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Birth and Beyond > Shocking New Cesarian Rates
Rosemaryluna's Avatar Rosemaryluna 10:43 PM 01-12-2010
I just read this article and was saddened by it. I had my second child in 1983, she was born by VBAC and was one of the first at our little country hospital. It seems such a pity that things are going the other way in other parts of the world.

http://www.msnbc.msn.com/id/34826186...lth-pregnancy/

isabchi's Avatar isabchi 11:29 PM 01-12-2010
Really sad!!!.I was one of this c-section and then a HBAC. I still feel guilty to allow the section with my first one.
DoulaVallere's Avatar DoulaVallere 11:45 PM 01-12-2010
Pretty well done survey, I think. Wish they would have mentioned how first world countries with the lower c/s rates have such low infant mortality rates compared to more "western" birthing nations.
AustinMom's Avatar AustinMom 12:22 AM 01-13-2010
How arrogant of us to think that we can birth babies "better" than our maker designed. UGH!

It won't be long till the US is the highest. we're on our way.....
FloridaBorn's Avatar FloridaBorn 12:27 AM 01-13-2010
This is a generalization of course, but it seems the women/OBs in these countries are equating "surgery" with "wealth."
emnic77's Avatar emnic77 02:07 AM 01-13-2010
Quote:
The study did not discuss specific reasons for the high number of C-sections, but it noted that more than 60 percent of the hospitals studied were motivated by financial incentives to perform surgeries.
*ding ding ding ding*
MegBoz's Avatar MegBoz 12:31 PM 01-13-2010
Quote:
“I think it’s safer for the mother and child to have C-sections, and the relatives feel more secure because it’s very simple and very common now,” said a Vietnamese woman, Trang Thanh Van, 25, just days away from giving birth to her first child. “People worry that using tools to pull the baby out (in a vaginal birth) may affect their brains.”
This drives me bonkers--> Comparing CS to "medically managed vaginal birth." The crazy thing is that I CAN see how CS can actually be better than medically-managed vag birth (which, too often ends in emergency CS anyway!) I think this is why many OBs say they'd chose elective CS for themselves or their wives... because they're making this comparison.

Truly, I personally might be tempted to chose CS for myself if I had no choices but fully medically-managed vaginal or CS. It's an awful choice to have to make.

If only there were some better education so people could learn the truth that truly physiological birth is by far, exponentially better for both mother & baby.
scottishmommy's Avatar scottishmommy 01:45 PM 01-13-2010
What I don't understand is how these doctors think it's necessary to do c-sections on small asian women having large babies. I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.
AustinMom's Avatar AustinMom 03:29 PM 01-13-2010
Quote:
Originally Posted by scottishmommy View Post
What I don't understand is how these doctors think it's necessary to do c-sections on small asian women having large babies. I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.
Our Doula was telling me about a mom she worked with, she was a HBAC, 4' 11'' and had a 10lb baby.
Freeman's Avatar Freeman 03:33 PM 01-13-2010
Quote:
Originally Posted by scottishmommy View Post
I just don't understand how your baby can get too big for a vaginal birth, unless maybe you have GD. I've known so many women who've delivered very, very large babies. My own dd was 9 lbs and it took 15 mins to push her out. I just don't see how the size of the baby can make that big of a difference. How much bigger are their heads? A centimeter or two? It seems like the baby's position is a better indication of how easily they will come out.
This is actually the case for some people, though. I have a friend whose pelvic opening was just too narrow to allow the baby to pass through -in her case, a c-section was truly necessary, and thank goodness it was available. Personally, I had the same experience as you - a 9+ lb. baby, delivered without any problems.

In speaking with OB's it seems the greatest motivator to perform a c-section in the U.S. is to avoid a malpractice suit. It used to be that many OB's wouldn't perform c-sections and did anything to avoid them, thinking that it would be riskier than a vaginal birth. Today, if there is any "blip" on the radar at all, a c-section is strongly encouraged in order to avoid the "risk" of a vaginal birth. The perspective on "risk" has totally shifted in the past 50 years.
MegBoz's Avatar MegBoz 04:31 PM 01-13-2010
Quote:
Originally Posted by Freeman View Post
This is actually the case for some people, though. I have a friend whose pelvic opening was just too narrow to allow the baby to pass through -in her case, a c-section was truly necessary, and thank goodness it was available.
Well, I'm sure this is indeed true sometimes. However, CPD (cephalo-pelvic disproportion - the diagnosis that the pelvis just can't accommodate the baby fitting through) is STILL grossly over-diagnosed in the US. In most cases, a little bit of assistance could have helped. Making sure baby was positioned properly & helping ensure OA positioning if baby is OP. & getting mama UPRIGHT & MOVING to help the pelvis open. The vast majority of American women birth in hospitals, and most of those births have mama in bed - often reclined, generally immobilized with an epidural, rarely pushing in an upright position.

