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Your biggest risk factor for a c-section may be your hospital (article)


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Didn't know if anyone had seen this. They compared rates for low risk women having their first baby (full term, head down, singleton pregnancy) and the rates ranged from 11% to over 50%. http://www.consumerreports.org/doctors-hospitals/your-biggest-c-section-risk-may-be-your-hospital/

 

You can look up your own local hospitals here to find their total c-section (and VBAC) rates: http://www.cesareanrates.com/2015/01/what-is-my-hospitals-cesarean-rate.html?m=1

 

My local hospitals are both over 40%. (I had home births in this area, the hospital I had my c-section at is in a different part of the state and has a similar rate)

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Very interesting! At our local hospitals it varies not only by hospital but by doctor. One of my friends wants to try to a VBAC. When she went in to labour, they drove an extra 30 minutes to a hospital in a neighbouring town, because the OB on call at our local hospital was known for doing C-sections for any reason at all, and the OB on call in the next town over was very supportive of low-intervention births. She ended up having a VBAC with no complications whatsoever... but had she gone to our local hospital she probably wouldn't have been given that option with this particular doctor in charge at the time.

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Very interesting! At our local hospitals it varies not only by hospital but by doctor. One of my friends wants to try to a VBAC. When she went in to labour, they drove an extra 30 minutes to a hospital in a neighbouring town, because the OB on call at our local hospital was known for doing C-sections for any reason at all, and the OB on call in the next town over was very supportive of low-intervention births. She ended up having a VBAC with no complications whatsoever... but had she gone to our local hospital she probably wouldn't have been given that option with this particular doctor in charge at the time.

 

Here most of the doctors blame the hospitals for why they don't do VBAC, then the hospitals blame it on the doctors. The VBAC rates at the hospitals near me are 6.9% and 4.5%. When evidence suggests that 70% of women who want a VBAC will be successful. Yeah...like I said, home births. The highest VBAC rate in the state is 2 hours away and still under 30%. 

 

Of course, we have a whole county with a c-section rate over 50%. 

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I think mine was due to the dr. (definitely a misogynist.  don't ask me why he was in obstetrics).    I had a different dr for #2 (same hospital), and even though she also didn't want to descend - how it was handled was 180 degrees opposite.   same hospital.

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i am not surprised by this at all.  OUr regional childrens/maternity hospital did a study a number of years ago comparing rates between GPs and OBYs for low risk births, and found that GPs had a significantly lower rate.  We didn't have midwives in hospital then, but we do now and they have an even lower rate.

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The thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

 

I've had four c-sections due to complications from a car accident when I was younger. I was a high risk patient and had my children at a hospital with a higher than average c-section rate, but that was because it was where the high risk clinic was located. The other area hospital, where I took my prenatal classes, loved to tout its super low c-section rate, but wouldn't allow me to deliver there. In fact, when I had complications with my third pregnancy, an ambulance took me to the low c-section rate hospital, and the nurses actually said, "Why did you bring her here? We don't have the facilities for this!" They had me ambulance transferred.

Edited by ghostwheel
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My local hospital (right up the street) has a c-section rate of over 40%. The hospital I birthed at for the last 3 kids has a rate of 32%. However, I go to that hospital (45 minutes away) because I see the Midwives in my OBG/YN office, rather than the docs themselves, and the Midwives have very few c-sections.

 

Also, the local hospital had an episiotomy rate of over 50% last time I checked.  :ohmy: My hospital of choice has a rate of under just above 2%. After the damage done during my first delivery due to an episiotomy against my will, that number right there is worth the drive!

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The issue thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

 

 

 

I hear that a lot, but the article was specifically only comparing low risk births. So that shouldn't be a factor. 

 

Also, I can say for a fact that every hospital claims that, except they all have about the same c-section rate (40%). They can't ALL be taking all the high risk patients! If one was, the others should then be lower, you know? 

 

But anyway, the article was not looking at total c-section rates but at only the rate in low risk births. 

