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MUST READ article about c-sections rising to get you REALLY angry

1067 Views 19 Replies 13 Participants Last post by  judybean
Everyone should forward this to every woman who has decided not to get pregnant yet.

Article published Jun 5, 2005 in Wilmington, NC paper,

Doctor won't make the cut
Feeling pressure from hospital for more c-sections, she leaves

Surrounded by a house full of cardboard boxes, Wilmington obstetrician Helen Sandland discussed how giving birth Mother Nature's way is in jeopardy.

Dr. Sandland - known for the past decade as the doctor local women went to if they desired natural, vaginal deliveries - moved to Mississippi last week after being told by New Hanover Regional Medical Center administrators to do more c-sections.

She refused.

"I leave NHRMC with my morals and backbone absolutely uncorrupted," Dr. Sandland wrote in her resignation letter dated May 15. "I am going to practice with a long-time friend, whose scruples I admire, and in a place where unnecessary surgery is not encouraged."

During a time when national health officials have sounded the alarm that the cesarean section rate is at an all-time high and needs to be sliced, Dr. Sandland's case raises questions about what factorsare pushing the numbers higher.
Cesarean hike
Since history has been recorded, cesarean sections have always been a procedure used on mothers. The procedure was given its current name when, under Julius Caesar's reign, Roman law decreed that all women dead or dying from childbirth were to be cut open to try to save the baby.

Until the 1800s, when formal anatomy education arose, the procedure rarely saved the mother's life. It was used as a last resort until the 1940s, when antibiotics became available, and into the 1950s, when most women switched to giving birth in hospitals instead of at home.

Considered major abdominal surgery with complications that can lead to death, c-sections became used more commonly for abnormally positioned babies or when the mother or baby is in distress. During a c-section, mothers are given anesthesia, an incision is made through muscles of the abdomen, organs are moved aside and the baby is pulled from a cut in the uterus.

By 1970, 5.5 percent of babies were delivered through c-sections.

The rate doubled in five years and continued to increase until 1990, when it peaked at 22.7 percent. It held steady and slightly declined through the 1990s before picking up again in 1998. The rate now sits at 26.1 percent of 4,021,726 births nationally. North Carolina's rate is 26.4 percent.

"I don't see any end in sight right now," said Dr. Bruce Flamm, regional chairman of The American College of Obstetricians and Gynecologists, saying there's little concrete data on how many c-sections are unnecessary. "All of the current pressures seem to be going in the direction of more c-sections, not less."

He and other national medical experts are concerned with the trend; a trend they believe is pushed by medical liability issues, convenience for both doctors and patients, and perhaps hospitals' financial and staffing pressures.

"There are some doctors who say the only cesarean section I have ever been sued for is the one I didn't do," Dr. Flamm said. "It's a sad but true situation."
Not only is there a decreased chance of getting sued if a c-section is performed, but it's less time consuming to perform c-sections instead of waiting out long and sometimes difficult labor.

"It's a very vulnerable time," said Deanne Williams, executive director of the American College of Nurse Midwives. "The increased demand is really a reflection of being told this is a quick fix, there's no risk, why wouldn't you? And that's by the medical community."

But, as many obstetricians will point out, pressure by doctors or hospitals is only part of the equation. Some women, they say, really are looking for a c-section because they fear the pains of labor or want to schedule it when grandparents are in town or around holidays.

"It's called doctor shopping," Dr. Flamm said, discussing how women will go from one doctor to another until they get what they want. "You have to be responsive, within reason, to the desires of the patient."

Regardless of the reason, health officials across the country are concerned with the rates.

Leading medical groups such as the Centers for Disease Control and Prevention, National Institutes of Health and the World Health Organization have all spoken out against the increase, demanding the medical community investigate ways to lower the rate to 15 percent or below.
C-section culture
Dr. Sandland thought she was doing just that.

In the decade she has delivered babies and cared for their mothers in New Hanover County, she has always had a rate below 10 percent.

"I've always maintained I'm a midwife with a MD behind my name," she said from her two-story Pine Valley home last week while preparing to move. "It's better for Mother Nature to decide when it's time, not the doctor. My philosophy is you don't interfere unless you really have to."

Her philosophy, admittedly different from the mainstream, attracted many patients who wanted the best chance of having a vaginal delivery. Dr. Sandland became known as one of the few doctors in the area who would try to deliver breech babies naturally or pursue a vaginal birth with a woman who already had one child with a c-section. Her solo practice boomed.

If her lack of medical malpractice lawsuits and gratitude of patients are of any account, she was not only popular, but also successful.

Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was considered too set in her ways or a renegade by some doctors, he admired her talents to deliver naturally in situations when other doctors would have automatically pushed for a c-section.
"She was a valuable asset for patients," he said.