So, I don't think it's fair to say "a baby can't fit through your pelvis" without giving it a real try- with the best possible circumstances. (Note, I'm not saying your friend did not have support, I don't know her case, just saying, I know in America it DOES happen where docs say "that baby won't fit" & they didn't do anything to HELP it fit - but rather hindered the process.)

Quote:
Originally Posted by Freeman View Post
In speaking with OB's it seems the greatest motivator to perform a c-section in the U.S. is to avoid a malpractice suit. It used to be that many OB's wouldn't perform c-sections and did anything to avoid them, thinking that it would be riskier than a vaginal birth.
Yup. Although, ya know, I think a lot of them are also beginning to believe that vaginal birth truly is so risky!! As Dr. Marsden Wagner writes, "Fish can't see the water they swim in." They see crash, emergency CS, they see awful PPH, they see a need for vacuum & forceps & the accompanying pelvic floor damage. They see this and perceive vaginal birth as risky! (Again, I think this is part of the reason a significant portion of OBs surveyed have said they'd chose purely elective CS for themselves of their wives.)

They simply don't KNOW, or don't realize & think about the fact that the doc's actions so often caused the problems & that vaginal birth is generally safe the majority of the time. (If you don't do dumb to it up, that is!) As Dr. Wagner & others have written, docs aren't properly educated on good scientific methods for research. They often practice based on clinical experience & what they see. Heck, I've even heard docs say it themselves & read it in books written by docs, "Well, in my experience this perineal massage technique reduces tears." (I remember reading years ago in an OB's guide to pregnancy & birth.)
"Well, I've never had a patient get pregnant on Alesse." (old Gyn said to me. )
Um, SAMPLE SIZE, people! Your own clinical experience is NOT sufficient sample size to make such judgments!

If you see crash CS so often, it's natural that you'll come to believe birth is just plain dangerous (and, therefore, CS is preferable to "trying" vaginal birth.)
MiaMama's Avatar MiaMama 04:37 PM 01-13-2010
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.
AustinMom's Avatar AustinMom 05:13 PM 01-13-2010
I don't think Dr really know what the diagnosis of CPD does to women and their offspring. Yes, it causes them to have repeat cs usually (because they unknowingly trust their OB) but their daughters are then brought of thinking that their moms were "too small" to birth, and struggle with that. My mom had my oldest brother by cs after not dilating past 7 or so (in a hospital, with little support, pit augmentation which led to pre-e) and the DR. said she was too small. Then all 4 of us other kids had to be cs. this was before the big sweep to vbac from acog. So me, I stuggled with that a lot when I was preg. Is it genetic? Will the same thing happen to me? I was very unprepared, and ended up with a cs with our first. It has been a lot to get through, and after interrogating my dad of what REALLY happened in their first labor (1980) I came to some more facts like the pit, no handy maneuvers to turn baby, no constant support, etc, and then realized that it was an improper diagnosis.

Women being to doubt themselves and that doubt passes on generation to generation, if not dealt with.
lovebug's Avatar lovebug 05:23 PM 01-13-2010

scottishmommy's Avatar scottishmommy 02:18 AM 01-14-2010
Quote:
Originally Posted by MiaMama View Post
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.
I think it has more to do with economics than ethnic diversity. Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc. I believe they also have very high breastfeeding rates. In America we have a lot of under served communities, such as undocumented immigrants or teen mothers who don't have good access to prenatal care. Also, because we are so diverse, it's difficult to reach out to all mothers about the importance of prenatal care and nutrition and avoiding risky pregnancy activities such as drinking or smoking. In countries like Japan or Sweden public health officials know who their target audience is, so it's easier to educate them.
MegBoz's Avatar MegBoz 03:35 PM 01-14-2010
Quote:
Originally Posted by MiaMama View Post
I am told that because there are only Sweedes in Sweeden , for example, they have healthier babies,
Dr. Wagner addresses this in his book "Born in the USA." Actually, I remember it word for word because I found it so funny, I laughed out loud! He wrote, "The American OBs' reactions to the Ducth experience [regarding safe homebirth outcomes] would be amusing if it wasn't so pathetic." He called them "pathetic"! I love it!

