Shocking New Cesarian Rates - Page 2 - Mothering Forums

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#31 of 58 Old 01-15-2010, 06:46 PM
 
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We are on the same side here.
Oh, OK, gotcha! I thought you were saying OBs don't have hard evidence on which to practice - which would excuse their many idiotic actions. i.e. you were AGREEING with ACOG when they say, for example, that it's impossible to establish a recommended maximum C-section rate. (Yeah, cuz the WHO just pulled that 10-15% number out of their backsides!) Ha- sorry for the misunderstanding

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I think that the real reason OBs perform so many c-sections is because they are becoming more and more common. ... Today they are so common that they are no longer seen as a "big deal.
I agree with you there. & actually many OBs have said as much- former ACOG president is actually quoted as saying that he thinks C-sections are always safer than vaginal birth, in every case, for both Mama & Baby! I read that in "Pushed" - that one blew me away!

Actually though, it's not just a nonchalant attitude that CS is "no big deal" - it really is a belief that the CS is so often necessary to save the baby! What they don't realize is that they are "saving" the baby from stress they themselves inflicted!!! With Pit, AROM, cEFM, etc. They simply don't realize this. They think this is the way obstetrics is done!
And because they don't see it any other way, they don't realize their involvement in causing 'failure to progress' or "fetal distress"!! Hence Dr. Wagner's analogy that "fish can't see the water they swim in."
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#32 of 58 Old 01-15-2010, 07:41 PM
 
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always safer than vaginal birth, in every case, for both Mama & Baby!
A local doctor said that in 1982. Doctors have had this mindset for decades.
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#33 of 58 Old 01-15-2010, 07:50 PM
 
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A local doctor said that in 1982. Doctors have had this mindset for decades.
Of course they have this mindset. For one thing, the medical community, as a whole (I know there are always individual exceptions) refuses to hear anything negative about them. I've had a doctor tell me that my problems with gas post-section had nothing to do with the surgery, and were because I was eating too many carbs - but I was eating fewer carbs than I had before! I was told that some bladder issues I was having and my inability to perform kegels were from the pregnancy itself, not from the surgery. Okay - you know, I'm actually bright enough to be able to tell when I can't do kegels or feel my bladder because of nerve damage. If I could do kegels all through the pregnancy, right up to the L&D room where they prepped me for surgery, why couldn't I do them from the moment the spinal wore off? If this is because ds2 was such a big baby (10lb. 8oz.), then why didn't it get any worse when I carried Aaron (10lb. 14oz.). Why can I still not feel those areas, 4.5 years later? They don't know, and they refuse to consider that it might have anything to do with the surgery.

My sister had an epi with her first. She loved it. Then, she had a backache right where the epi had gone in, and it lasted for weeks. The doctor told her that epis don't do that, and the pain was from pushing.

I have intermittent trouble with stress incontinence. IMO, this is not helped by the amount of pelvic numbness I experience. It's certainly not helped by being virtually unable to do kegels for the last 4.5 years (I can do them, kind of, now...but not properly and it's incredibly difficult). They don't want to hear it, and women will still be cut, partly because "everyone knows" that c-sections protect from pelvic floor damage.

How can they possibly know what side effects occur, when they refuse to even consider the possibility that what a woman is going through post-partum and/or post-op could be related to what happened during the birth/surgery?

Ugh.

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#34 of 58 Old 01-15-2010, 07:50 PM
 
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I think "trends" influence new Obs when they step into practice and see tenure OBs doing them, and then they become "routines". As in, this is what I have always done, and it's what I think works. Both Bull *&^%.
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#35 of 58 Old 01-15-2010, 09:10 PM
 
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How can they possibly know what side effects occur, when they refuse to even consider the possibility that what a woman is going through post-partum and/or post-op could be related to what happened during the birth/surgery?
To be fair to OB's, most doctors have this mental block. I have been told that celiac does not cause headaches, yet, I am a celiac, and when I get glutened, I get severe headaches.

Although anecdotal evidence is not really evidence, it is observations about the world around us that prompt the best scientists to ask questions. Questions like, hmmm, "many women complain about numbness afte c-sections, could they be related?" Or "Why do so many celiacs get migraines?"

But doctors are not really scientists, they are practitioners. If they never report the anecdotal evidence to any scientists, then who is left to ask the questions?