Dr. Sandland said she became the target of the hospital's professional review and credentials committees. Because it is confidential by law, she could not legally discuss the peer review process.

But the Star-News viewed two letters addressed to her from committee members. Written on New Hanover Regional letterhead dated July 6 and July 7, 2004, the letters discuss the conversation committee members had with her.

The first letter, written by Dr. Cobern Peterson, chairman of the Professional Review Committee, stated "concerns" regarding her practice. They include higher than average infant birth weights, much lower than average c-section rates and later than average gestational age of neonates at delivery.

The letter states "the main concern reiterated several times was an overall practice attitude rather than any individual case."

The next letter, written by Dr. Janelle Rhyne, acting chairman of the Credentials Committee, states Dr. Sandland's privileges at the hospital would be reappointed for a period of six months but monitoring would continue.

It reads, "Your c-section rate is to be within an acceptable range as determined by the NHRMC OB/GYN Department with a plus or minus deviation of two."

No reason was given in the letters, other than adding the committee would be watching other outcomes like collarbone fractures - something experts say is a minor, common complication of vaginal deliveries.

New Hanover Regional spokeswoman Kendra Gerlach said two standard deviations equates to five or six percentage points above or below the average.

The c-section rate at New Hanover Regional is 27.9 percent. At the time, Dr. Sandland said, it was about 26 percent. That meant the committee was requiring her to reach at least a 20 percent c-section rate. To do so, she'd have to more than double her current rate.

"It's just not something I could see happening," she said. "You just don't change your practices overnight. I certainly wasn't going to change them to meet some arbitrary quota."

Jack Barto, chief executive officer of New Hanover Regional, said he was not familiar with the letters but that it sounded to him more like a "guideline" than a "quota."

"To me, a quota is, 'You will be at X percent,'»" he said. "I think it gives a range to allow physicians to have discretion."

When asked if other doctors who deliver patients at the hospital are given the same guideline, he would not answer the question.
He did not say why a guideline would be necessary.

But Dr. Sandland said that in a March conversation with Mr. Barto, part of the reason became clear.

"Barto said in a separate meeting that a c-section rate of 25 percent would reduce the likelihood of getting sued," she recalled.

Mr. Barto confirms he had a meeting with Dr. Sandland but would not discuss the conversation.

"I had a private conversation with one of my physicians," he said, asserting he did not recall discussing liability issues. "I talked with her about a variety of topics."

Dr. Sandland also said the decree put a "seed of doubt" about other things going on during labor and delivery.

One time, she said a fellow physician called her to tell her she had a woman who was attempting to vaginally deliver a breech baby and, when Dr. Sandland explained the patient was aware of the risks and wanted to at least try, he said maybe he should go talk to the mother and try to "bully her" into a c-section.

Other times, especially when the unit was overrun with laboring moms, she said, there was pressure from department heads to speed up labor or consider a c-section.

"Quite a lot of c-sections are being done for so-called failure to progress," Dr. Sandland said. "If you haven't progressed in a couple of hours, a c-section's waiting. There's certainly a pressure to keep patients moving on through."

Fellow obstetrician Dr. Vogel said he never felt pressured by New Hanover Regional administrators but he knows it goes on from time to time, mostly at for-profit hospitals for financial reasons.

The hospital's chairman of the OB/GYN department, Dr. Bora Duruman, declined to comment on Dr. Sandland but said doctors are not pressured to do c-sections nor do they pressure patients toward c-sections unless the procedure is medically necessary.

"There's no guideline at New Hanover Regional," he said. "I take that back. There's absolutely a guideline at New Hanover Regional. The guideline is healthy mother, healthy baby. The c-section rate then falls where it falls to achieve that."
Concerns for future
Emily Lanier's greatest fear when she went into labor Mother's Day with her first child was of getting a c-section.

"My main thing was c-sections are not natural, and I wanted to experience natural delivery and I did not want to go through the recovery time," the 29-year-old said.

But when her son's head got stuck in her pelvis, her blood pressure shot up and his heart rate plummeted, she understood the necessity of the operation.

Nearly a month later, she said she's saddened New Hanover Regional has put a c-section "guideline" on at least one doctor.

"Something like that really doesn't surprise me," she said. "Kind of like at the end of the month, a cop has to give more tickets.

Everybody has quotas. I feel like if it happens at one hospital, it's going to happen everywhere, so there's really no escaping something like this."

Ms. Williams said members of her nurse midwives organization have long suspected hospital administrators may be driving the c-section rates behind the scenes, but she was shocked to hear a hospital actually put a quota in black and white.

"It's likely happening," she said. "If one person has the guts to come forward and say this has happened to me, it means it is happening a lot."