He also mentioned the whole excuse that, "Well, the US has a wider genetic variety." First of all, there are 2 myths there:
1. that the Netherlands is NOT genetically variant - this is actually untrue, they've had their share of immigration as well!!
2. That genetic variance leads to higher risks, worse outcomes (i.e. unsafe HB, actual justification for higher CS rates, etc.) - this too is untrue.

But, hey, ya know we've already established that ACOG doesn't give a hoot about actually valid scientific evidence to back up their claims & policies.
MegBoz's Avatar MegBoz 03:37 PM 01-14-2010
Quote:
Originally Posted by scottishmommy View Post
I think it has more to do with economics than ethnic diversity. Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc. I believe they also have very high breastfeeding rates. In America we have a lot of under served communities, such as undocumented immigrants or teen mothers who don't have good access to prenatal care.
Well, I suppose lack of access to health care & education certainly may contribute to neonatal mortality.

But it does NOT explain the high CS rate in the US! Women with private insurance in private hospitals are MORE likely to have CS - NOT the poor who haven't had prenatal care.
mntnmom's Avatar mntnmom 04:14 PM 01-14-2010
Quote:
Originally Posted by MegBoz View Post
Dr. Wagner addresses this in his book "Born in the USA." Actually, I remember it word for word because I found it so funny, I laughed out loud! He wrote, "The American OBs' reactions to the Ducth experience [regarding safe homebirth outcomes] would be amusing if it wasn't so pathetic." He called them "pathetic"! I love it!

He also mentioned the whole excuse that, "Well, the US has a wider genetic variety." First of all, there are 2 myths there:
1. that the Netherlands is NOT genetically variant - this is actually untrue, they've had their share of immigration as well!!
2. That genetic variance leads to higher risks, worse outcomes (i.e. unsafe HB, actual justification for higher CS rates, etc.) - this too is untrue.

But, hey, ya know we've already established that ACOG doesn't give a hoot about actually valid scientific evidence to back up their claims & policies.
No kidding! The Dutch are actually quite diverse to start with. "Dutch" ancestry includes most every group present in Europe traditionally. Add to that 20-30yrs of highly liberal immigration policy, and the Dutch are probably as diverse as we are in the States. Though they are a little more culturally homogenous, making education efforts simpler. Oh, and everyone has access to prenatal care. Yeah, that could be a big factor.
Storm Bride's Avatar Storm Bride 10:07 PM 01-14-2010
Quote:
Originally Posted by scottishmommy View Post
Swedish women have better access to health care, therefore have better access to prenatal care, nutrition etc.
I'm Canadian. I have excellent access to health care. Prenatal "health care" translates as:

-a 5-10 minute appointment once a month to check my blood pressure and measure my abdomen (and listen to the baby's heart rate, when applicable). -blood work at the beginning of my pregnancy
-a routine ultrasound
-five c-sections...two for breech, one for having had two already, one for a baby's heart that stopped beating (and I shouldn't have bothered with surgery, as he didn't make it, anyway) and one because I just gave up. I gave consent for four of them...and uncoerced consent for only one.
-assurance that if I took my prenatals, I'd be fine, but to make sure I took them, because "it's impossible to get adequate nutrition for pregnancy from food alone".

I don't have the exact numbers in front of me, but last time I looked, 28% of Canadian births were c-sections, and in my province (BC), the rate was over 30%.

"Better prenatal care" is a slippery subject, and it has nothing to do with medical professionals. I've never received any prenatal care from anyone, except dh,my mom, one birth attendant, and some from a friend and from ds1. The rest of it has come from me. What I've received from the "health" care system is a whole bunch of by-the-numbers prenatal monitoring, and information...some useful and some...not so much. Oddly enough, none of that monitoring has ever turned up any kind of problems, whatsoever (except very mild anemia). Several women I know who had difficult pregnancies, medically speaking, have never had a c-section.