Women on message boards, that's who. LOL
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#36 of 58 Old 01-15-2010, 09:55 PM
 
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To be fair to OB's, most doctors have this mental block. I have been told that celiac does not cause headaches, yet, I am a celiac, and when I get glutened, I get severe headaches.
I know. I've also received the "that doesn't hurt" thing more times than I can count. (Thankfully, I have avoided the c-section without anesthesia, though. Apparently, women are just too stupid to know the difference between pain and pressure.) I just don't think the fact that doctors in other fields are equally arrogant and ignorant should mean OBs get a free pass.

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Although anecdotal evidence is not really evidence, it is observations about the world around us that prompt the best scientists to ask questions. Questions like, hmmm, "many women complain about numbness afte c-sections, could they be related?" Or "Why do so many celiacs get migraines?"
Yup. Most doctors, if pressed, will admit that c-section can cause "mild numbness", but they won't (ime) admit that numbness can actually have any effect on quality of life, or on bodily functions.

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But doctors are not really scientists, they are practitioners.
True. But, they don't seem to realize that, themselves, and they sure try not to let their patients figure it out. I don't expect my doctor to be a scientist, but I don't think that actually considering the possibility that a patient's post-op symptoms might be related to her surgery requires scientific training, yk?

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#37 of 58 Old 01-15-2010, 10:54 PM
 
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Doctors are paid a fee for their service (FFS). The more invasive the procedure the bigger the reimbursement. IMO higher reimbursement encourages a high c-section rate. I wonder what the c-section rate would be if OBs were paid the same regardless of whether the delivery was vaginal or a section? I just can't help but believe that money is a big motivator. But of course, no doctor in his/her right mind would admit this.

lather, rinse, repeat
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#38 of 58 Old 01-16-2010, 04:04 AM
 
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C-sections are also a lot quicker and can be done at convenient times. An OB/GYN has to be at a lot of births to pay for the high malpractice insurance. He/she cannot sit around waiting for women to give birth. They have lives, too. It's the entire system that is making this happen. I thought "Pushed" by Jennifer Block spelled things out clearly yet allowed me to come to my own conclusions. (I feel very good about my choice to have another out-of-hospital birth with competent HCPs).
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#39 of 58 Old 01-16-2010, 07:08 PM
 
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C-sections are also a lot quicker and can be done at convenient times. An OB/GYN has to be at a lot of births to pay for the high malpractice insurance. He/she cannot sit around waiting for women to give birth. They have lives, too. It's the entire system that is making this happen. I thought "Pushed" by Jennifer Block spelled things out clearly yet allowed me to come to my own conclusions. (I feel very good about my choice to have another out-of-hospital birth with competent HCPs).
I can't agree with you more. I LOVED Pushed and would recommend it to any mom, pregnant or not, heck, any woman in childbearing years, even dads....AND politicians! Lol!

I think that a dr. MAY be able (as I don't know a lot about medical malpractice insurance) to lower their deductible if they have a good record of successful outcomes, and work in a hospital/organization with a good record as well. I hope so. I hear in FL it's sometimes as high as $200K (according to Pushed). That's insane! Maybe Obs should become Midwives! LOL!
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#40 of 58 Old 01-16-2010, 07:46 PM
 
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A c/sec is not quicker.

The surgical delivery is easier to predict, to schedule, and to deliver the baby, but the rest of the clean up is time consuming. And of course, for the mother, the recovery is protracted by the additional time of recovering from major abdominal surgery with all of the incumbent complications and long time side effects.

My reference for this is the book by Michelle Harrison, M.D., A Woman in Residence pubished in 1981. Ask yourselves if thing have changed much since.
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#41 of 58 Old 01-16-2010, 08:30 PM
 
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The size comments make me wonder about the argument that I often hear about why the US has high surgery rates and poor outcomes. I am told that because there are only Sweedes in Sweeden , for example, they have healthier babies, lower c-section rates, and better neonatal mortality stats. That because we have a lot of genetic diversity in the US, we therefore have more complications, like mamas growing babies too big for their bodies.

I wonder about pure-bred dogs, who tend to have WAYY more health complications than mixed-breed. In other species, I have never ever heard of genetic diversity being a bad thing. Actually, quite the opposite.

I wonder how the genetic giversity in China compares the the US.
You bring up an interesting point. I don't know the actual genetic diversity in different countries, but I can tell you as an evolutionary biologist that humans are an extremely similar group. We are a very young species. You would find far more genetic diversity in the dandelions or grass in your yard, or in chimpanzees or gorillas than you find in humans. Our genomes are all nearly identical to each other so I would imagine that the US is not that much more diverse because none of us are diverse. Besides Asians adopting a western diet are now growing much larger (all of my friends in Hawaii were much taller than their parents who grew up in Asia).