Ms. Williams said hospital administrators would probably be happy to schedule all c-sections because it would control costs of staffing a labor and delivery unit around the clock.

"They want to put women on the conveyor belt," she said. "They could save tremendous amounts of money."

New Hanover Regional administrators said there's no such movement at their hospital.

"For most people, this is the most amazing, wonderful moment of their lives," Dr. Duruman said, also denying the hospital is out to make more money by doing c-sections. "What crosses your mind the whole time is healthy mom, healthy baby."

Mrs. Gerlach said the hospital charges $4,700 on average for noncomplicated vaginal deliveries and $14,200 for noncomplicated c-sections. Those amounts do not include doctor fees.

Consumer watch dog group Public Citizen has estimated that half of cesarean sections are unnecessary and result in 25,000 serious infections, 1.1 million extra hospital days and cost more than $1 billion each year.

Meanwhile, the procedures don't seem to be making a difference, noted Dr. Flamm, explaining that while the c-section rate continues to climb, the number of fetal deaths remains steady.

Legally it's safer, he said, but not necessarily safer medically. He added that he and other physicians debate constantly and can't come to a conclusion of what the correct c-section rate should be.

Ms. Williams is concerned that the more c-sections become the norm, the riskier giving birth will be.

"We are going to see an increase in morbidity and mortality for the mothers," she said, explaining how the first and even second c-sections are fairly risk-free but then scar tissue builds up and increases the surgery's risk.

"Every subsequent cesarean section, the risk of a woman ending up with a severe hemorrhage, losing her uterus or ending up dying goes up," she said. "By the time women figure that out, we're going to be long gone."

[email protected]
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I feel dirty after reading that. Not surprised... just dirty.
Also not surprised at that. I'm in Canada and know that in my community C-section rates are among the highest in the country. It's a fact that scares the hell out of me. Especially with the knowledge that I will be delivering in the hospital. With a midwife, sure. But just knowing I'm going to have to go to a hospital is a big source of stress.

Naomi Wolf wrote a wonderful book about the medicalization of childbirth, including an indepth examination of skyrocketing c-section rates in the US. Her book is called Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood. Here is a link to an excellent review of the book, if you're interested.
:puke I was one of those "failure to progress...cause Dr wants to be home by 6pm."

I really wonder how bad it has to get before it gets better. When are women going to wake up and demand better treatment and better births?
Oh. My. Goodness.

Maybe I've simply been blessed with no knowledge of this before... but.. I had no clue.

A QUOTA?! That totally deserves the pukey smiley (but I just can't bring myself to put it without getting queasy myself).

And. It terrifies me. Midwifery isn't legal in my state. I don't feel confident enough for a UC at this time. So, to the hospital I go. Thus far, I feel very confident with the doctor I chose, as he seems to be quite in line with what I discuss with him (and I have talked to him quite a bit in my very few visits!).

But still. Like Spark, I feel like I need a shower.
judybean But still. Like Spark said:
Judy, are you coming onto me?!?! Did you just invite me to take a shower with you!?!?
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Originally Posted by Spark
Judy, are you coming onto me?!?! Did you just invite me to take a shower with you!?!?

:LOL :LOL :LOL (and that was *totally* needed in a thread like this)!
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I JUST posted that in my blog. Isn't it awful?

BTW... I think it's against rules to post the whole article. Copyright law. Instead, you're supposed to post a quote and a link.
Make Me So Mad! It makes me mad at the hospital, the insurance companies, the doctors and yes the mothers who just don't bother to learn about birth or don't care enough to fight for what is good and safe for them and their babies. I know that there are necessary c-sections. I know that sometimes c-sections save lives that wouldn't have been saved without them. And I am grateful for medical advances in as much as lives are saved. But when lives saved are way outnumbered by lives risked by a procedure... ugh. And when lives are risked for a quota... UGH!
I read this just yesterday. Good for her sticking up for what she knows is right and not compromising just for money or a more "lucrative" career by their standards.
last year, my best friend was told she had no choice but to have a c-section because her baby was breach. supposedly, the doctor couldn't tell whether he was in the "good" breach position or the "bad" breach position. so they just went ahead and forced her to have a c-section anyway.

wth? they couldn't TELL? what about ultrasounds and the old-fashioned touch? *gasp* they didn't even give her a chance. and she's one of those people who does what they're told. she was so afraid to "risk" her baby's life. i don't blame her, of course. i blame the medical profession.

it's scary to think about how my own birth will go. all i can do is prepare, prepare, prepare.

Just this morning I had a "are you that safe?" comment from a co-worker about my planned homebirth. A few weeks ago, when a co-worker had a c-section because of fetal distress, no one said a's accepted as normal birth...but if I mention a homebirth, I'm the crazy one! It's frustrating that people see c-sections as normal and safe, yet homebirths as crazy and unsafe...what has the world come to???
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Originally Posted by xmasbaby7
Meanwhile, the procedures don't seem to be making a difference, noted Dr. Flamm, explaining that while the c-section rate continues to climb, the number of fetal deaths remains steady.