I have no answers, but I don't think access to "better health care", even if you get it, is going to do much to cut US c-section rates. The one good thing about our system is that I'm at least spared the insult of receiving a big, fat bill for all this crap...that goes to the taxpayer, instead. Since so many of them seem to think that c-sections are just fabulous, I don't object that much to them footing the bill.
MiaMama's Avatar MiaMama 10:49 PM 01-14-2010
Quote:
Originally Posted by Storm Bride View Post
"Better prenatal care" is a slippery subject, and it has nothing to do with medical professionals. I've never received any prenatal care from anyone, except dh,my mom, one birth attendant, and some from a friend and from ds1. The rest of it has come from me. What I've received from the "health" care system is a whole bunch of by-the-numbers prenatal monitoring, and information...some useful and some...not so much. Oddly enough, none of that monitoring has ever turned up any kind of problems, whatsoever (except very mild anemia). Several women I know who had difficult pregnancies, medically speaking, have never had a c-section.
I agree with this. I was having a discussion with someone about disparate outcomes for the US vs other countries (including but not limited to c-sections). I looked up Maryland's vital statistics for 2007. Over 11 percent of all births were before 37 weeks, the c-section rate was about average for the country (between 30-40%), and high rates of other problems were recorded. Interestingly, they also had the % of mothers who had early and regular prenatal care. It was over 80%, like 88 if I remember correctly.

The prenatal "care" I recieved was mostly useless, personally. I can weigh myself and take my BP at home. I DID have a poor outcome (low birth weight/IUGR), and they didn't even catch it until the day before I delivered. A midwife asked me today if it was possible my dates were wrong, and I realized that it is totally possible (I'd had a m/c only a few cycles before). It is entirely possible that my "care" (induction for IUGR) caused the low birth weight, because she wasn't really 38 wks yet. BTW, no doctor could ever figure out what went wrong.
MegBoz's Avatar MegBoz 01:09 PM 01-15-2010
Quote:
Originally Posted by Storm Bride View Post
I have no answers, but I don't think access to "better health care", even if you get it, is going to do much to cut US c-section rates.
Totally agreed. However, I do believe there is research that points to lower infant morality rates with adequate access to medical care (I think some of those studies include access to prenatal care.)

But yes, as I've already posted, access to medical care, specifically private insurance (not government medicaid) & private hospitals increases the CS rate for healthy women.

I have some answers, as does Dr. Marsden Wagner & others. We need many steps to improve maternity care in America, but chiefly among them:
1. a cultural shift to reduce the fear of birth
--specifically to reduce how we view it as a dangerous medical event instead of a normal, physiological process, and an acceptance that the pain can be manageable (Instead of the common belief that "natural birth (without an epidural) makes as much sense as natural dentistry."
2. More midwives, fewer OBs
3. Perhaps some government oversight, or just education/ publicity on the concept of 'evidence-based care' so more people get as infuriated as me at the inanity of things like laboring women being told they cant' have food & drink & must have IV fluids. etc.

Just some thoughts.
scottishmommy's Avatar scottishmommy 02:22 PM 01-15-2010
Quote:
Originally Posted by MiaMama View Post
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.
Just to clarify: I don't think that being an ethnically diverse population causes mothers to give birth to babies who are too large for their pelvises. We aren't dogs. Dogs can weigh anywhere from 1 lbs to 300 lbs, so yes it's possible for a small dog not to be able to give birth to puppies sired by a really big dog. Pugs have been purposefully bred to have enormous heads.
I believe that one of the major reasons for the relatively infant mortality rates in the US, is because it's hard to educate and provide prenatal/pediatric care to such a diverse population. Of course you can have a healthy pregnancy without prenatal care, but it sort of depends on why you don't have it. For instance if you are a young girl from a disadvantaged background you may not have the resources or education to take care of yourself during pregnancy. You may not realize you need folic acid or extra iron. A lot of prenatal care is to educate women. Choosing not to have a medical professional look after you is different than not having access to a medical professional. I have a friend who was an ob/gyn at a hospital in a disadvantaged area of Chicago. He told me that a lot of women would come to the hospital after their babies were born if there were serious complications, like hemorrhaging. These women were having unassisted births out of necessity, not because they wanted to.
I don't know why Sweden would have a lower c-section rate. Perhaps c-sections are just more trendy in the US.
Plummeting's Avatar Plummeting 02:32 PM 01-15-2010
Quote:
Originally Posted by scottishmommy View Post
JChoosing not to have a medical professional look after you is different than not having access to a medical professional.
I could not agree more!!!
MegBoz's Avatar MegBoz 03:01 PM 01-15-2010
Quote:
Originally Posted by scottishmommy View Post
I don't know why Sweden would have a lower c-section rate. Perhaps c-sections are just more trendy in the US.

Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have some impact, but otherwise, it's the US approach to maternity care - medicalizing birth - that increases our CS rate. Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:
  • induction
  • augmentation with pit
  • AROM
  • epidural
  • cEFM
  • denying mother both food & drink in labor
  • denying mother freedom of movement in labor
  • denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
  • routine CS for breech
  • routine CS for twins
  • routine ERCS (denying or strongly discouraging VBAC)
  • time limits/ CS for "failure to progress" (Failure to be patient!)
  • CS for "suspected fetal macrosomia" (big baby)
  • Having an OB instead of a MW*
  • birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, it is the entire approach to the birth process that leads to the higher American CS rate.
AustinMom's Avatar AustinMom 03:57 PM 01-15-2010
Quote:
Originally Posted by MegBoz View Post

Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have some impact, but otherwise, it's the US approach to maternity care - medicalizing birth - that increases our CS rate. Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:
  • induction
  • augmentation with pit
  • AROM
  • epidural
  • cEFM
  • denying mother both food & drink in labor
  • denying mother freedom of movement in labor
  • denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
  • routine CS for breech
  • routine CS for twins
  • routine ERCS (denying or strongly discouraging VBAC)
  • time limits/ CS for "failure to progress" (Failure to be patient!)
  • CS for "suspected fetal macrosomia" (big baby)
  • Having an OB instead of a MW*
  • birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, it is the entire approach to the birth process that leads to the higher American CS rate.
Totally with you on this. Oh, BTW, by denying a woman food and drink you risk two things that commonly happen, one, she becomes dehydrated and the uterus doesn't contract well, so, it's then deemed "failure to progress", Or, she is OVER hydrated, which can cause hypertension, glucose to shoot up, baby's glucose to shoot up, and then after birth, after baby isn't being given IV fluids by mom, glucose drops, and then supplements are given.

I DO think that it has to do with the way OBs/Dr look at birth. I don't think it is necessarily access to prenatal care. Yes, if a woman can't get prenatal care, her chances MAY be higher to have complications. If a woman chooses to not have prenatal care and say choose and unassisted birth her chances are lower to have complications, I'd even go so far as to say lower than the average woman receiving prenatal care through an OB.

It's the type of care that a woman is given. We all agree that MW care is better because it focus more on nutrition, exercise, emotion issues, etc. I don't think any OB focuses on those. They more so "monitor" how a mom is doing, with growth, weight, BP, US, etc. Example, a very successful ob here is Austin told a mom, "if water makes you sick to drink (as she had really bad nausea) get your hydrating from popsicles" Yeah, if you are supposed to drink 8-8oz glasses of water a day, that's A LOT of HFCS popsicles you are "drinking". They don't focus on preventing or reversing pregnancy complications (pre-e, GB, low fluid etc) they only focus on diagnosing and medicating, or delivering when they occur.

Another mom, (who LOVES her OB) had "no fluid" at 37 weeks, so had a cs that day, turns out fluid was fine, they couldn't figure it out. She said to me later "I stopped drinking water in the last trimester, I mainly drank coffee". Yeah, I bet is she was going through a typical MW, things would have been a lot different all the way around.

It's not access to care, it's getting Dr. to provide quality care to their moms. It's not just "take your prenatal and you'll be fine". There's a lot more to it Obs....get on the wagon!
scottishmommy's Avatar scottishmommy 05:52 PM 01-15-2010
Quote:
Originally Posted by MegBoz View Post

Really, you don't know why?

