a woman's risk for a c-section - Mothering Forums

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Old 03-25-2004, 10:05 PM - Thread Starter
 
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We know that the most recent stats by the CDC for prevelence of cesarian birth in the USA is 26.1%. This number included the undebatable group of mamas who need a c-section for one reason or another, repeat c-secs, and a number of mamas who might have had vaginal births under other circumstances.

I once heard a gal saying that for her, homebirth was the right choice, because she had a 1 in 4 chance of a c-section if she chose to birth in a hosptial, since the rate is 26.1%.

This, and other musings, have led me to wonder what the risk really is, for regular ol' mamas who might have a c-section but might have had a vaginal birth, given a different doctor, CNM, hosptial, etc...

I've heard that white women with insurance who use a caregiver in a private practice have an increased risk of cesarian birth, and that low-income black woman who birth in a teaching hosptial (like a hosptial affiliated with a university.)

A completely healthy pregnancy first-time mama must be at greater risk for a c-section than the same second-time mama who has already birthed a baby vaginally, right? A small, community hospital with limited access to anesthesia might do fewer c-sections for that reason--and then mamas are at less risk for an uneccessary c-section, right, 'cause if it's 'failure to progess,' mama might progress in the time it takes for anesthesia to show up at the hosptial, right?

So, barring well-founded reasons for c-sections, what is a woman's risk? We know a primipara's risk for an episiotomy is 60% in some hosptials, 90% in others--do we have any c-section numbers? Facts or opinions?
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Old 03-25-2004, 10:50 PM
 
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Originally posted by tinyshoes
We know that the most recent stats by the CDC for prevelence of cesarian birth in the USA is 26.1%. This number included the undebatable group of mamas who need a c-section for one reason or another, repeat c-secs, and a number of mamas who might have had vaginal births under other circumstances.

I once heard a gal saying that for her, homebirth was the right choice, because she had a 1 in 4 chance of a c-section if she chose to birth in a hosptial, since the rate is 26.1%.

This, and other musings, have led me to wonder what the risk really is, for regular ol' mamas who might have a c-section but might have had a vaginal birth, given a different doctor, CNM, hosptial, etc...

I've heard that white women with insurance who use a caregiver in a private practice have an increased risk of cesarian birth, and that low-income black woman who birth in a teaching hosptial (like a hosptial affiliated with a university.)

A completely healthy pregnancy first-time mama must be at greater risk for a c-section than the same second-time mama who has already birthed a baby vaginally, right? A small, community hospital with limited access to anesthesia might do fewer c-sections for that reason--and then mamas are at less risk for an uneccessary c-section, right, 'cause if it's 'failure to progess,' mama might progress in the time it takes for anesthesia to show up at the hosptial, right?

So, barring well-founded reasons for c-sections, what is a woman's risk? We know a primipara's risk for an episiotomy is 60% in some hosptials, 90% in others--do we have any c-section numbers? Facts or opinions?
C/sec rates vary *greatly* by region/hospital. I remember recently seeing stats for one Southern state (I think it was FL?) where the rates ranged from 17% to *80%* (!!!!!) depending on the hospital.

One thing that is misleading when talking about c/sec stats is that it doesn't tell you the *primary* c/sec rate - rates of first time c/sec rates. I believe the primary rate in the US is 15%. This tells you something about the number or repeats, but it also shows that when a woman walks into a US hospital *in labor*, her theoretical chance of having a c/sec is 1.5 per 10, not 1 in 4. I only mention this b/c I hate hearing the oft repeat phrase 'every woman should be prepared for a c/sec b/c she has a one in four chance of needing one". That being said, I'll still take my less than 2% risk with my midwife at home .
editted to add: for a woman who has had a previous vaginal birth, if her baby is not breech, even in a US hospital, her risk of needing a c/sec goes down to under 1%. The overwhelming number of c/sec's are performed on first time moms.
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Old 03-26-2004, 03:00 AM
 
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I've heard that white women with insurance who use a caregiver in a private practice have an increased risk of cesarian birth, and that low-income black woman who birth in a teaching hosptial (like a hosptial affiliated with a university.)
The majority of medicaid patients I know IRL have been sectioned, regardless of race or health status. One reason may be that hospitals have a financial incentive to increase the cost of a medicaid patient's stay, since medicaid pays only 70% of what private insurance would.

(I used to work in the billing department of a hospital that accepted medicaid, and one of my jobs was to find ways to increase the money we could get from them. This included falsifying diagnoses and records.)