From my own experience, I had a lovely 3 hour homebirth of a 11 lb baby just 6 months ago. And my midwife told me that my baby wasn't the largest she had delivered and she regularly delivered babies even that large born to Asian women (usually with husbands of a different race). We live near Queens, NY so about as diverse an area as you can get worldwide, with every kind of racial mix, and she has not had a problem with a baby not fitting.

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#42 of 58 Old 01-16-2010, 09:31 PM
 
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And my midwife told me that my baby wasn't the largest she had delivered and she regularly delivered babies even that large born to Asian women (usually with husbands of a different race). We live near Queens, NY so about as diverse an area as you can get worldwide, with every kind of racial mix, and she has not had a problem with a baby not fitting.
I was raised in a European country, which is definitely less diverse than the US, but it's C-Section rate has reached almost 30% in the last few years.

Maybe the latest increase in C-Sections has also to do, that more and more hospitals are banning VBACS and around here it has been getting more and more difficult for Moms to find hospitals that allow them.

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#43 of 58 Old 01-17-2010, 12:50 AM
 
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If anyone has seen Orgasmic Birth, there is an extras feature that talks about US cs rates compared to other countries and reasons for it. It's not to do with maternal request, that's bull, it's not all to be blames on maternal health, only a VERY small percentage. A LOT has to do with not allowing VBACs. Personally, I think that even a VBAC attempt in a hospital is a poor choice (health permitting to OOH birth) because it lowers your chances significantly, especially if certain routines are done, Pit and or other drugs are commonly used and there is no hydrotherapy. A lot of things need to change in order to lower the cs rate. Women birth at home or in birthing centers. Women take control of their VBAC birth, OBs "allow" VBAC and most importantly SUPPORT VBAC, and encourage professional labor support from a Doula/Montrice. Here's a good start for the US.

As far as outlawing cs or surgical "births" no, it's a bad idea, for many reasons, some moms DONT take care of themselves and their babies are better off outside of them, this includes with complications during pregnancy and in labor. Some moms aslo have things arise even if they do everything right. This is no excuse for a 30%+ cs rate of course. Now, ELECTIVE SCHEDULED cesarean births, I do agree, should be outlawed. I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.
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#44 of 58 Old 01-17-2010, 01:05 AM
 
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I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.
Sexual assault. I have a very close friend who elected and scheduled a c-section because of the psychological trauma she was going through thinking about labor because of a previous violent sexual assault (sadly, how the baby got in there in the first place).

It comes down to women's rights. And outlawing elective c-sections will be VERY damaging towards women's rights. I think electing a c-section should be preceded by EXTENSIVE counseling and true informed consent about the risks the mother is taking upon herself (as it did in my friend's case), but this is truly about women's rights, and I support any woman who feels that she needs to have a c-section in the absence of fearmongering and with knowledge of the risks.

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#45 of 58 Old 01-17-2010, 01:21 AM
 
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Sexual assault. I have a very close friend who elected and scheduled a c-section because of the psychological trauma she was going through thinking about labor because of a previous violent sexual assault (sadly, how the baby got in there in the first place).

It comes down to women's rights. And outlawing elective c-sections will be VERY damaging towards women's rights. I think electing a c-section should be preceded by EXTENSIVE counseling and true informed consent about the risks the mother is taking upon herself (as it did in my friend's case), but this is truly about women's rights, and I support any woman who feels that she needs to have a c-section in the absence of fearmongering and with knowledge of the risks.

As a victim of sexual abuse I can see this being a true reason. Hopefully, your friend has extensive counseling before birth, not only on whether or not she wanted a cs opposed to a vaginal birth, but because she needs to heal from the trauma, regardless if pregnancy occurred from it or not.

But yes, I do see your point, and would hate for this to be denied from a woman, but, IMO, I think this is not an "elective cs" It's a medical condition that interferes with the mother's health if she has a vaginal birth. So, I don't see if elective cs were dubbed illegal that a person in her situation would have to fight for a cs.
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#46 of 58 Old 01-17-2010, 01:25 AM
 
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Elective c/s isn't ever going to be illegal, as "elective" isn't used by medpros the way it's being used here.

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I truly cannot think of any senerio where an elective scheduled cs would be "safer". If someone can give me an example of a senerio where this would be better I am all ears, but in my research and reading, I find none. Go into labor on your own first, and labor as long as possible and then if NEEDED cs.
Placenta previa.

