C-Sections on the rise.

[Halinja]

An interesting news article. I know the number of c-sections called for on very slim grounds was/is very frustrating to me. Not that we didn't know this was happening, but the actual numbers made it more real.

http://www.latimes.com/news/nationworld/nation/la-sci-premature29-2008may29,0,1859374.story

[OzMW]

The OB group I used charged insurance the same rate regardless of method of delivery. Now, obviously the hospital billed more for a C-section than a lady partsl delivery, but it was refreshing to know that the OBs weren't profiting from elective C-sections.

Well they do profit don't they ....in time. You pay x amount of bucks for a 30 minute section and a few 10 minute visits postpartum. Or you pay the same amount of money for he or she to see you through an 8 hour labour. Hmmmm................can do a hell of a lot of sections in one day in comparison to labours.

[babyktchr, BSN, RN]

Interesting that it was brought up about paying for elective c/s. I really never thought about the fact that cosmetic surgery for the most part is and out of pocket expense, and if momma wants to spare herself the pain of labor and/or stretching out "down there"...then why isn't she made to just pay for that (but then again, insurance pays for VIAGRA). I just cannot fathom that docs will just cut into a woman because she ASKS. This is major surgery people!!! There are complications....things happen. Women were BUILT to have children. It really just makes me so mad, the creative charting that goes on, the tales that are told, doesn't it ALWAYS happen...the patient ultimately says, "thank God the doctor did the c/s, that baby would've never come out".

[imenid37]

I think 15 or so years ago, the insurance companies were pushing moms to have a TOL if they had a prior C/S before all of the info. re. uterine rupture even w/ the LTCS came out. We now do NO VBAC's at my facility unless the head is on the perineum at

+3/4 on admisssion because we have no OR and anesthesia in house. People like to schedule everything. We have tons of inductions. Our docs do try to encourage pts. to have a lady partsl delivery, but they prefer inductions (it seems). If the baby is huge or mom is very obese, etc. I think they are perfectly fine w/ choosing and sometimes do encourage the elective scheduled C/S because they want more control of the situation due to liability. The tend I hear of lately is peds in small hospitals not wanting to come to all of these C/S in smalll hospitals and nurses, NP's, or PA's taking over this function.

[Jolie, BSN]

Well they do profit don't they ....in time. You pay x amount of bucks for a 30 minute section and a few 10 minute visits postpartum. Or you pay the same amount of money for he or she to see you through an 8 hour labour. Hmmmm................can do a hell of a lot of sections in one day in comparison to labours.

I should probably clarify that this was 13 years ago, before "patient-requested" C-sections were the mainstream of OB practice. They were an ethical group and did not perform C-sections for convenience or patient preference. They were trying to make a "statement" by removing the appearance of performing unnecessary C-sections for financial gain, probably because there were other groups in the area doing just that. BTW, they also provided epidurals at no additional charge for their labor patients because the anesthesiologists at that hospital refused to do so for Medicaid patients or patients who had not been financially pre-approved prior to labor. As you can guess, there was politics aplenty at this facility, and they were trying to rise above that in the best interests of their patients.

I doubt that they are still able to provide epidurals. I'm sure that the anesthesiologists have found a way to put a stop to that.

[babyktchr, BSN, RN]

Financially pre-approved for labor. WOW.

I know I will open a new can of worms here, but perhaps the world-wide publishing of celebrity SCHEDULED c/s (for control issues) has also fueled a bit of a flame here. I mean, lets face it, if Christina Aguilera can have one....why can't everyone???? (and at 36 weeks)

I really wonder though, if patients are truly counseled about c/s and the risks at the time of c/s, post partum and with subsequent pregnancies. I know many times I get and "elective c/s" in for work-up and they are terrified, asking questions I think should've been tackled way before the " I am going to put an IV in and a catheter in your bladder" portion of the show. Contrary to popular belief, although you don't have labor pain, you have SURGICAL pain, and GAS pain. One of my favorite shocked looks is when you tell them that only ONE person can be with them in the OR.