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My local hospital (right up the street) has a c-section rate of over 40%. The hospital I birthed at for the last 3 kids has a rate of 32%. However, I go to that hospital (45 minutes away) because I see the Midwives in my OBG/YN office, rather than the docs themselves, and the Midwives have very few c-sections.

 

Also, the local hospital had an episiotomy rate of over 50% last time I checked.  :ohmy: My hospital of choice has a rate of under just above 2%. After the damage done during my first delivery due to an episiotomy against my will, that number right there is worth the drive!

 

Holy crap! I honestly thought episiotomies weren't done anymore, other than vacuum births and the like. 

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Well, if a guy enjoys feeling superior to women and being in authority over them, obstetrics seems like quite a natural career choice to me. :(

 

 

 

Yeah. I know of a woman locally who was told by her OB that vaginal birth "ruins" the vagina, so she should just have a c-section, for her husband's sake. And yes, his wife had c-sections. 

 

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The issue thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

Although this is not true in my area. The hospital with the highest acuity NICU has the lowest C Section rate. I was actually wondering if income levels have anything to do with it. The hospital with the most births, highest acuity NICU and lowest C Section rate does far more charity care than the other hospital. It's second location, which is in a high income area, does not have a high acuity NICU and does less charity care, has a higher C-Section rate than the main hospital. Some doctors deliver at both of the hospitals, some doctors only deliver at one of them.

 

ETA: The competing hospital system, located at approximately the midpoint geographically, has the highest C-Section rate of all. They are well known for refusing indigent patients.

Edited by TechWife
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One reason I had home births was because I didn't want a doctor pushing an unneeded c-section.

 

Me too. But I know that the hospital is the safer option in certain situations, and it chaps my hide that we don't have good options available. There is a history of twins in my family (Dad is a twin, he has another set of twin brothers, and his mom was a twin). I know there is a higher than average chance of me having them and it is illegal for a midwife to deliver them out of hospital here. So if I want a twin vaginal birth my options are various hospitals all of which have a higher than 40% c-section rate. There are ZERO hospitals with a low c-section rate. And of course, some women just prefer a hospital birth for many good reaons. We should be doing better by them. 

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The hospital where I gave birth has a rate of 21%, which seems to be decent. I had to have an emergency c-section for sudden, severe preeclampsia and I also have epilepsy, so without the c-section dd and I might not be here. I'm not complaining. ;) 

 

Looking at the rates in my state, I can't see any trends that could explain it. The highest rate I see is 34%, so it could be worse, but there are affluent cities and low-income areas both in the thirties. There are big cities and smaller towns with comparatively high rates. There doesn't seem to be any rhyme or reason behind the numbers.

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The issue thing to keep in mind with these stats is that often the hospitals with the higher c-section rates are hospitals that take high risk patients and have the NICUs to support them.

 

I've had four c-sections due to complications from a car accident when I was younger. I was a high risk patient and had my children at a hospital with a higher than average c-section rate, but that was because it was where the high risk clinic was located. The other area hospital, where I took my prenatal classes, loved to tout its super low c-section rate, but wouldn't allow me to deliver there. In fact, when I had complications with my third pregnancy, an ambulance took me to the low c-section rate hospital, and the nurses actually said, "Why did you bring her here? We don't have the facilities for this!" They had me ambulance transferred.

 

Normally hospitals are grouped into two types for comparison, local type hospitals that take normal births, and larger regional types which get more high risk births.  Section rates are expected to be somewhat higher at the latter.

 

But for comparing low risk births across the board that isn't really relevant.

 

But section rates of 40% or 50% are higher than is considered optimal for safety even at the hospitals where there are more high risk births, so really I don't think many of them have a leg to stand on no matter what type of institution they are.

 

It really gets under my collar that these OB/GYNS complain about women wanting home births or midwives in hospital when the reason is they themselves are supplying unsafe care.  Even if their insurance companies, or the hospitals insurance companies, is insisting - if there was a widespread backlash by doctors refusing to comply, it would make a difference. 