I had my dd at 32 weeks due to placenta previa and related hemorrhage. The doctors who performed the surgery determined that, while neither her life nor mine was immediately at risk, there was a risk that if I stayed pregnant, either the oxygen-transfer membrane in the placenta or the baby's blood supply would be compromised. She was safer out than in, but a trial of labor stood a high chance of killing us both.

But because no one's life was immediately at risk, the hospital paperwork indicates that my c-section was elective. If the hemorrhage hadn't happened, if I had simply continued to term with an unresolved previa, we'd have had a scheduled elective surgical delivery, because a trial of labor would still have probably killed us both.
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#48 of 58 Old 01-17-2010, 03:00 PM
 
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As a victim of sexual abuse I can see this being a true reason. Hopefully, your friend has extensive counseling before birth, not only on whether or not she wanted a cs opposed to a vaginal birth, but because she needs to heal from the trauma, regardless if pregnancy occurred from it or not.

But yes, I do see your point, and would hate for this to be denied from a woman, but, IMO, I think this is not an "elective cs" It's a medical condition that interferes with the mother's health if she has a vaginal birth. So, I don't see if elective cs were dubbed illegal that a person in her situation would have to fight for a cs.
Babies who are transverse and wont move into a better position need to be sectioned. Also women who have had many prior uterine surgeries. Or babies with serious birth defects such omphaloceles and the like. Sometimes labor itself can be a danger to these women or babies. I also feel like a woman should have the right to request a section. I think it's a crazy thing to do, and I don't agree with the decision, but I don't think it should be illegal. Who are we to tell someone what she can or can't do with her own body?

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#49 of 58 Old 01-17-2010, 04:05 PM
 
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IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.

Until tort reforms are made, we will continue to see an increase and rise in c/s rates, as OB/CNMs start to cover the backsides more and more. Not only will the primary rate increase, but I think as more and more hospitals face increasing malpractice costs/liabilities, we will see a decrease in the number of hospitals that allow VBAC and therefor start seeing a huge increase in RCS because of increasing number of bans.
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#50 of 58 Old 01-17-2010, 05:48 PM
 
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Yes, Placenta Previa is one where a cs is needed. I AGREE, I want to make that clear. It's funny that didn't come to mind to me, as I am a VBAC and placenta previa is more common. In that case, yes, I would say a scheduled cs should be done. Of course, you should not go into labor as well, as it can be dangerous, and hemorrhage is a high risk and very dangerous for the two of you.

Yes with a transverse baby, of course a cs is needed too. I highly doubt the baby could be born vaginally without turning head down or breech. I think that one should go into labor on their own in this case, as the studies show it is better for mom and baby to labor some and OR wait for onset of labor. But, yes, a cs should be done, as a vaginal birth would be next to impossible.

Woman's rights in not "allowing" elective cs can easily turn into a discussion on abortion. As I am not wanting to go down that road, as that is not what this thread is about.

Personally, woman who want a cs because they "don't want to labor" (for reasons other than sexual abuse, etc), or because "it's convenient" or "it's what my dr. said" should not be allowed. You risk the baby's health, your health, and you up the cost of your maternity care, which in the long run can effect us all. Now, OBs who say, "your baby is too big", "your placenta is ageing" (when it is not proven) "your pelvis is too small/misshapen" (when it is not in a case of ricketts, dwarfism, injury etc) "I'm going on vacation", "It's near the end of the year", "we don't allow VBAC", I think are all wrong for a DR to enforce, let alone even tell a mom. I think this is wrong. I think to change it, we need to educate moms better what the consequences of their actions are, good or bad. I have never felt a mom has not taken into consideration the health of her or her baby. No mom would choose a more risky procedure if it unnecessarily put her or her baby at risk.

Just as I don't think an OB should use Cytotec for induction (other than abortion) I don't think they should use a cesarean for means of non medical uses. It's sad, Pitocin is not even FDA approved for induction without medical means, but it happens ALL the time. Yes, sometimes it should be used, just like a cs, when the risks of continuing the pregnancy out weigh the risks of the procedure. But, when you take away the risks of continuing the pregnancy, and there are none (non medical ones) then you only have the risks of the procedure and it is then too risky. Sadly mom's aren't all told this, and blindly choose inductions for non medical reasons.
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#51 of 58 Old 01-17-2010, 08:19 PM
 
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Uh, nevermind.
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#52 of 58 Old 01-17-2010, 09:13 PM
 
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IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.