I have to stop....this just riles me to no end.

[tntrn, ASN, RN]

Interesting that it was brought up about paying for elective c/s. I really never thought about the fact that cosmetic surgery for the most part is and out of pocket expense, and if momma wants to spare herself the pain of labor and/or stretching out "down there"...then why isn't she made to just pay for that (but then again, insurance pays for VIAGRA). QUOTE]

That's what I thought. Until my DH had prostate cancer, had a retropubic prostatectomy, sparing the nerves surgery. He had no problem with erections prior to the surgery, but our insurance won't pay for Viagra. It's good insurance, too. Our cash output for then entire 3 day hospital stay including anesthesia, recovery, everything was $100.

I agree that an elective section should go under the category like plastic surgery does. Either justify it or pay for it. And the staff who has to juggle other necessary tasks to this elective procedure should get extra pay!

[RXtech]

I always hear that OB's are doing more sections due to "fear of litigation," but I wonder how valid this fear is. Is there any evidence that the number of lawsuits filed goes down when the section rate goes up? Does a hospital with a lower section rate have a higher rate of malpractice payouts? I think it would be interesting to know how those stats would relate to each other.

[jhhrn68]

C-sections are not being done for the mother's convenience, but the doctors. The high rate of inductions is the cause of these c-sections. A woman comes in at 11 PM for an induction, the doctor comes in in the morning and ruptures membranes, by 5 PM the pt. is only 3 cm and the doctor ( who doesn't want to miss dinner or be awakened at 3 AM) convinces the pt. that the baby is not "coming down" and a c-section is necessary and, after all, she has been in "labor" 16 hrs. So, of course, the mother agrees because she trusts her doctor and is tired of being in bed tied to monitors.

[crysobrn]

It seems like our c/s rate is through the roof lately. And it will only get worse in years to come since we don't offer vbacs. We generally have the docs site either macrosomia or ftp. The macro babies are on average 7.5 lbs WOW. And the ftp's are as the previous poster said almost always scheduled elective inductions that do not progress as the doc thinks they should. I mean why would they when you schedule someone who's closed thick with a ballotable baby, they are obviously not ready to deliver. But often those are given some "reason" like high bp's in the office and the patient's bp's on night shift are 100/50. Sad.

I'm pregnant for baby number three, both of my previous children were 10 lbs, I "know" that if I asked for a c/s I could easily be granted just that based on a history of macrosomia. I also know if I were not me and my OB did not work with me I could easily be convinced that I "need" a c/s this time. I'm a smaller person and honestly I get so sick of hearing people that have c/s for 8 lb babies say "it's a good thing I had my c/s because I NEVER would have been able to deliver this huge baby lady partslly" Sometimes I casually throw in there that I have delivered two 10 lbers. "really" they say. I'm sure it's because the OB's are telling them in the office that there's just NO WAY a baby can come out of the lady parts if it's over 7 lbs. Sad.

[LandDRN]

Our docs always quote "when in doubt, cut it out..." They are very liability trigger ( or should I say scalpel) happy here in FL.

[LandDRN]

I agree about the unfavorable inductions. I wish we ( and more docs) still used bishop's scoring......it would get rid of alot of our "failure to progress" inductions.

Interesting side note. We have the macrosomia issue at our facility too. I birthed a 9lb 13 oz baby as a primip and one of the docs I worked with ( not my OB) told me I was crazy for doing it!! What ever happened to trial of labor?

[Elvish, BSN, DNP, RN, NP]

You know, I really don't think we need to be inducing people at all as long as Madame Placenta is doing what she's supposed to be doing.

I am talking more along the lines of post-dates and macrosomia inductions here. Women's pelvises have been birthing babies of many sizes for a long time, and it really annoys me that all of a sudden we've become incapable.