Elective Cesareans/On Demand

naggytabby, BSN, RN · Jul 16, 2005

here's another thought: no one has mentioned (at least not noticed by me during my skim through of this set of postings, so if someone did, my heartiest apology and a hug) the fact that a single cesarean (elective, emergency, repeat- any cesarean) carries with it a risk of fetal death/stillbirth with subsequent pregnancies.

Just another thought to throw into the brew.

For the record, I am intrigued by the shift in women's attitudes. Having been around in the 70's and 80's I remember (and was part of) the struggles for natural birth and hands-off-- now it seems that for some the tide of feminism has turned to an encouragement for more technology- both having the same foundation in 'it's my body/baby'.

just some thoughts to muddle over.

a lovely day to all....

epiphany · Jul 16, 2005

National csection rate is 50%? I thought it was more like 26%. Where did you get that figure, out of curiosity? (not trying to start a debate, but I am really behind the times if these rates are that high). Thanks in advance for any info you can provide me.

26% of Births in City Are Caesarean Deliveries, Study Says

http://www.nytimes.com/2005/07/13/nyregion/13child.html?

Here's an article on C-section rates in the NYT just a couple of days ago. I pasted and copied, i

By MARC SANTORA

Published: July 13, 2005

The number of Caesarean section births performed at hospitals in New York City varies greatly, with the average well above the recommendations of the World Health Organization and the Centers for Disease Control and Prevention, according to a report to be issued today by the city's public advocate. New York is keeping pace with the national increase in the number of Caesarean sections, which accounted for more than a million births nationwide since 2003, five times more than in 1980.

The procedure, in which the baby is delivered through an incision in the mother's abdomen or uterus, was performed on 27 percent of women in the United States who gave birth, according to data compiled by the federal Department of Health and Human Services.

In New York City, 26.4 percent of women had Caesarean deliveries in 2003, and statewide the rate was 28.4 percent, said Betsy Gotbaum, the public advocate.

A survey of 44 hospitals by Ms. Gotbaum's office found that nine had Caesarean rates greater than 30 percent. NewYork-Presbyterian/Weill Cornell had the highest rate of such deliveries, 37.3 percent."There is a tremendous risk" in conducting such surgeries unnecessarily, Ms. Gotbaum said in an interview, adding that it was clear that the trend was going in the wrong direction.A representative of NewYork-Presbyterian/Weill Cornell said the hospital performed many high-risk births, which helped account for its relatively high rate of Caesarean sections.But Ms. Gotbaum cited reports by the Centers for Disease Control and the World Health Organization recommending that surgery be used only in cases in which a lady partsl birth would put the health of the mother or the baby at risk. Such a standard, the groups said, would help reduce the rate of Caesarean sections to the 15 percent they recommend.Hospitals are required to provide data on the number of Caesarean sections they perform to patients who request it, under a 1989 state law, the Maternity Information Act. When the law was adopted, it was hailed as the first comprehensive effort in the nation to curb unnecessary operations. In the years after the law was passed, rates in New York did drop, but in recent years they have again begun to climb.