Most teen mothers I know have also had sections. I think if the attending doctor doesn't approve of your pregnancy, you are not going to have a good birth experience.
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Old 03-26-2004, 11:38 AM
 
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Greaseball,

Thats interesting. When I had my 1st child (by cesarean, BTW) I was a teen mother on medicaid. Ack! I always thought that someone on Medicaid would be offered less interventions since it was the state paying. Thats really sad.
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Old 03-26-2004, 02:17 PM
 
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That's interesting.. only two of the many teen mothers I've met had c-sections, and one of those was because her babies were premature and had other complications (prolapsed cord, for example). And I know lots of people on medicaid who've had vaginal deliveries, far more than sections..

I've been told that the c-sec rate at the hospital I plan to go to is about 1 in 5, but i'm really curious about how much that varies from doctor to doctor. I know that the vast majority of docs would have sectioned me, but I happened to get someone who was totally against the idea. I'll have to ask at my next appointment what my doc's rate is.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 03-26-2004, 03:25 PM
 
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I wonder if "annoying" patients have more sections? You know, the ones who scream a lot and are always asking for extra food and pillows and things.

Teens are not as likely to know their rights. I've read articles from some who said the doctor told them he would take the baby away and never bring it back unless they did exactly as he said. If someone said that to me, I'd know it was wrong.

According to "Open Season," the people most likely to be sectioned are doctors' wives. Nurses are also very likely.
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Old 03-27-2004, 02:38 PM
 
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i used a freestanding birth center for my prenatal care and part of my labor. now looking back in retrospect I KNEW all along that's where I would end up. not sure if it was just my intuition or what? luckily I had a really positive birth experience but I can't help but question it. I definitly think my chances of a hospital transfer/birth went up dramatically when I chose the BC over a homebirth. the ironic thing is my MW at the BC was the one that talked me out of a HB because of possible *complications*. ha! I am now wondering what would have happened had I chose to homebirth or UC?

Blissful Mama to DD-(5), DS-(6) and someone new due in November!
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Old 03-27-2004, 04:26 PM
 
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Also, from what I've seen, the medicaid patients are released a lot earlier after a c/s, usually the next day instead of the 4 days given to private patients.
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Old 03-27-2004, 08:12 PM
 
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In my doula work I see a csection rate of at least 50%. And having a doula is supposed to lower your rate! From what I see in the hospitals I work in the csection rate is at least that high, and the postpartum csection ward is always a lot more crowded than the vag postpartum ward.

The doctors here (in Florida) vary in their forthrightness about what they're doing. Some play along with the "cascade of interventions" and make it seem like it's just what's happened, not the result of the care given in the hospital (though it is quite obvious), but others are quite bald about it. I have heard doctors say, "well, it's 1 am, and I need to get home, and another hour isn't going to make a difference to whether you have this baby or not" and I've heard, "look, I've given you twelve hours, a lot more than I give anyone else, because we're friends, but I can do a csection in twelve minutes."

When I step in the hall to warm up rice sox, etc, I hear the nurses discussing who's going to be "sectioned" or not, and how soon. The nurses and doctors discuss how long the woman will be given long before they clue her in to their plans to operate.

Florida seems particularly bad in terms of malpractice/insurance/litigation/cesarean connections. While there is a wide range of good health care here if you are old and have angina, the same high-tech medical care is being applied to birth, with depressingly predictable results.

It is often my clients who are most adamant about natural birth with no interventions that end up being induced at 39 weeks with an epidural started before the pitocin, even, and surgery within a few hours. Interestingly, these clients seem less realistically prepared than others, and then end up being frightened into all kinds of things by their doctors.

My personal opinion is the best way to avoid a cesarean is to stay away from the hospital, and even then, choose your homebirth attendant *very* carefully. Some are quite medically-minded, or, unfortunately, also have to deal with the legality of allowing certain things, for fear of losing backup or licensure or both. Their protocols for screening out, like a birth center's, can land you with interventions that might not have been necessary in the first place.
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Old 03-28-2004, 08:09 PM
 
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I've actually heard the opposite about what has happened to some teen moms. The hospital staff wanted the young moms to feel the pain of labor and suffer for their 'sin' of getting pregnant. The teens would then end up with a vaginal birth, or even unmedicated vaginal birth.
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Old 03-28-2004, 10:13 PM
 
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I think it depends on what the staff would feel is more of a punishment. I, for one, would much rather have severe pain than be forced to have an epidural, and I know that a c-section would be more painful than an unmedicated vaginal birth (at least in the days to follow). Teens are less likely to receive pain medication when they ask for it, but are likely to get it when they don't ask, probably because it keeps them quiet, in one place, and not in control.