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The hospital where I gave birth has a rate of 21%, which seems to be decent. I had to have an emergency c-section for sudden, severe preeclampsia and I also have epilepsy, so without the c-section dd and I might not be here. I'm not complaining. ;)

 

Looking at the rates in my state, I can't see any trends that could explain it. The highest rate I see is 34%, so it could be worse, but there are affluent cities and low-income areas both in the thirties. There are big cities and smaller towns with comparatively high rates. There doesn't seem to be any rhyme or reason behind the numbers.

 

Yeah, that's half the rate of the hospitals here. Half. That's crazy. And no, no real trends to explain it. 

 

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The local HMO-owned hospital, Kaiser, is the only one in the area that permits nurse-midwives and has quite a bit lower c-section rate than the independent hospitals. In most cases, I'd say this is probably a good thing. But whereas the independent hospitals have a financial incentive to do a c-section in an ambiguous case, Kaiser has the financial incentive to NOT do one. This is going to result in a certain number of babies experiencing birth defects or even dying that could've been avoided with a c-section.

 

I don't know what the c-section rate should be, but it's probably somewhere in between what Kaiser's is and what the independent hospitals' are.

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The local HMO-owned hospital, Kaiser, is the only one in the area that permits nurse-midwives and has quite a bit lower c-section rate than the independent hospitals. In most cases, I'd say this is probably a good thing. But whereas the independent hospitals have a financial incentive to do a c-section in an ambiguous case, Kaiser has the financial incentive to NOT do one. This is going to result in a certain number of babies experiencing birth defects or even dying that could've been avoided with a c-section.

 

I don't know what the c-section rate should be, but it's probably somewhere in between what Kaiser's is and what the independent hospitals' are.

 

My understanding based on WHO stats is that over 20% and you start seeing more harm done than good. 

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My understanding based on WHO stats is that over 20% and you start seeing more harm done than good. 

 

Yup.

 

And I don't know if you've ever seen the section stats for The Farm, but they are far far lower than that with good outcomes - like under 10%.  They only do low risk births but they include mothers who risk out under their care in their stats which isn't always the case.

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All three hospitals where my children were/could have been born had rates of about 40%, and all three are small town hospitals who do not take high risk births (in fact, I have a friend who was rushed by ambulance to the children's hospital an hour away because she was *one day* before 37 weeks, and they "were not prepared to deal with a premature baby").  My son was born at one of these hospitals, and we were very, very close to being a c-section - fortunately, we had a very good, patient on-call doctor who was willing to work with us.  We moved out of state, and the next two were homebirths, but because I had dealt with our local hospitals on several occasions, I actually had it written into our emergency birth plan that I refused to be under the care of a certain doctor at one of these hospitals.  His c-section rate (and care in general) is truly that bad; I have no idea how he still has a medical license.

 

My mother-in-law is a nurse, and she was terrified of us homebirthing.  I was more scared of going to the hospital!

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Yup.

 

And I don't know if you've ever seen the section stats for The Farm, but they are far far lower than that with good outcomes - like under 10%.  They only do low risk births but they include mothers who risk out under their care in their stats which isn't always the case.

 

Yes, but they are extremely picky about who they take. But even still, there were plenty of big hospitals in the CR article with rates about that. 11%, 13%. Whole states with that rate. Maybe I need to go to South Dakota to have my next kid!

 

(I'm actually lucky, I have a great midwife for out of hospital birth, but not everyone does or qualifies or wants that)

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Yeah, that's half the rate of the hospitals here. Half. That's crazy. And no, no real trends to explain it. 

 

I think the culture among the docters and OBs has a lot to do with it.

 

I had my third baby at a local hospital, they were horrible with sections, and I could give various examples of things they did that were clearly not best practice.

