Originally Posted by danotoyou2
I'm interested... What do you believe the reason is for the high c/s rate in the country?
, as in, you believe there is ONE reason?
There are actually a lot of reasons. I can list a few, though the list is certainly not complete, nor is it in any particular order.
1. Women waiting until they are older to have babies. Older moms have more complications statistically, and more complications translates into more c-sections.
2. Multiple birth rate is higher, almost assuredly because of increase in use of fertility treatments, though older moms tend to have more spontaneous multiples as well. Multiples are more likely to be born prematurely, experience complications, etc, and are more likely to be born by c-section.
3. Women are heavier than in the past. Overweight and obese women have more pg complications statistically.
4. Induction insanity. *Some* docs want to practice '9-5' medicine and not deal with being called in the middle of the night, so it's easier to induce at or near the due date. *Some* women pressure docs to induce (I actually see/hear of this more than the docs doing the pressuring.)
I have little patience for women OR docs inducing much before 42 weeks without a COMPELLING reason or medical necessity *unless* the woman has a favorable Bishop score AND understands the risks of induction. I think in the end, if mom truly wants to be induced DESPITE the risks with a poor Bishop score, it should be her choice, but I really think a lot of women would opt to wait a few more days if they looked at the numbers.
5. Malpractice/litigation fear. If the least little thing goes wrong
during delivery, here comes a lawsuit. I see this even on MDC where someone posts about a delivery with complications, and within the first few replies, people are saying the parents should sue. This is quite often
without even the very basic informatin about the complications being posted. People just start shouting for a lawyer. It's the American way it seems.
6. *Some* docs want to get home, get to the golf game, get to the holiday party, get to their kids' baseball game...and all of that can be accomplished if the mom in labor would just have the baby already.
7. Lots of repeats now that the VBAC climate is so hostile in so many places. IIRC, if you eliminate repeats from the national average and look strictly at primary section rates, they aren't nearly as bad (certainly way less than the 30%+ overall national average). Primary rates are still too high, but if that number was lowered, the overall number would be lowered as well since the whole VBAC issue wouldn't come up as often.
8. All the monitoring that is 'standard' in most places has done little to improve overall outcomes, but leads to more sections. This is well known, but as long as most docs are still doing it, the fear becomes 'What if?' It's obviously impossible to go back and PROVE that a particular bad outcome would have still been bad even if continuous monitoring had been used.
In a malpractice case, if there's no fetal monitoring strip to look at, the question becomes 'Well, doc, COULD this baby have been saved if you'd MONITORED him/her during labor...like the vast majority of your peers do
? Come up with a good answer for THAT one.
I could go on, but hopefully you see that there are a whole lot of reasons for our current c-section rate.
I *do* think that a lot of c-sections are done as a CYA pre-emptive move on the doc's part. If something goes wrong and doc practiced even slightly outside of the most conservative guidelines, they are wide open for a lawsuit and they know it.