Until tort reforms are made, we will continue to see an increase and rise in c/s rates, as OB/CNMs start to cover the backsides more and more. Not only will the primary rate increase, but I think as more and more hospitals face increasing malpractice costs/liabilities, we will see a decrease in the number of hospitals that allow VBAC and therefor start seeing a huge increase in RCS because of increasing number of bans.
One notable study shows that of 1500 claims, the overwhelming majority were not frivolous. The majority were settled out of court. Plaintiffs lost 80% of the cases that made it to court. In short, doctors who practice defensively are practicing out of fear, not reality. And then they try to stick it to the consumer, whose only recourse for justice is through the courts, by demanding tort "reform." (Most consumers are not little old ladies suing over spilled hot coffee. The 800-lb gorilla in the room: There are incompetent physicians out there. They can and do kill or cause irreparable damage to patients).

The correlation just doesn't add up to bolster the case for tort caps. Mississippi, for example, has caps on both punitive and non-economic damages. Yet its cesarean rate is an astronomical 35.4%, one of the highest rates in the nation.

The real reason for the tort cap movement is to lower insurance rates (which, by the way, doesn't work).

Listening to the AMA and ACOG, you would think that putting caps on compensation was the ultimate panacea. They talk as if their hands are tied, and doctors "have" to slice women open to avoid lawsuits. Sorry, Charlie. I'm saving my sympathies.

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#53 of 58 Old 01-17-2010, 09:26 PM
 
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If anyone has seen Orgasmic Birth, there is an extras feature that talks about US cs rates compared to other countries and reasons for it. It's not to do with maternal request, that's bull, it's not all to be blames on maternal health, only a VERY small percentage. A LOT has to do with not allowing VBACs.
I don't think the statistics bear this out. The problem is with primary CS. The VBAC rate is never 100%, and is usually not even close. In the UK, it's about 32%, which is a little more than twice the US rate. That's also what it was in the US when VBAC was at its height and OBs pushed it in the early-mid '90s. 20% of women who have already had a CS is really not statistically significant compared to all the women having primary sections.

The decline in VBAC happened to accompany certain other changes in medicine, and in the medico-legal climate (John Edwards' CP cases, for example). There was an overall change in birth that also affected VBAC.

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#54 of 58 Old 01-18-2010, 06:40 PM
 
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Hello!

I have removed several posts from this thread.

Please report inflammatory posts rather than responding.

Thank you.

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#55 of 58 Old 01-19-2010, 12:52 PM
 
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IMHO, this is why health care reform will not work. What is currently proposed would penalize states that already have or want to put into place malpractice reforms.

Until we reform our Court/malpractice lawsuit problems, doctors are not practicing true medicine. They are practicing malpractice avoidance and the insurance companies are the ones who are practicing medicine and medical management.
I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.

It is the entire view that birth is dangerous and SHOULD be "managed" (whereas hands-off, medically known as "expectant management" is best in about 90% of cases!)

We need MUCH fewer inductions. We need more doulas. We need more birthing tubs & other hydrotherapy options to reduce the epidural rate. We need more & better education. We need more FSBC.

Ironically, health insurance companies stand to profit royally from reform to maternity care!!!!!!! The FEWER CS, FEWER inductions, the CHEAPER it will be for them to pay maternity health care fees!! This is one of very few situations where the cheaper option (less intervention) is the better option for BOTH mamas & babies!
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#56 of 58 Old 01-19-2010, 10:08 PM
 
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Placenta previa.
Rates of placenta previa and placenta accreta have skyrocketed in part because previous surgery on the uterus, including c/secs, contributes to having scar tissue on the uterine wall and causing problems with the placenta.

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I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.
True.

The c/sec rate in Canada parallels the rate in the U.S. even though Canadian doctors get paid the same amount for the delivery. Doctors simply believe that they do better than nature.
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#57 of 58 Old 01-19-2010, 11:33 PM
 
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Originally Posted by MegBoz View Post
I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.

It is the entire view that birth is dangerous and SHOULD be "managed" (whereas hands-off, medically known as "expectant management" is best in about 90% of cases!)

We need MUCH fewer inductions. We need more doulas. We need more birthing tubs & other hydrotherapy options to reduce the epidural rate. We need more & better education. We need more FSBC.

Ironically, health insurance companies stand to profit royally from reform to maternity care!!!!!!! The FEWER CS, FEWER inductions, the CHEAPER it will be for them to pay maternity health care fees!! This is one of very few situations where the cheaper option (less intervention) is the better option for BOTH mamas & babies!
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#58 of 58 Old 01-20-2010, 12:54 PM
 
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I think you all need to read "Born in the USA" by Dr. Marsden Wagner. It is only so much about malpractice-avoidance.
Marsden Wagner makes a compelling case against tort "reform."

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