Ms. Gotbaum blamed the New York State Health Department for not following through on monitoring the issue.The deputy health commissioner, William Van Slyke, said the department compiled the data as quickly as possible and passed the information along to hospitals. But ultimately, he said, the hospitals were responsible for providing the data to patients.The law contains no punitive measure that could compel a hospital to provide the information. Mr. Van Slyke said he was aware that the number of Caesarean deliveries had been rising in recent years, but said he saw no reason for alarm.The surgery has been used for years and is widely considered the best choice for a mother whose health is at risk. Some obstetricians contend that it is as safe as a lady partsl birth and that if a woman prefers surgery, she should be allowed to choose that option. There are several reasons that a woman might elect a Caesarean birth, including the convenience of advance scheduling.Some advocates, however, worry that hospitals are overusing the procedure. They cite the fact that in 1970, only 7 percent of babies were born by Caesarean section.Maureen Corry, the executive director of the Maternity Center Association, a national nonprofit advocacy group for pregnant women, said her group analyzed some 300 studies. "Bottom line, without a doubt, unless there is a clear compelling medical need for a C-section or assisted lady partsl birth, the evidence shows that lady partsl birth is the safest way for women to give birth," she said. There are many reasons that hospitals might benefit from surgery, she said."I think malpractice has a lot to do with it," she said. "Nobody ever sues a provider for doing an unnecessary C-section."Hospitals stand to reap a bigger profit by performing surgery and having the patient stay in the hospital for several days, she said.It is also easier, administratively, to perform a Caesarean section because the birth can be scheduled.Another factor for the increase may be that fewer women later deliver a baby lady partslly after having done so by a Caesarean section, said Dr. Bruce Flamm, a medical professor at the University of California, Irvine.He said this alone made it unlikely that Caesarean rates would decline to the level of two decades ago. He also said he believed that part of the reason for the increase was that more women wanted the procedure.

epiphany · Jul 16, 2005

National csection rate is 50%? I thought it was more like 26%. Where did you get that figure, out of curiosity? (not trying to start a debate, but I am really behind the times if these rates are that high). Thanks in advance for any info you can provide me.

26% of Births in City Are Caesarean Deliveries, Study Says

http://www.nytimes.com/2005/07/13/nyregion/13child.html?

Smiling:

Here's an article on C-section rates in the NYT just a couple of days ago. I copied it down below, because it goes into archive and is irretrievable later. Anyway, national rate is 27 percent. I think it's a sad state of affairs.

By MARC SANTORA

Published: July 13, 2005

The number of Caesarean section births performed at hospitals in New York City varies greatly, with the average well above the recommendations of the World Health Organization and the Centers for Disease Control and Prevention, according to a report to be issued today by the city's public advocate. New York is keeping pace with the national increase in the number of Caesarean sections, which accounted for more than a million births nationwide since 2003, five times more than in 1980.

The procedure, in which the baby is delivered through an incision in the mother's abdomen or uterus, was performed on 27 percent of women in the United States who gave birth, according to data compiled by the federal Department of Health and Human Services. In New York City, 26.4 percent of women had Caesarean deliveries in 2003, and statewide the rate was 28.4 percent, said Betsy Gotbaum, the public advocate.

A survey of 44 hospitals by Ms. Gotbaum's office found that nine had Caesarean rates greater than 30 percent. NewYork-Presbyterian/Weill Cornell had the highest rate of such deliveries, 37.3 percent."There is a tremendous risk" in conducting such surgeries unnecessarily, Ms. Gotbaum said in an interview, adding that it was clear that the trend was going in the wrong direction.A representative of NewYork-Presbyterian/Weill Cornell said the hospital performed many high-risk births, which helped account for its relatively high rate of Caesarean sections.But Ms. Gotbaum cited reports by the Centers for Disease Control and the World Health Organization recommending that surgery be used only in cases in which a lady partsl birth would put the health of the mother or the baby at risk. Such a standard, the groups said, would help reduce the rate of Caesarean sections to the 15 percent they recommend.Hospitals are required to provide data on the number of Caesarean sections they perform to patients who request it, under a 1989 state law, the Maternity Information Act. When the law was adopted, it was hailed as the first comprehensive effort in the nation to curb unnecessary operations. In the years after the law was passed, rates in New York did drop, but in recent years they have again begun to climb.Ms. Gotbaum blamed the New York State Health Department for not following through on monitoring the issue.The deputy health commissioner, William Van Slyke, said the department compiled the data as quickly as possible and passed the information along to hospitals. But ultimately, he said, the hospitals were responsible for providing the data to patients.The law contains no punitive measure that could compel a hospital to provide the information. Mr. Van Slyke said he was aware that the number of Caesarean deliveries had been rising in recent years, but said he saw no reason for alarm.The surgery has been used for years and is widely considered the best choice for a mother whose health is at risk. Some obstetricians contend that it is as safe as a lady partsl birth and that if a woman prefers surgery, she should be allowed to choose that option. There are several reasons that a woman might elect a Caesarean birth, including the convenience of advance scheduling.Some advocates, however, worry that hospitals are overusing the procedure. They cite the fact that in 1970, only 7 percent of babies were born by Caesarean section.Maureen Corry, the executive director of the Maternity Center Association, a national nonprofit advocacy group for pregnant women, said her group analyzed some 300 studies. "Bottom line, without a doubt, unless there is a clear compelling medical need for a C-section or assisted lady partsl birth, the evidence shows that lady partsl birth is the safest way for women to give birth," she said. There are many reasons that hospitals might benefit from surgery, she said."I think malpractice has a lot to do with it," she said. "Nobody ever sues a provider for doing an unnecessary C-section."Hospitals stand to reap a bigger profit by performing surgery and having the patient stay in the hospital for several days, she said.It is also easier, administratively, to perform a Caesarean section because the birth can be scheduled.