 

It was largely down to an obstetricts team, and department head, that had a very mechanistic and danger-oriented attitude to birth, and a pretty narrow experience of practice as well.

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My understanding based on WHO stats is that over 20% and you start seeing more harm done than good. 

 

Around the world, most women are still having babies in their late teens or 20's. Around here, most women are having babies at 35+. The c-section rate is going to be higher for hospitals serving mostly older moms. You see that with the Kaiser HMO hospitals- the ones in the Central Valley (that serve more Latina moms) have a lower c-section rate than the ones in the San Francisco Bay Area (that serve more white and Asian moms).

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Around the world, most women are still having babies in their late teens or 20's. Around here, most women are having babies at 35+. The c-section rate is going to be higher for hospitals serving mostly older moms. You see that with the Kaiser HMO hospitals- the ones in the Central Valley (that serve more Latina moms) have a lower c-section rate than the ones in the San Francisco Bay Area (that serve more white and Asian moms).

 

Whereas Miami, with a high hispanic population, has a much higher rate than Palm Beach County, with wealthier older moms. But no area should be able to justify over 40%, which is my area. It's just not justifiable. And like I said, it's all the hospitals, not one. So it's not demographics. Central Florida is a pretty diverse area. 

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Around the world, most women are still having babies in their late teens or 20's. Around here, most women are having babies at 35+. The c-section rate is going to be higher for hospitals serving mostly older moms. You see that with the Kaiser HMO hospitals- the ones in the Central Valley (that serve more Latina moms) have a lower c-section rate than the ones in the San Francisco Bay Area (that serve more white and Asian moms).

 

Latinas are also much less likely to get pain medication for any procedure, though. "They're used to it." Ask me how I know. 

 

That said, I agree that many of these studies do not take hospital demographics into account and age is a huge factor.

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I had two C-sections.  One emergency and yes, necessary, the second was elective, by me.  After my first traumatic birth I refused to go through it again.  

 

I had a female doctor.

 

The hospital where they were born seems to have a 35% C-section rate but I can't quite figure that table out on my small screen.

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This held true for me. My first was born in a hospital with a c-section rate of 70%. Insane, right? Looking back I can see all the choices made that contributed to mine, which was likely entirely avoidable up until to the point of breaking my water.

 

The hospital where I had my first two VBACs has a much lower c-section rate and I chose a doctor known for his laid back demeanor in labor, he is very respectful and encouraging of normal birthing. My midwives for the last two have been even moreso. Despite any number of funky malpositions I still haven't had a repeat c-section, but the first hospital made it very, very difficult to avoid without strong advocacy and a doula.

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

My c-section was unwanted, unneeded, and traumatic to me. It made all my futures pregnancies riskier and I fight that every time I have another baby, because in this state VBACs are difficult to have and much of he medical community is unsupportive and direct entry midwives aren't allowed to attend the births without risking their licenses.

 

I'm glad you liked and needed yours. Mine kind of ruined my life for half a year and then has popped up to haunt me four times since then.

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I had hospital based midwives for my first birth. I pushed for four hours before my section. My kid had a 99.99% head and she had been wedged against my pelvis. I lost a lot of blood and had a rough recovery.

 

My second child was premature and breech. Another section. Turns out it's way easier to recover when you don't push for four hours first. If I had a do-over I wish my first section had been scheduled. I wish someone had ordered an ultrasound and explained to me that based on my age and the size of my baby's head I had a 50% chance of a cesarean anyway. This study on fetal head circumference and fetal outcomes is fascinating: http://www.biomedcentral.com/1471-2393/13/106

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The average in the UK is 25%.  This quotation was interesting:

 

"Richmond, based at Liverpool Women’s Hospital – which delivers about 8,500 babies a year, more than any other hospital in Europe – said the increased rate of C-sections was being fuelled by the rise in maternal obesity, obstetricians’ fear of being hit with a lawsuit if something goes wrong during labour, and a small number of women asking to have the procedure."

