead of doing any real work.

He DOES comment often on how irresponsible it is for docs to do sections 'just because', usually right around shift change he always seems to notice a sudden increase in the number of 'problems' that seem to miraculously crop up. This would be in the teaching hospitals he's worked in, as the residents who have been working that shift only get 'credit' for a birth that actually occurs on their shift. So if mom doesn't deliver til 10 minutes into the next guy's shift, that guy gets credit, so instead of allowing that to happen, it was common to see the first resident in question insist on sectioning mom. Does that make sense? (Not as in, it's ok to do it, just it seems so wordy, so does what I'm saying make sense?)

As for the push for pain meds during labor, I think a lot of pressure comes from the nursing staff, but the majority of women come in knowing they want an epidural asap when they hit the door. Or at least that's been DH's experience. And they also expect it to completely take away ALL of their pain, which is incredibly unrealistic. Education on how epis work, how numb you SHOULD expect to be, etc might be a good place to start with the majority of women.

[gentlebirthmothr]

Originally Posted by wifeandmom

As for the push for pain meds during labor, I think a lot of pressure comes from the nursing staff, but the majority of women come in knowing they want an epidural asap when they hit the door. Or at least that's been DH's experience. And they also expect it to completely take away ALL of their pain, which is incredibly unrealistic. Education on how epis work, how numb you SHOULD expect to be, etc might be a good place to start with the majority of women.

celery,

, to wifeandmom said to you above here.

I'm a clerical volunteer at the local hospital by me, in their Maternity Department. Well, I'm not in labor & delivery part of it, but I know the doctors, nurses, other medical professinals even the BAs are very mainstream, not like me since I been coming here since last year (July, 2005). MDC has really re affirmed what I thought before I came here even my mom whos an register nurse is very mainstream as well. My dad and fraternal twin sister as well.

[frontierpsych]

sooo... really, they'd have a 3% c-section rate? 5% at the most?

I have yet to see a hospital with those stats...

[boongirl]

I think my OBs stats were 18% and I thought that was low (compared to national average)

But, I would give the poor mom to be a break. She is probably clueless, like I was, but does not realize it (I didn't). Give her a few easy to read books, but do it slowly. She has a lot to learn!

[frontierpsych]

I agree about the epi education. I hear a lot of women say things like "Oh, I'm getting the epi, so I won't feel anything." or "I'm getting the epi, so I don't have to have a birth plan."

[wifeandmom]

Originally Posted by frontierpsych

sooo... really, they'd have a 3% c-section rate? 5% at the most?

I have yet to see a hospital with those stats...

I was under the impression that the WHO recommended an overall c-section rate of 5-15%? I couldn't find anything with the 3-5% numbers you indicated.

[wifeandmom]

Originally Posted by frontierpsych

I agree about the epi education. I hear a lot of women say things like "Oh, I'm getting the epi, so I won't feel anything." or "I'm getting the epi, so I don't have to have a birth plan."

Yeah, and you ought to hear the women that don't get their epi when they ask for it cause DH is off in the OR with a crash c-section.

[boongirl]

Originally Posted by frontierpsych

I agree about the epi education. I hear a lot of women say things like "Oh, I'm getting the epi, so I won't feel anything." or "I'm getting the epi, so I don't have to have a birth plan."

Yeah, I heard this a lot before dd was born. I do not remember anyone telling me that sometimes the epi does not work nor do I recall being told it would make me feel numb, like when you have dental work. I had a pitocin induced back labor with a tail bone breaking and 4th degree tearing and the f-ing epidural only worked on one side. And, the tingly feeling was HORRIBLE! And, I could move on my right side but that did not mean I could get off the table! Anyone think an epidural is easy, come to me. I would much rather be in pain and be able to move than go through that again.

[maxmama]

Originally Posted by wifeandmom

As for the push for pain meds during labor, I think a lot of pressure comes from the nursing staff..

Please don't blame the nursing staff! I get SO tired of this incessant scapegoating of nurses for decisions that patients make. On my unit, we will do our damnedest to help women labor without meds; we don't even put in IVs routinely. We hold our patients up, help them in and out of the tub, rub their backs, walk with them, encourage them. But a lot of women come in planning a block, and do become irate when they need to wait, or when they're complete and will birth before it's in. Nurses are not the enemy. My goal is not to get an epidural in every patient, but to help her have the birth she wants.

[lolar2]

Originally Posted by maxmama

Please don't blame the nursing staff! I get SO tired of this incessant scapegoating of nurses for decisions that patients make. On my unit, we will do our damnedest to help women labor without meds; we don't even put in IVs routinely. We hold our patients up, help them in and out of the tub, rub their backs, walk with them, encourage them. But a lot of women come in planning a block, and do become irate when they need to wait, or when they're complete and will birth before it's in. Nurses are not the enemy. My goal is not to get an epidural in every patient, but to help her have the birth she wants.

Every nurse is different. I had one who was happy to help me labor without meds, and then at shift change I got one who was supremely annoyed that I wasn't epidural'd when she came in. You sound more like the first, fortunately, but it takes all kinds to make a world and all that....

[pampered_mom]

Originally Posted by wifeandmom

I was under the impression that the WHO recommended an overall c-section rate of 5-15%? I couldn't find anything with the 3-5% numbers you indicated.

You are correct that the WHO recommendations are a c/s rate of 5-15%, but what you need to understand is that the WHO had wanted to put the upper limit at 5%. They caved in to external pressures. The 3-5% the pp is referring to is more likely in line with the spirit of the WHO recommendations.

Originally Posted by maxmama

Nurses are not the enemy. My goal is not to get an epidural in every patient, but to help her have the birth she wants.

I'm certain that this could be said of you by the laboring moms that you have worked with, but I don't think this is true of all nurses and quite frankly it's likely that you are one of the few stellar L&D nurses out there. I don't think what you have described is the SOP at the majority of hospitals out there.

To be fair - pain meds can also be pushed by some hospital based midwives as well...because, after all, there's no need to be a hero!

[Celery]

Unfortunately the c-section rate is 30%. It IS a NICU hospital, so they have a high risk population, but...

But, I would give the poor mom to be a break. She is probably clueless, like I was, but does not realize it (I didn't). Give her a few easy to read books, but do it slowly. She has a lot to learn!

hence the delivery of obstetric myths/research realties that should hit her door next week. There is no time to do it slowly - she has two weeks of holidays, then starts her OB rotation. How much hope are we going to have of educating her when she's 16 weeks pregnant and watching her first births?

[maxmama]

Originally Posted by pamered_mom

You are correct that the WHO recommendations are a c/s rate of 5-15%, but what you need to understand is that the WHO had wanted to put the upper limit at 5%. They caved in to external pressures. The 3-5% the pp is referring to is more likely in line with the spirit of the WHO recommendations.



I'm certain that this could be said of you by the laboring moms that you have worked with, but I don't think this is true of all nurses and quite frankly it's likely that you are one of the few stellar L&D nurses out there. I don't think what you have described is the SOP at the majority of hospitals out there.

To be fair - pain meds can also be pushed by some hospital based midwives as well...because, after all, there's no need to be a hero!

To be fair to the 45 other nurses on our unit, there is not one I would ever expect any less from. Our unit policy is to support NCB and exclusive BF. It's not me; it's the culture of our floor.