Another factor for the increase may be that fewer women later deliver a baby lady partslly after having done so by a Caesarean section, said Dr. Bruce Flamm, a medical professor at the University of California, Irvine.He said this alone made it unlikely that Caesarean rates would decline to the level of two decades ago. He also said he believed that part of the reason for the increase was that more women wanted the procedure.

epiphany · Jul 16, 2005

And here's an abstract of a NYT article which reflects what is slowlyg happening to the trend of VBAC's.

NATIONAL DESK | November 29, 2004, Monday

Trying to Avoid 2nd Caesarean, Many Find Choice Isn't Theirs

By DENISE GRADY (NYT) 2052 words

ABSTRACT - Growing number of hospitals that once allowed lady partsl birth after Caesarean are now banning it and insisting on repeat Caesareans; many smaller hospitals say lady partsl birth after earlier Caesarean is riskier than once thought and that they do not have staff to handle emergencies that may arise; obstetricians estimate there is 1 percent chance that old Caesarean scar will cause uterus to rupture during subsequent labor, which can cause dangerous blood loss in mother and brain damage or death in baby; decade ago, risk of rupture was thought to be 0.5 percent or less; many women are willing to take risk, and hospitals' stance has become charged issue; some women say their freedom of choice is being steamrolled by obstetricians who find Caesareans more lucrative and convenient than waiting out normal course of labor; doctors say their position is based on concern for patients' safety; some doctors and hospitals freely acknowledge that fear of being sued has driven their decisions; many women prefer lady partsl birth because they recover more quickly and with less pain than they do from Caesarean; in addition, Caesarean increases risk of complications in next pregnancy for women who want more than two or three children.

SmilingBluEyes · Jul 16, 2005

lots to chew on. Thank you! I will really read these things carefully and comment later.

RNnL&D · Jul 16, 2005

Maureen Corry, the executive director of the Maternity Center Association, a national nonprofit advocacy group for pregnant women, said her group analyzed some 300 studies. "Bottom line, without a doubt, unless there is a clear compelling medical need for a C-section or assisted lady partsl birth, the evidence shows that lady partsl birth is the safest way for women to give birth,"

:yeah:

RNnL&D · Jul 16, 2005

Breech lady partsl births carry a higher risk of injury to the baby.

Actually, I read a study that stated planned CS for lady partsl births had not improved outcomes as much as was expected.

Of course, it's a study that I would have to dig for and since I am NAK, I'm not going to right now.

Minou · Jul 16, 2005

Hi,

I have to say that a c/section just because it's convenient is outrageous ( be it on the pt's part or...the doc's ...) But I do support c/s for valid reasons ...