 

I didn't know that obesity was a risk during childbirth.

 

http://www.theguardian.com/society/2016/jan/31/caesarean-health-risks-c-section-first-time-mothers

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And of course, some women just prefer a hospital birth for many good reaons. We should be doing better by them.

 

 

 

Absolutely. If I got pregnant again, I don't think I'd do another home birth.

 

 

It really gets under my collar that these OB/GYNS complain about women wanting home births or midwives in hospital when the reason is they themselves are supplying unsafe care.  Even if their insurance companies, or the hospitals insurance companies, is insisting - if there was a widespread backlash by doctors refusing to comply, it would make a difference.

 

Yes. I did homebirths because I wanted to avoid a chain reaction of overly aggressive care that might lead to a c-section. I orginally started prenatal care with my oldest at a freestanding birth center with nurse-midwives that was less than one mile from a university hospital. I left there because one of the midwives was such a jerk to me.

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Latinas are also much less likely to get pain medication for any procedure, though. "They're used to it." Ask me how I know. 

 

That said, I agree that many of these studies do not take hospital demographics into account and age is a huge factor.

 

Okay, but how does demographics explain every hospital in my city having the same high rate? It doesn't. People want to believe it is the demographics, but there is more at play here. 

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I wonder why it's considered a negative to have a c-section?

For one, one c-section tends to lead to more for other births. I had a friend who had one with her first. With her second, she couldn't find a doctor that would do a VBAC. She currently has 8 kids, so that first c-section, which may have been unneccessary (can't remember the circumstances), has led to seven more.

 

I've read that Brazil has a 70% c-section rate. When the rate gets so high, newer doctors don't get a chance to learn how to do things to avoid c-sections. The skills get lost and doctors begin to automatically say a c-section is needed because they don't know how to try to get the baby to turn, etc.

 

Another issue is that c-sections mean the baby is colonized by whatever bacteria are in the OR rather than the mother's birth canal. The big difference in gut flora starting out is prompting some doctors to swap c-section babies with bacteria from the mother's vagina in the hope that it will help them get a better start.

 

Finally, unwanted/unnecessary surgeries take longer to recover from and cost more. So this isn't really a Mommy War battle, but rather a battle of reducing overly aggressive care.

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

 

The complications from anesthesia (spinal nerves being damaged, depression to the baby, delay in bonding/first feeding with baby), excessive blood loss, the possibility (likelihood of adhesions in the recovery process), post surgical infections, and a long list of other complications are associated with cesareans.  ICAN.org is a good place to read more about cesarean complications.

 

Babies 1 & 5 were both born by emergency cesarean. I'm glad I got to VBAC babies 2-4.  I have no problems with medically necessary cesareans. I would've died and lost my babies a couple of times over without them (placental abruptions, etc.).  I had complications resulting from my cesareans, though, and I know many others who have as well.

 

I wish that there was greater education and awareness about complications. I wish that there was more discussion about the natural progression of labor.  I wish that more supportive labor care was available.  But I see no need for the mommy wars that go on. 

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

I would encourage you not to take this discussion personally.  A serious national conversation about the gross overuse of surgical delivery is long overdue.  For the vast majority of mothers who give birth surgically and are absolutely fine, and grateful for their safely delivered baby, there is no problem. The problem is societal and cultural, not personal. 

 

It's not fiction that surgical childbirth is riskier, more painful, and more expensive than vaginal birth.  For women who actually require a c-section, doctors and hospitals should do every possible thing to minimize the risks and the expense.  But the risk to ALL mothers and the expenses would be reduced far more effectively by reducing the overall numbers of surgeries.  And there is compelling evidence that surgical birth is greatly overused. 

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Okay, but how does demographics explain every hospital in my city having the same high rate? It doesn't. People want to believe it is the demographics, but there is more at play here. 