Teens are also more likely to be low-income, so it's kind of a double whammy for them. I hear about low-income people being denied epidurals, and although they're probably better off without them, that shouldn't be the deciding factor.

Both teens and low-income people are less likely to have been exposed to anything but mainstream medicine, so they may have no idea they don't have to listen to the doctor all the time or that they are not necessarily high risk. I don't know any teens who described their birth experience as positive and empowering, though occasionally I will hear from one online who was able to have a homebirth and will describe it as such.
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Old 03-28-2004, 11:39 PM
 
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Quote:
Originally posted by Greaseball
I wonder if "annoying" patients have more sections? You know, the ones who scream a lot and are always asking for extra food and pillows and things.
If that was the case, my son would have been born on Thurs morning by c-section instead of Friday morning. :LOL : I was beyond annoying, very very loud, I wanted to eat but not what they had, and when a very sweet nurse brought me tea I was upset that it was black tea and not green (and she went looking and found me some green tea!! way above and beyond the call of duty, that). I did every "annoying" thing in the book.

I'm kind of curious: I wonder if the nurses even get to see which patients have which kind of insurance? I'd be willing to bet they don't, and that it makes a huge difference in the level of care you receive. Also, the fact that I had family and friends constantly around; most of the teenagers I know who've had babies have delivered them in the hospital and alone or with a parent. The fact that Mike and his mother were there probably made us seem more married and grown-up, even though I don't look like a grown-up and I certainly wasn't acting like one. : :

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 03-29-2004, 12:14 AM
 
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I'm kind of curious: I wonder if the nurses even get to see which patients have which kind of insurance?
It's been said that the doctor and nurses aren't supposed to know what insurance you have - only the billing department is supposed to know - but really, everyone knows. It's often on your hospital bracelet, and hospital patients are typically separated into the "public" and "private" wards. This might be only in the large teaching hospitals, though.

When I worked in the records department of a hospital, the doctor would write in the chart what insurance the patient had. And then when I worked at that same place as a mental health counselor, I was instructed to spend time with the private patients first before the publicly funded ones.

So really, it should not be of concern to the nurse, but the two-class system of health care is not a myth.

I'm proud to have been an annoying patient as well!:LOL Didn't seem to hurt me any. Most of my "demands" were met.
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Old 03-29-2004, 12:26 AM
 
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Originally posted by Greaseball

So really, it should not be of concern to the nurse, but the two-class system of health care is not a myth.
I was in a large teaching hospital, but it was definately not on my bracelet (or Eli's) and I know that there aren't separate wards, really, just a prenatal area (people on hospital bedrest) a perinatal area (l&d) and "couplet care" (women who'd had their babies). The vast majority of babies room in, the exceptions being NICU babies and when a woman asks that her baby be taken to the nursery so she can take a shower or sleep alone (usually a very small portion of the babies at any given time). I'm sure it's not a myth, but I'm also fairly certain I didn't experience it. Score for Lancaster General! :LOL

Most of the time when I read about these things, I really feel privileged to live where I do.

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Old 03-29-2004, 12:42 AM
 
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Originally posted by eilonwy
I'm kind of curious: I wonder if the nurses even get to see which patients have which kind of insurance? I'd be willing to bet they don't, and that it makes a huge difference in the level of care you receive.
We do. It's on your chart with your admit info where I work. Also, where I work it's on the faceplate that is used to stamp every piece of paper attatched to your chart (though in "code", just initials). And I would say, yes, some nurses have an attitude about medicade pts. Esp. if they always come in by ambulance, come in repetedly for bogus reasons, frequent flyer in the ER, travel from one hospital to the other after being discharged from one, etc. Unfortunately there is a certain "profile" of this type of pt.
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Old 03-29-2004, 12:47 AM
 
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Ah - and the "two class" system. It mainly has to do with the fact that medicaid/innercity/teenage clients tend to frequently be treated in teaching hospitals and residents' clinics. I'll give you a good example here. One of the teaching hospitals where I trained has a week where it is "forceps week" - they "lay on" forceps to as many pts. as they can to show that they know how to place them. They will justify it by saying "we just place them, we don't pull". Same for vacuums. Personally, I think that residents and indigents, despite all the moaning and groaning about how the poor and uninsured are "sucking up our tax dollars", have a symbiotic relationship. Were it not for the uninsured (and medicaid pts) in this country, where would we find the fodder to train new doctors?
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Old 03-29-2004, 01:17 AM
 
