Are unnecessary c-sections on the rise?

[TNT2]

Hello, my name is Tiffanie and I am currently a junior nursing student at the University at Buffalo in New York State. My assignment is to choose a topic pertinent to the current Ob-Gyn nurse and to get some current nurses' opinions on the topic. The topic that I would like your opinion on is the seemingly increasing rates of C-Sections. Cesarean sections have been on the rise in first-time mothers and currently constitute 22% of total U.S. births. There is a common belief that doctors' habits may overshadow the actual need for a C-section. While doing my clinical rotation in the labor & delivery ward of a suburban-Buffalo hospital, more than half of the patients that I cared for on any given day had delivered via C-section. Most of these patients were young women and some were on their first pregnancy and birth.

I would like to know what you feel about this topic. Do you believe there is a growing rate of unnecessary C-sections? What do you feel are the factors influencing the rise in C-section rates? What do you feel is the nurse's role in this growing trend?

[Maxs]

Perfect... medical advice from a sociology professor.

Cesarian sections are done for two reasons:

1. fetal complications

2. maternal complications (decels, 9 lb baby in a 7 lb pelvis, etc)

If a c-section is performed for fetal complications, and there are no maternal complications... a lady partsl delivery can be performed in subsequent deliveries (V-back). The problem is that the LEGAL (not medical) system is mandating that v-backs be performed less and less. It has nothing to do with patient safety because v-backs are safer. It has everything to do with trial lawyers suing a hospital into the ground if complications arise from a v-back. Again, IT IS SAFER TO PERFORM A V-BACK THAN A REPEAT C-SECTION, however we are often not allowed to do so.

But I'm sure your sociology professor knows all of this....

Is this a sarcasm? If so, it's not like I am taking his sociology class now, but I just heard him mention it in lecture when I was taking his class, period....Anyhow what if he is a sociologist? does it discredit him to comment on such manner? Do you want me to pull out his email address from the school website so you can further interrogate him? Just so you know, I have a great respect for any professors that I have sat in their classroom.

Maxs

[Maxs]

Arrrggggg... I'm perseverating but it is aggrivating when I hear sweeping generalizations such as the "sociology professor's" comment.

Ask him/her about the huge increase in cephalopelvic disproportion (android pelvis, etc) seen in younger patients these days. This is one of the most common causes of c-sections today. See if the good professor knows about it's increasing incidence. Also ask about the increase in women older than 30 delivering... and potential complications that can arise. Ask about increased (voluntary) utilization of reproductive specialists and the resultant increase in high-risk deliveries. Ask about the increasing incidence of C-sections WORLDWIDE, not just in the US. These countries have completely different reimbursement patterns...

And we've already touched on the legal pressures to decrease VBAC's.

Finally, if anyone wants to do a VBAC, there must be facilities to deliver the baby within 15-20 minutes to avoid neonatal neurological problems. There must therefore always be an obstetrician and an anaethetist present in the labour ward at all times. Because of these requirements and the fear of litigation, the incidence of VBAC is steadily declining. Again, I'm sure your professor has thought this all through before making rediculous comments about physicians.

Theoritically you make a lot of sense, but everything that can be depicted or exists theory doesn't constantly occur in real life. The sociologist didn't bash any physician's. And I think what you're saying is exactly correct. However, here is a question that you didn't answer or perhaps you have no clue about. Could it be possible that some c-sections are performed so that some doctors (unethical ones) can charge more?

Max

[parteiranagua]

There are sociologists like Suzanne Arms and Robbie davis floyd as well as Marsten Wagner (also an MD) who are specialized in the childbirth sociology and who are have done extremely sensitive and fine analysis of the past and current trends of the C/s situation in the US. Their researches are well grounded and serious and this is maybe what this sociology teacher was reffering to. The WHO recommands a percentage (5 to 15%) that is well under our national current rate (29%).