"Every subsequent cesarean section, the risk of a woman ending up with a severe hemorrhage, losing her uterus or ending up dying goes up," she said. "By the time women figure that out, we're going to be long gone."

[email protected]
The whole article is maddening. The statistic of fetal deaths is sad, I had never realized that there has been no change. Hospitals have pretty much forgotten how to help a women labor, hence so much failure to progress. If this trend continues, it is scary to think of what our daughters might face someday.

My OB with Zoe, had mentioned some research coming out of Brazil I think it was, about doing lots of elective c-sections. He said it was interesting-as in a good interesting. Towards the end of Zoe's pregnancy he continually offered to induce me as we had a "good baby now." After being induced and all the problems with Aric's birth, and then my two angels, I neede to know my body could do it. It did with amazing speed! I was kind of glad that he moved out of state before my next pregnancy as I was feeling like I wanted aanother OB, but didn't have want to hurt feelings.

Something else that I realized after Aric's birth, and am reminded of again and again when I watch those tv birth shows is the amazing ability of the mothers body to labor and deliver a baby despite all the hinderences modern medicen put on it (like putting a laboring mom to bed the whole time).
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I have a pregnant friend who is using an OB. On the OB's website under the commendations area, there is one from a woman who said friends couldn't believe her OB massaged her perenium during labour. They were shocked by that level of care coming from an OB. It shocked me to read that. And it's why I've chosen to go with a midwife. I will have ONE person there the WHOLE time who is focussed on my labour and delivery. Not on balancing a ward full of patients and moving them through L&D as fast as possible.

Sadly, many OBs simply don't know how to help women labour. They only know how to deliver babies. What western medicine continually fails to understand is that the delivery is just the last stage in the process. The shortest stage. The labour is where the woman needs help, support, coaching and continuity. And labour is where almost all OBs fall down on the job.
Yes, I really agree with the last thread.

The thing that gets me the most is how OBs enter the field so uneducated about natural birth. If the labor deviates from what they know, they are forced to do what they do: surgery.

So few OB's are willing to take on breach or twin vaginal deliveries because they really don't have the experience. Why wouldn't a good doctor make an effort to learn the "tricks" midwives have been using for years?

Also, for those of you who are having a hospital birth, Ina Mae Gaskin's Guide to Childbrith has a great section on making the hopital environment work for you in a natural birth that would be essential to read.
Well, because especially in the US, the risk for lawsuits is absolutely huge if anything should go wrong with the labour and delivery. Like the OB said in the article, he's only ever been sued for the c-section he didn't do, not for any of the ones he did. So many people have this expectation of perfection. They have also bought into the myth that doctors are infallable and can literally do no wrong. Doctors are just people. They sometimes have bad judgement. They sometimes don't know what to do. And sometimes, despite their best efforts, something goes wrong anyway. But doctors are discouraged from pushing the boundaries and "learning on the job" by the huge possibility of malpractise suits.
Yes, medical lawsuits are completely ridiculous and out of control. My OB, who delivered Madeline and Katherine left the state because of the outlandish costs needed to practice obstetrics. And, fromthat standpoint, I could almost see why many are pushed towards c-sections -- they're more profitable. And, I live in a very small community (five stoplights!)... in order to cover solely the cost of insurance for practicing obstetrics... he would have had to deliver (trying to remember the exact number here)... I'll say around 40 babies per year. In his last year of practice here, he delivered 13. He lost a lot of money choosing to do obstetrics. I'm bummed he left because he never ever tried to push me towards a c-section at all.

But... that's another story entirely.

I'm nervous about having an OB for my labor. But midwivery is illegal in my state. I guess if I feel pushed towards anything, I'll just have to trust my body, leave, and have a great time at home! (which is why I'm educating myself -- through much of MDC, thank goodness -- on ... well, everything birth!)
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I actually delivered dd at this hospital. I am soooo glad I was already planning a homebirth this time. The amazing thing is that NO ONE has yet written a letter to the editor on it. So I did and just sent it in. This is crazy and the worst part is that the midwives who allowed me an incredible birth with dd (delivered squatting on the floor, not hooked up to anything) are suddenly and mysteriously not practicing anymore
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With response to that article and on-demand c-sections, my husband made this priceless comment, "God did not design women with ziplock pouches."

rofl... what a great way to put it =)

Originally Posted by Taedareth
With response to that article and on-demand c-sections, my husband made this priceless comment, "God did not design women with ziplock pouches."
Entirely too true!!!!!!!!!
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