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Originally posted by CK'sMama
I had a huge, comfortable birthing room with a Jacuzzi, my own bathroom, & all sorts of fun things, and I also had a private room with my own bathroom during recovery. For the most part the nurses were very nice and helpful, and despite having to be induced nobody pushed any drugs on me. Even after a long labor and a couple of hours of pushing everyone was very patient and C-Section never once came up. This was a teaching hospital if that makes any difference.
See, I had all this stuff too. I was 25 (but I look a bit younger, I'm told) and on medicare & medicaid. We must have a particularly equitable system.. now if only we could get the schools to operate just as beautifully... :

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Old 03-29-2004, 01:36 AM
 
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Originally posted by eilonwy
See, I had all this stuff too. I was 25 (but I look a bit younger, I'm told) and on medicare & medicaid. We must have a particularly equitable system.. now if only we could get the schools to operate just as beautifully... :
The truth is that medicaid has become so common for pregnant moms (health care/ins. crisis) that many private OB's take it. In that case you are not going to see a difference in care. However, many teen and inner city moms still frequent resident clinics where very different care is received. Does that clear up the distinction I was trying to make?
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Old 03-29-2004, 01:53 AM
 
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It does... I understand what you're saying, but what I'm saying is that I was/am seen in a resident clinic; that in every way, my circumstances were/are what you're describing. This time I have an attending physician but last time I had a resident. The hospital where I'll deliver has many patients from outisde the clinic; it's now one of only two places in the entire county that deliver babies. The other is a small hospital with a single floor for delivering babies, while Women & Babies is a huge hospital dedicated exclusively to delivering babies and women's health issues. It is technically part of the Lancaster Health Alliance but is really an entity unto itself.

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Old 03-29-2004, 10:36 PM
 
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risk is an interesting thing...the rate may be 20% or it may be 50% or it may be 2% - all irrelevant if you fall into the percentage...

my first child in '94 was a five hour, non medicated, birth center delivery with two lay midwives in attendance...

my second child was born last november after a 25 hour home labor (attempted homebirth) with two lay midwives and a doula in attendance...it ended with a c-b and hospital transfer...

so while there were all the indicators that child number 2 would fly down the chute, so to speak, it isn't always the case...i made the best choices i could make, that's all anyone can do to decrease risk...
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Old 04-12-2004, 02:11 PM - Thread Starter
 
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I just found some answers to my questions in the book A Good Birth, A Safe Birth by Diana Korte and Roberta Scaer, 3rd revised edition, copyright 1992.

On p 141:

Quote:
The cesarean birth rate is much in primiparas than in multiparas who have never had a cesarean--three to eight times higher, according to a Massachusetts Department of Public Health study....The typically longer labor of a primipara is an important factor in the cesarean epidemic.
also

Quote:
Four reasons account for over 80 percent of cesareans today:
-repeat cesarean birth
-abnormal labor
-fetal distress
-breech positions of the baby
Anyway, sorry to drudge this thread in case ya'll are tired of it, but I thought these observations in this book were what I was looking for when I first posted this thread, and I thought my fellow mamas might be interested, too.
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Old 04-12-2004, 02:24 PM
 
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Could you clarify something for me? What does "abnormal labor" mean?

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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Old 04-15-2004, 08:47 PM - Thread Starter
 
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"abnormal labor" meaning dystocia, as in failure to progress, CPD, poor uterine contractions, or malpositioned baby.

HTH
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Old 04-16-2004, 03:39 PM
 
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Originally posted by eilonwy
I know that the vast majority of docs would have sectioned me, but I happened to get someone who was totally against the idea. I'll have to ask at my next appointment what my doc's rate is.
Can I ask why most docs would have given you a c-section? My friend is going through this right now. Her doc is demanding that she have a c-section because she has had large babies in the past. Is is just a liability thing??
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Old 04-16-2004, 09:58 PM
 
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Well, because I was GBS+, at 37 weeks, prolonged rupture of membranes, very low amniotic fluid, Eli passed meconium, and I developed a fever and pre-ecclampsia. Most doctors wouldn't have let that go for more than 10 hours, especially considering *all* of those things going on. Mine let it continue for just over 20 and I ended up having a siezure as Eli was being delivered.

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