 

The cynic in me says: increased billing rates, convenience in scheduling, and a possible pairing with nip/tuck could be at play.  It's not uncommon to get a mommy makeover done with your cesarean in certain parts of the world.  Google c-tuck if you want to learn more about that.  :scared:

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

 

Because surgery that isn't medically needed carries many risks, up to and including death? We are seeing an increase in placenta accrete, for example. A highly serious, dangerous condition for which previous c-sections are a known risk factor. Babies also get benefits from labor, and face risks from c-sections. Not to mention the much higher financial cost. The article quotes the statistic that women are THREE TIMES more likely to die or have serious complications from a surgical birth than a vaginal birth. It seems natural to want to avoid those risks if the surgery isn't actually needed.

 

Now NO ONE is saying we should eliminate c-sections. They save lives!  But heart surgery saves lives too, and I'm so glad we have heart surgery as an option, but I don't want to have open heart surgery if I don't actually need it. Or gall bladder surgery, if there is nothing wrong with my gall bladder. As a general rule, unneccesary surgery is seen as something to be avoided. 

 

I've had a c-section. It hurt like the dickens to recover from. It cost me more money than a vaginal birth would have. My son had fluid in his lungs because it didn't get squeezed out like in a vaginal birth.  If all those things could have been avoided by better, more evidence based care, I think that would be a good thing, right? 

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I wonder why it's considered a negative to have a c-section?

 

 

Having a c-section opens mom and baby up to whole host of risks. It's major abdominal surgery. Therefore, a c-section is something that a good provider should want to avoid in most scenarios.

 

Are there times c-sections are necessary? Absolutely! 

 

But the fact remains that many women are given a c-section when it is not necessary.

 

There are a host of reasons for this. One, for example, is that if a doctor notices something abnormal during birth (like slow heart-rate), he/she then has a decision. Should something be done to alleviate that? If so, what? And in our culture, I am sure many choose to do something and eventually that something is a c-section. 

 

Why? Because if the doctor does nothing and it's the incredibly rare case where something bad does happen, the doctor will get sued (in many cases).

 

The reality is that much of the time, the issues the doctors see are just a normal variation in the birthing process. Many doctors don't know what the spectrum of normal (unmedicated, nonintervention) birth looks like as they don't have lots of opportunities to observe them.

 

Anyway, I'd guess I say the c-sections themselves aren't negative..it's the fact that there are too many unnecessary ones coupled with the risks of abdominal surgery that are negative.

 

Back to the OP, I'd say that both the hospital and doctor can make a huge difference. 

 

I know that I love my homebirth MW. During my first pregnancy I actually made one appt. with a hospital MW to see if I liked that more. I ended up having to cancel the appt. I didn't meet that MW until after DS5 was born and we were having nursing issues. The MW is an IBCLC so I made an appt. to see her. It was awful.

 

I would absolutely, positively rather give birth with my MW in awful circumstances (think her having no access to her supplies, which I can't fathom happening) than see that MW again. So I think the individual dr./mw makes a difference too.

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I wonder why it's considered a negative to have a c-section?

 

I will forever be SO grateful for mine. My baby was healthy, I am alive, my body is undamaged...a total win all around. Sure it was a surprise, but a negative? Not at all. Just one more of those mommy war insinuations that having one (like having only one child) somehow doesn't make you are "real" mother. I'll insert my vomit emoticon here.

 

And if, somehow, that isn't the underlying point of this discussion, I really do wonder is.

I don't think it is the point of the conversation. I think the point is that birth is a normal process and for the vast majority of women in the United States, pregnancy and delivery is considered low risk for adverse events. With this is mind, it would seem that the need for medical intervention in the delivery process should also be low. But, if you look at the tables attached, you can see that it is not the case. In fact, many doctors/hospitals perform C-Sections in over 40% of those cases. That seems like an incredibly high rate for a medical intervention in a perfectly normal event that, by being classified as low risk, was expected to proceed with a vaginal delivery.

