Rise in the cesarean birth rate.

[kmwheels21]

hi my name is kristin and i am a nursing student at the orvis school of nursing in reno, nevada. i have been following the ob-gyn and midwifery nursing forum for a week now and i am very interested in the topics that are discussed. i am writing a paper on the rising rate of cesarean births and whether or not it is justifiable. in the journal of nurse practitioners, it is evident that the rate of c-sections has increased from 1 in 20 in 1970 to 1 in 4 in 2003 (terhaar, 2005, p. 141-147). consequently, c-section is the most frequent surgical procedure in the united states. the dramatic increase has led me to investigate the cause. according to social science & medicine, physicians prefer to perform a c-section over a lady partsl delivery more often than medically necessary. based on the journal's findings, the trend towards more c-sections is based on factors such as rising malpractice rates, fear of malpractice suits, desire for higher income since c-sections are more lucrative, and the convenience to the physician's schedule since lady partsl deliveries take much longer to complete (lo, 2003, p. 91-96). in contrast, the journal of nurse practitioners points to the mother-to-be as the cause for the increase in c-sections. this journal states that late in pregnancy mothers want their pregnancy to be over and that they are anxious about their ability to handle labor. also they are fearful of the pain to come and they are concerned for the safety of their unborn child. consequently, some women prefer a c-section even when it is medically unnecessary (terhaar, 2005, p. 141-147). based on your experience, do you feel that the increase in the cesarean birth rate is due to the doctor's partial preference for cesarean birth or is it due to the choice of the mother-to-be? also in your practice, when a doctor chooses to do a cesarean delivery, is it your observation that it is medically necessary or not medically necessary?

references

lo, j. (2003). patients' attitudes vs. physicians' determination: implications for cesarean sections. social science & medicine. 57 (1, july): 91-96.

terhaar, m. (2005). the decision for cesarean birth. the journal for nurse practitioners. 1 (3, october): 141-147.

[bagladyrn, RN]

I've seen an increase in both issues.

In most hospitals I've done contracts at, it's common knowledge which doctors are going to find a reason to call a section if the pt. isn't close to delivery by 6-7 p.m. Many do seem also intimidated by the malpractice rates and issues and are less likely to "wait and see" with a slightly questionable FHR strip or try other interventions first. One can certainly see their viewpoint, though, when you pass giant billboards asking "Birth Injury? Learning Disability? Call such and such Malpractice Attorneys - we'll sue for you"!

More and more women seem to be opting for planned c/sections even for first deliveries. I've heard such reasons as convenience, scheduling so the family can come, fear of pain, and "not wanting to be stretched out down there". Not sure how convenient and scheduled they think babies are going to be after they're out! And most of them are quite shocked to find that there is pain involved after a c/section!

[SmilingBluEyes]

Factors:

Insurance Industry/Demands and Expectations

Risk Management Issues ---Liability

People who want what they want and want it to go right----now. (referring here to the "clients", formerly known as patients)

Really, it all can be summed up to those issues/players. Complicated? YOU BET---reams of paper can be found that articulate and break down these problems---- and the studies surrounding the rise in csection rates in the USA; just discussing these can fill up a room with more paper.

It really comes down to convenience, (for doctor and client alike) liability issues, risk management and changing attitudes on the parts of our "customers" (e.g. the patients).

Heck---there is a trend toward csection-on-demand (for primips), also. (ala Britney Spears). You could write an entire paper on that alone---also it's been discussed at length here at our forum....

Good luck on your studies---wishing you the best!

[ljds]

Here is a copy of a recent email I received:

=================================

Grassroots Network Message 603009

Cesarean News -Women are not choosing them!

Dear Friends,

For the links to the latest news about cesarean sections, go to http://www.cfmidwifery.org and click on the blue " New & Noteworthy" box on the home page! Here are some highlights:

Today the American College of Nurse-Midwives held a media briefing on "The Untold Story of Cesarean Birth: Risks from Complications Understated and Misunderstood" to highlight complications from cesarean section and new national data on women's views and experiences. Please read their press release at http://www.cfmidwifery.org/Resources/Item.aspx?ID=103 and don't miss their media briefing materials, including fact sheets and articles from the various organization, available at http://www.midwife.org/news.cfm?id=890.

As an invited participant in ACNM's media event, Citizens for Midwifery prepared a news release, "Problems with Cesarean Sections," posted at http://www.cfmidwifery.org/Resources/Item.aspx?ID=102 and a Fact Sheet, "Out of Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women," posted at http://www.cfmidwifery.org/pdf/cesarean2.pdf .

Of special relevance, Childbirth Connection (formerly Maternity Center Association) has just released findings from the latest Listening to Mothers Survey (2005) that indicate that women are NOT "choosing" cesarean sections. Find the details in the press release at: http://www.childbirthconnection.org/article.asp?ck=10087 . This is the first "hard evidence" disputing the claim that the rising cesarean section rate is due to women choosing cesareans - only one woman out of 1300 surveyed "who might have chosen an initial or "primary" cesarean without medical reason did so" according to the results released today.

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Hope you find this helpful.

[ljds]

I wanted to add; I worked as a nurse at a birth center for four years, and I still work as a doula for my friends. This is a complicated issue. Women do not make the decision to have a c-section in a bubble. The input that they get from their docs and society certainly holds sway. And that input right now is that a c-section is safer, easier, and less pain. Even though those feelings are not correct for a normal, healthy woman.

I currently work on a medical floor. Whenever we talk childbirth, there is always someone who says "GIVe me a c-section anyday." I think, are you kidding me? Major abdominal surgery, with all it's risks, including the risk of adhesions and complications 30+ years later, and you choose it?

In my work at the birth center, I saw how empowering and awesome childbirth could be. It makes me sad that many people don't realize how amazing it can be. It doesn't even have to be the mode (though I much prefer natural childbirth); it is the amount of respect and love that the caregivers provide to the mother and baby. This is what I feel is missing in much of the routine childbirth, and this lack of respect for the entire process starts way before birth, and is fueled primarily (in my opinion) by a medical system that is ran by insurance companies. Even the best of nurses (or doctors) can't compete with a hospital policy set in place by it's lawyers! This is the situation we have in my area right now....I am privy to some of the meetings through my former boss, and I know that it is the hospital lawyers who are currently making many of the policy decisions, and the docs and nurses are frustrated and discouraged.

I highly disagree, though, with the article that states that women choosing c-section is the primary reason for the rise in the rates. The declining offering of VBACS plays a huge factor. And like I said, women don't make the decision to have a c-section in a vacuum.

[1972]

My friend lost her grandson , her daughter was left in labour for about 44 hours she is small the baby was big helllllllloo! The baby died and the loss of 1 child in this day and age is intolerable, they did do a c-section but was to late. With prenatal care and nutrition we are seeing bigger babies and I think that is the main reason for the increase of c- sections. For myself I would rather see to many sections then lose a child because one wasnt done.

[utahliz]

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