Certainly the fact that we don't have universal healthcare my have some impact, but otherwise, it's the US approach to maternity care - medicalizing birth - that increases our CS rate. Just off the top of my head, here are some things that increase the CS rate - and they are all things that are more common in the US:
  • induction
  • augmentation with pit
  • AROM
  • epidural
  • cEFM
  • denying mother both food & drink in labor
  • denying mother freedom of movement in labor
  • denying mother non-pharmacological pain relief (no tubs, showers, sterile water injection, TENS, etc.)
  • routine CS for breech
  • routine CS for twins
  • routine ERCS (denying or strongly discouraging VBAC)
  • time limits/ CS for "failure to progress" (Failure to be patient!)
  • CS for "suspected fetal macrosomia" (big baby)
  • Having an OB instead of a MW*
  • birthing at a hospital instead of home or FSBC*
*I include those last 2 because it's statistically proven that your care provider and birth location are the highest predictors of whether or not you'll have a CS. and Birth in hospitals, and with OBs are both substantially higher in the US than Europe.

Some other items I listed may not have very high associations with CS risk, such as denying mother food, but clearly things like denying other pain relief options (bath tubs) will increase the rate of epidurals, which - in turn- do indeed increase the CS rate. So, again, it is the entire approach to the birth process that leads to the higher American CS rate.
And I would argue that all of those are simply medical trends. No one really knows why we birth this way. OBs can't do double blind studies, so they can't make choices based on hard evidence. They just follow trends.
scottishmommy's Avatar scottishmommy 05:58 PM 01-15-2010
also, I'm not arguing that lack of prenatal care increases c-section rates. I think it may possibly increase infant mortality, among underserved communities where there is little access to prenatal care.
Storm Bride's Avatar Storm Bride 06:17 PM 01-15-2010
MegBoz: Right on. Also add "denying mother the support of a doula". A sign from an OB office in the US recently made the rounds on facebook. They told women that they were all about providing good care to women, and that if expectant moms wanted a doula or birth "contract", they shouldn't even bother with that practice. So...yeah...
MegBoz's Avatar MegBoz 06:24 PM 01-15-2010
Quote:
Originally Posted by scottishmommy View Post
And I would argue that all of those are simply medical trends. No one really knows why we birth this way. OBs can't do double blind studies, so they can't make choices based on hard evidence. They just follow trends.
Well, sure, the studies are not "double" blind (i.e. a physician obviously can see whether or not a patient is continually hooked up to EFM, or whether or not he breaks her water.) It can't be blind to the physician the way taking a pill is. But that doesn't mean it is still not hard evidence.

Quote:
Originally Posted by scottishmommy View Post
OBs can't do double blind studies, so they can't make choices based on hard evidence. They just follow trends.
(bolding mine)
This is simply not true. Any OB who would claim that is lying. Period. That sounds like a complete cop-out to me. While randomized, controlled double-blind trials are the gold-standard of medical research, that does not mean anything less is worthless! That type of study may be the ideal, but lesser types still yield good evidence! Particularly in sufficiently large sample sizes.

The evidence is pretty clear on a lot of these things. For example, episiotomy significantly increases the risk of serious (4th degree) perineal tears & long-term pain with the only advantage being a slightly faster 2nd stage. AROM is generally bad with only slight advantages (speeding up 1st stage labor by an average of 20 min), cEFM increases the incidence of intervention WITHOUT any subsequent improvement in fetal outcomes.

The jury is in on many of these things. They are not up for debate. To CONTINUE to do many of the above listed things on a purely routine basis is to be practicing in opposition to evidence.

I highly recommend reading "The Thinking Woman's Guide to a Better Birth" by Henci Goer. It clarifies a lot of the excellent research that has been published in OB/Gyn journals.

As for the "WHY" - Dr. Marsden Wagner has great theories on that in his book, "Born in the USA." Another great read with lots of research.
scottishmommy's Avatar scottishmommy 06:57 PM 01-15-2010
We are on the same side here. What I'm saying is that a lot of OBs follow trends. I think that the real reason OBs perform so many c-sections is because they are becoming more and more common. Even in the 50's when women were put under twilight sleep, c-sections were relatively rare because doctors avoided doing them. Today they are so common that they are no longer seen as a "big deal". The trend will only continue. I would not be surprised if rates reach 40% in the next decade. The more young residents and med students see obs performing sections, the more comfortable they will become with the procedure.
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