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?

[CEG]

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.

I'm not an Ob nurse, so I am just curious. Can you explain why is there a 1/3 increase due to higher rate of discovering dystocia? Are there 1/3 more cases of dystocia? What do you mean by discovering dystocia? If a baby truly was too large/pelvis too small it would always have been done discovered, right? I hear of a lot of people told their baby is too big before the fact and go on to have lady partsl births. What are the means of discovering this prior to labor? Again, I am not an ob nurse so I am guessing dystocia to mean the same as cephalo-pelvic disproportion not shoulder dystocia? Or are they the same general thing? Thanks for a response, I am a doula and I had never heard those numbers before.

[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.

Here, they say money numbers mean more than words. I am not taking any stand point on this as it's a national debate.

In 2002 the cost for a hospital birth in the U.S. varied depending on the type of delivery:

lady partsl Birth - $5,200

Primary Cesarean - $10,200

Repeat Cesarean - $8,300

VBAC - $5,800

The average length of stay and total charges are over 40% higher for repeat Cesareans than for a VBAC.

Women who have primary Cesareans incure the longest stay, 4.1 days and

the highest total charges, $10,200

Women with private insurance have the highest Cesarean rate (24.4%).

Women without insurance are less likely to have a Cesarean (18.6%)

http://www.nchomebirth.com/art-safetyStats.html

Here I stumbled another article that stated "Some health care experts believe that half of all c-sections performed in the U.S. are unnecessary. A cesarean section delivery is major surgery and should be done only when the health of the mother or baby is at risk. It should not be considered an option for the convenience of the doctor or the parents, or for any nonmedical reason."

Maxs (I am just quoting so it can help some people think from mulitple perspective).

[SmilingBluEyes]

Just remember, those "costs" are not all going to the obstetrician, you know. There are anesthesia bills, room costs, newborn care, and various other things that are figured in....sadly "nursing" does not even figure, which is another thread, I know.

Personally, I do not believe our OB's are getting rich just doing csections, either. As a matter of fact, their individual csection rates are being watched and tracked VERY closely by our administrators, risk management and corporate headquarters. I dont' think they are doing it to "get rich", but I won't deny I believe impatience on their parts, does indeed come into play, strongly.

[Jolie, BSN]

Maxs,

Deb is absolutely correct that those numbers don't necessarily reflect the OB's portion of the cost of a C-section patient's care. LOS is typically 1-2 days longer for a C-section mom and baby, effectively doubling the post-partum and newborn care costs, as reflected in the daily room rate. The cost of of pharmaceuticals, supplies, lab work, and anesthesia is significantly higher for C-section patients as well, but none of those funds actually goes to the OB.

Perhaps your sociology professor would like to investigate the role of hospital administrators in contributing to increased C-section rates, (by disallowing VBACs for example, or advertising elective C-sections), as hospitals stand to benefit financially by having more beds filled for a greater period of time.

I am not trying to create the impression that OBs never do unnecessary C-sections. Of course it happens. But again, I believe that it is over-simlifying a very complex issue to focus on OB reimbursement as the main culprit.

[SmilingBluEyes]

Maxs,

Deb is absolutely correct that those numbers don't necessarily reflect the OB's portion of the cost of a C-section patient's care. LOS is typically 1-2 days longer for a C-section mom and baby, effectively doubling the post-partum and newborn care costs, as reflected in the daily room rate. The cost of of pharmaceuticals, supplies, lab work, and anesthesia is significantly higher for C-section patients as well, but none of those funds actually goes to the OB.

Perhaps your sociology professor would like to investigate the role of hospital administrators in contributing to increased C-section rates, (by disallowing VBACs for example, or advertising elective C-sections), as hospitals stand to benefit financially by having more beds filled for a greater period of time.

I am not trying to create the impression that OBs never do unnecessary C-sections. Of course it happens. But again, I believe that it is over-simlifying a very complex issue to focus on OB reimbursement as the main culprit.

I agree completely with this post.

[BETSRN]

I'm not an Ob nurse, so I am just curious. Can you explain why is there a 10% increase due to higher rate of discovering dystocia? Is there 10% more? What do you mean by discovering dystocia? If a baby truly was too large/pelvis too small it would always have been done discovered, right? I hear of a lot of people told their baby is too big before the fact and go on to have lady partsl births. What are the means of discovering this prior to labor? Again, I am not an ob nurse so I am guessing dysotcia to mean the same as cephalo-pelvic disproportion not shoulder dytocia? Or are they the same general thing? Thanks for a response, I am a doula and I had never heard those numbers before.

I have to agree. I have been a L&D nurse for over 10 years (20 in the field) and I have NEVER heard of diagnosig a dystocia ahead of time. Maybe the poster was using the wrong terminology. You might have a c/section for "failure to progress and deliver a large baby who never would have fit through the pelvis, but that is NOT diagnosing a dystocia.