Ginny Doula OB RN SNM

[babyktchr, BSN, RN]

The c/s rate at my hospital is well over 40%. It is outrageous. Factor in though, that we do not advocate VBAC delivery anymore...so repeats are rising. My concern is with the primes who have a section at the ripe old age of 19, now destined to have a section for the rest of her life. I could scream outloud at work when a doc announces "you just aren't progressing" after 8 hours of PIT on an unripe cervix. I tell you, I want a bat!!!!! OB has become quite the daytime sport...if it doesn't happen between 8-4...oh well. Inductions have become a joke...we might as well just set them up with pre-op labs and just do it. I am being way too cynical here.

Docs should be going to fetal monitoring courses regularly, to get themselves "in the know". Believe it or not, they don't know it all when it comes to reading a strip. I have a doc who still says its not a late unless you have SE applied. The docs always look like the hero....with kudos to them for saving their baby's life for doing the section when he did (at 1cm and not in labor...no distress..only failiure to labor).

I went to a seminar last year, and the speaker gave a different opinion of the docs who rush to section to save time and energy. In the rise of people who now research and are educating themselves in the areas of childbirth ( and anything for that matter) there will come a day when a patient is sectioned for FTP or non clinical CPD or some other reason that cannot be justified...and that doctor will find himself in a lawsuit for unnecessary surgery litigation. Wouldn't that be interesting.

Don't get me wrong. There are definite times for a section. We have all seen that strip where we just want to run and hide. More often than not...especially in my experience at my institution, sections are becoming more a convenience.

Nurses really need to become advocates for their laboring moms. If the baby is good, there is no need to section just because they aren't progressing as fast as the doc wants. If your patient is really not wanting to be cut...tell the doc. Be a voice. Go the distance and don't be afraid. Sometimes I want to lock the door behind me, so the doc can't come in...lol.

By the by...I am a previous section for fetal distress. I was not in OB when I was pregnant, but looking back, I was not ready to be induced (my OB wanted the induction, not me) and my induction was NOT well run and my baby was induced into the distress. I wish I could see my chart now!!!!

[Jolie, BSN]

My sociology professor said in lecture that "C-sections are increasing because the physicians will charge more money." I don't know if this is true, but he also stated that "70% all c-sections performed are unneccessary."

Maxs

I too would like to take issue with the notion that "C-sections are increasing because the physicians will charge more money."

Perhaps your sociology professor is unaware that many OB/GYNs charge the same flat rate for prenatal, delivery, and post-partum care REGARDLESS of the method of delivery. They do so precisely to avoid accusations of enriching themselves by performing unnecessary C-sections. There are also a number of insurance companies that pay the same rate for lady partsl and surgical deliveries, again, to avoid encouraging unnecessary C-sections.

I don't think anyone here believes that the C-section rate in the US couldn't and shouldn't be lower than it is. But it is a multi-faceted problem, and promoting the notion that OB-GYNs are simply motivated by greed is counter-productive. It is necessary to examine a number of factors involving medical practices, parental expectations, and the litigous nature of our society in order to effect meaningful change.

[parteiranagua]

I too would like to take issue with the notion that "C-sections are increasing because the physicians will charge more money."

Perhaps your sociology professor is unaware that many OB/GYNs charge the same flat rate for prenatal, delivery, and post-partum care REGARDLESS of the method of delivery. They do so precisely to avoid accusations of enriching themselves by performing unnecessary C-sections. There are also a number of insurance companies that pay the same rate for lady partsl and surgical deliveries, again, to avoid encouraging unnecessary C-sections.

I don't think anyone here believes that the C-section rate in the US couldn't and shouldn't be lower than it is. But it is a multi-faceted problem, and promoting the notion that OB-GYNs are simply motivated by greed is counter-productive. It is necessary to examine a number of factors involving medical practices, parental expectations, and the litigous nature of our society in order to effect meaningful change.

The way I see it? slippery sloppe of self defensive obstetrics where Ob dont have the time to really and seriously think about their actions ... much pressure and fear about law suits and peer pressure. Plus this paradigm shuts them off to lift their head above the water to breathe and seing other alternatives..

i have seen ssooo many inductions staying several days of pit off and on to finish by C/s.

As of becoming a voice of reason i dont know, nurses dont always believe there is another way, peer pressure is also a big issue (evaluations etc..) and voicing alone can be soo frustrating..