 

The results pose several questions that get at the potential reasons behind the high rate of c-sections that can be addressed to improve I've the healthcare of women and children:

 

Physician training

Nurse training

Insufficient Prenatal care and fetal monitoring that lead to the misclassification of low-risk vs high-risk

 

A Cesarean Section is major surgery and has all of the potential complications that go along with it, such as inf cations, reactions to anesthesia, etc.. I think healthcare providers shouldn't rush to expose women and children to these risks.

 

I also think that our litigious society has inevitably led us in this direction. When doctors aren't sure of the outcome, they are more likely, IMO, to opt for a quick, usually predictable, C-section.

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I had hospital based midwives for my first birth. I pushed for four hours before my section. My kid had a 99.99% head and she had been wedged against my pelvis. I lost a lot of blood and had a rough recovery.

 

My second child was premature and breech. Another section. Turns out it's way easier to recover when you don't push for four hours first. If I had a do-over I wish my first section had been scheduled. I wish someone had ordered an ultrasound and explained to me that based on my age and the size of my baby's head I had a 50% chance of a cesarean anyway. This study on fetal head circumference and fetal outcomes is fascinating: http://www.biomedcentral.com/1471-2393/13/106

 

I think that's pretty relative. My sister had her first c-section in a situation similar to yours. Good recovery. Up and around right away. Her second was planned, with the idea recovery would be easier. Instead it took MUCH longer and she was in much more pain. Same surgeon. Same hospital. I honestly don't think we know all the factors that go into the recovery. I wish we did! 

 

I did find that study interesting..I wonder how much is influenced by the doctor assuming or knowing the baby is big, and making decisions on that knowledge? 

 

In totally anecdotal, not statistically relevant info, my last baby was over 10lbs, and had an off the charts head (well over 100 percentile). He was a vaginal birth and my easiest one to push out. I was also advanced maternal age. My first was my c-section baby, and was tiny in comparison. I was in my early twenties with him. Go figure!

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The cynic in me says: increased billing rates, convenience in scheduling, and a possible pairing with nip/tuck could be at play.  It's not uncommon to get a mommy makeover done with your cesarean in certain parts of the world.  Google c-tuck if you want to learn more about that.  :scared:

 

Ha, my sister asked for a c-tuck! But they wouldn't do it. 

 

It very much has to do with billing and with convenience. Honestly, if you add up the inductions and the scheduled c-sections you have pretty much every birth in this city. They honestly look at your strange if you just show up in labor on your own...they assume all women will be scheduled for induction or surgery. 

 

My ex did a nursing rotation in labor and delivery for several months and never saw a single woman not get pitocin during labor, even the few that did show up in labor. Pitocin speeds things up but also increases the risk of fetal distress and a c-section, especially if you have doctors that "pit to distress" because they are predicting a surgical birth anyway, so might as well convince mom and get on with it. 

 

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I didn't read the article. But I have a friend who had a c-section with her 1st. She went on to have 5 successful vbacs. I din't know the specifics... if she moved or just changed hopsitals or what, but for baby #7 hospital policy required her to have a c-section because it didn't allow vbacs. Even though she had already had 5. Unbelievable.

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Is it taking into account those that prefer and ask for a c-section? I'm not sure if doctors are supposed to allow it but it seems like many do. I have one family member who asked for and scheduled all of hers well in advance. There was no medical reason, just her preference. I've known quite a few others who did the same. It's not something I understand at all and they think I'm the strange one for not doing the same.

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Is it taking into account those that prefer and ask for a c-section? I'm not sure if doctors are supposed to allow it but it seems like many do. I have one family member who asked for and scheduled all of hers well in advance. There was no medical reason, just her preference. I've known quite a few others who did the same. It's not something I understand at all and they think I'm the strange one for not doing the same.

 

No, but in other studies/surveys those women account for statistically a very small percentage of cesarean births. Especially if you are talking about first time mothers, as the article was. Culturally though that may very well be a big part of the issue in the highest ranked (highest rate of surgical births in first time, low risk moms). 

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