I have 2 c/section stories...that actually happened a day apart not too long ago.. ( I swear !!! )

First the happy story : I had a pt come in for a primary c/section...When getting report I was told that she had had a cerclage done ... G3P0 ...I go in to the room and think... Gee she looks familiar...look at her name and 'Bam', now I know...she was my pt 2 years previously when she miscarried for the 2nd time...I remember it vividly because it was one of those cases that stays with you for a long time, that makes you cry...miscarriages r/t incompetent cervix, hence the cerclage...which it was decided by pt/doc to not mess with in case she wanted another child later on ...off to elective c/s. It was truly an inspiring/rewarding case for me as I saw the whole family in tears...and such a wonderful family...Now that c/section made sense

OK, for the icky story : This Doc has 2 pts in labor. Comes in to deliver the 1st, gets a little annoyed that the 2nd is only 3-4 cm because his office is far away and he will have to come back... Checks the pt and to everyone's disbelief ( as in...it ain't true ) he feels a pulsating cord...STAT C/S...Being the nsy rn that day I look up at the monitors and see only excellent EFM strips..." Hum...they must already be wheeling her in..." So off I go, get in the OR and there's nobody holding the head up ! ..." Hum...", " Shouldn't someone... "...."There's no time ", replies the Doc giving me a LOOK. So I shut up and do my thing. He doesn't wait for an assistant and makes the circulating rn scrub in. Now that is a violation of our unit policy unless it is a dire emergency, which he claimed, which it wasn't...

I'm rather disgusted with this Doc ( he does crap all the time ). Anyone with suggestions? similar experiences ? If that pt gets wind of this, asks for a review, this Doc is toast, because the is no evidence to support his DX, but it's his word against ours !!!

mitchsmom · Jul 16, 2005

All this is good and true but how many docs are giving evidenced-based, balanced informed consent information? It's not like they are giving this out, at least not in my town:

What every pregnant woman should know about cesarean section:

http://maternitywise.org/pdfs/cesareanbooklet.pdf

The risks of cesarean delivery to mother & baby:

http://www.motherfriendly.org/Downloads/csec-fact-sheet.pdf

Problems & hazards of induction of labor:

http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf

There are some other countries that don't have our inflated c/s rate (I think the UK, scadinavian countries, etc.)... I wonder how their resultant OB mortality and morbidity rates compare to ours?

jkaee · Jul 16, 2005

I'm not Deb, but I'd like to butt in here :) It does not sound as if your sister's C-section is being done for "maternal comfort". She has a breech baby, and has had a previous C-section, both legitimate reasons for scheduling a C-section at term. Her size and history of arthritis may make her recovery from surgery more challenging than recovering from a lady partsl birth, so in no way is she "taking the easy way out". I wish her well!

Just an update.....my sister gave birth to a 10 lb 8oz baby boy yesterday via CS.....baby is in the NICU because his breathing has been very fast and shallow, mom began to hemmorage last night but thankfully is okay now (after Hemabate, Cytotec and Methergan??? haven't heard of that one) She's very anxious to see her baby, but they still want to keep him. He had meconium staining, but his CXR was clear yesterday.

Okay, I'm finished hijacking the thread...continue on! :rolleyes:

rpbear · Jul 17, 2005

I have a very hard time with primary elective c-sections. I want to ask these women where they learned sex ed, because I learned that the baby comes out the lady parts at about 9 months gestation. If you do not want a baby coming out of your lady parts then don't get pregnant. I have an even harder time with MD's who allow this. We had one OB nurse who wanted an elective c-section and she could not find anyone who would do this for her. She got an epidural and had a lady partsl delivery.

Jolie, BSN · Jul 17, 2005

Just an update.....my sister gave birth to a 10 lb 8oz baby boy yesterday via CS.....baby is in the NICU because his breathing has been very fast and shallow, mom began to hemmorage last night but thankfully is okay now (after Hemabate, Cytotec and Methergan??? haven't heard of that one) She's very anxious to see her baby, but they still want to keep him. He had meconium staining, but his CXR was clear yesterday.
Okay, I'm finished hijacking the thread...continue on!

Thanks for the update! I wish everyone well!