Ginny Doula OB RN SNM

[tntrn, ASN, RN]

Don't discount the impact celebrities have in the picture either. Many Hollywood types are having elective sections. Some don't, but many do. I've read several articles in the newspapers about it and one of our docs, who likes those 5 pm "procedures" due to failure to progress, has stated he sees nothing wrong with them.

[windsurfr]

Maxs-

Yes, in fact, the fact that he is a sociology professor does discredit him... just as a MD preaching sociology would be discredited. And yes it is a problem when that person is making rediculous comments that he/she knows nothing about.

1/3 of the increase in C-sections comes from a higher rate of detecting dystocia

10% comes from the abdominal delivery of breech presentations

15% can be attributed to a growing propensity to diagnose fetal distress

Finaly, approximately 25% of the increase results from repeat cesareans.

Again, before you accuse physicains of inappropriate use of C-sections, look at the facts and indications for the procedure. Look at the INTERNATIONAL rate. Look at the legal pressure. And look at the public pressure.

[babyktchr, BSN, RN]

Don't discount the impact celebrities have in the picture either. Many Hollywood types are having elective sections. Some don't, but many do. I've read several articles in the newspapers about it and one of our docs, who likes those 5 pm "procedures" due to failure to progress, has stated he sees nothing wrong with them.

Elective sections are a whole different animal here. Believe it or not..there are women out there who just do not want to labor. With any surgery, they are informed of the risks of surgery, possible adverse effects, yada yada yada. They sign consent to have their baby via surgical intervention. I really don't see a problem with it....though I don't think it is for me. It is their choice. We are seeing more and more of it, as with breast augmentation, reductions, and face lifts. It is elective surgery....and has nothing to do with people who are sectioned because "time is up" on the obstetrical clock. I guess the question is...is an elective c/s considered unecessary??

[Maxs]

Elective sections are a whole different animal here. Believe it or not..there are women out there who just do not want to labor. With any surgery, they are informed of the risks of surgery, possible adverse effects, yada yada yada. They sign consent to have their baby via surgical intervention. I really don't see a problem with it....though I don't think it is for me. It is their choice. We are seeing more and more of it, as with breast augmentation, reductions, and face lifts. It is elective surgery....and has nothing to do with people who are sectioned because "time is up" on the obstetrical clock. I guess the question is...is an elective c/s considered unecessary??

True.

Maxs

[Maxs]

Maxs-

Yes, in fact, the fact that he is a sociology professor does discredit him... just as a MD preaching sociology would be discredited. And yes it is a problem when that person is making rediculous comments that he/she knows nothing about.

1/3 of the increase in C-sections comes from a higher rate of detecting dystocia

10% comes from the abdominal delivery of breech presentations

15% can be attributed to a growing propensity to diagnose fetal distress

Finaly, approximately 25% of the increase results from repeat cesareans.

Again, before you accuse physicains of inappropriate use of C-sections, look at the facts and indications for the procedure. Look at the INTERNATIONAL rate. Look at the legal pressure. And look at the public pressure.

Since when did he preach the procedures of a C-section? He was probably quoting a study that was done. I am actually willing to go and talk to this professor myself to clear things up and I will keep you informed.

"Again, before you accuse physicains of inappropriate use of C-sections, look at the facts and indications for the procedure." (windsurfr) funny, when did I accuse physicians of anything. You have to understand the difference between quoting and accusing.

Maxs

[imenid37]

C/s are definitely increasing. This is for a variety of reasons. ACOG's affirmation that a pt. may request an elective primary C/S. Fear of litigation for neurologically damaged children. The current disfavour of VBAC (lady partsl birth after c.section). Recent (past few years) studies which have indicated that elective c.section is safer than lady partsl breech birth. Older moms and more medically complicated moms delivering one or more babies as the result of modern technology who would've never even gotten pregnant a generation ago. Obesity. Acceptance of c.section as "normal" birth in our society and other (Venezuela 80+% of educated women having C/S). and ... Impatience! (JMHO)