Interesting article - re: c-section rates

[karinothing]

harvardmagazine.com/2012/11/labor-interrupted?utm_source=university&utm_medium=email&utm_campaign=Oct12Highlights

It does get a little gory in the begining (well it describes the surgery). It is actually pretty interesting and mainly talks about the balancing act surrounding c-sections. I thought this was intereseting

In the broadest sense, attaining an optimal C-section rate may be a matter of finding a middle ground between two approaches to birth and risk—between vigilance toward the “disaster waiting to happen” and support for the “physiologically sound process.” That way, surgery happens when necessary, but is avoided in the many cases when it’s not.

[Deleted]

Thanks for posting. It is interesting - long, but worth the read.

“A balance needs to be reached,” says pediatrician Ana Langer, professor of the practice of public health and coordinator of the dean’s Special Initiative in Women and Health—“that will allow women to have normal deliveries with as little intervention as possible, and at the same time will be ready to address any unexpected emergencies.” She, Ecker, Osborne, Singer, Lieberman—all agree that reaching such a balance is in part a matter of public and professional education. Says Langer, “Doctors, women, and families should know that an unnecessary C-section does involve increased risk.”

I liked that.

[Deleted]

Whew! That was long! lol.

[sunshineluv]

No way can I read it, I had a c section, and I don't like to think about the details. Ignorance is bliss .

[karinothing]

Ha, sorry it is very long! I should have mentioned that

Yeah, Token I liked that too. One of my biggest issues with Obstetrics, is that I fear a lot of the time women are not given the full picture (meaning may not be advised of all risks) when it comes to care. I feel like this is the way it is with a lot of medicine. I am guilty of it too. We are so used to just accepting everything and failing to ask about risk. I remember when DS went to the pedi and they wanted to put him on a medication, I asked about the risk associated with it and was just brushed off. It made me really uncomfortable.

[karinothing]

Oct 23, 2012 14:21:37 GMT -5 sunshineluv said:

No way can I read it, I had a c section, and I don't like to think about the details. Ignorance is bliss .

Ha, well the details of the surgery are only in the first paragraph and there are 200 or so after that if you want to skip it ha ha

PS. That picture is awesome! I just want to squish those cheeks.

[arch01]

Oct 23, 2012 14:22:13 GMT -5 karinothing said:

Ha, sorry it is very long! I should have mentioned that

Yeah, Token I liked that too. One of my biggest issues with Obstetrics, is that I fear a lot of the time women are not given the full picture (meaning may not be advised of all risks) when it comes to care. I feel like this is the way it is with a lot of medicine. I am guilty of it too. We are so used to just accepting everything and failing to ask about risk. I remember when DS went to the pedi and they wanted to put him on a medication, I asked about the risk associated with it and was just brushed off. It made me really uncomfortable.

Looking back at my c/s, this was the case. They told me after almost 2.5 hours of pushing that it was going to be a c/s but didn't explain any risks. Not that I had many options at that point, but...

I am also admittedly bad about asking about risks with medications. I will read up on it, but not have a face to face conversation about it.

[Saudade]

Oct 23, 2012 14:28:57 GMT -5 arch01 said:

Oct 23, 2012 14:22:13 GMT -5 karinothing said:

Ha, sorry it is very long! I should have mentioned that

Yeah, Token I liked that too. One of my biggest issues with Obstetrics, is that I fear a lot of the time women are not given the full picture (meaning may not be advised of all risks) when it comes to care. I feel like this is the way it is with a lot of medicine. I am guilty of it too. We are so used to just accepting everything and failing to ask about risk. I remember when DS went to the pedi and they wanted to put him on a medication, I asked about the risk associated with it and was just brushed off. It made me really uncomfortable.

Looking back at my c/s, this was the case. They told me after almost 2.5 hours of pushing that it was going to be a c/s but didn't explain any risks. Not that I had many options at that point, but...

I am also admittedly bad about asking about risks with medications. I will read up on it, but not have a face to face conversation about it.

I was not informed of the risks (beyond having to quickly sign a consent) because I was 10cm, getting ready to push, and found out DS had flipped breech. There was no time to inform me of risks. I had no options. It truly was an emergency c-section. I'm ok with that. I am ok with not being informed of the risks because at that time waiting was a bigger risk.

[karinothing]

Oct 23, 2012 14:53:02 GMT -5 @msstarry said:

I also am terrified to know the details of my csection. Probably one of the only reasons I am glad I was under general. I am confident csection was the right choice for me but if I don't have the same problems next time I will try for a VBAC. I definitely knew a csection was risky but bleeding to death would've been worse.

I may read the article during a late night nursing session

Yes, I would agree that bleeding to death is not a good plan of action. The article was kind of timely becuase I was just reading a post (on another board) about a woman who is wondering whether she should sue her doctor becuase he cut her baby's face with the scapel during the c-section. The baby was presenting sunny side up (the doctor didn't know). I was surprised becuase I considered this a common risk of c-sections and didn't see the dr as negligent, but realized these things probably aren't mentioned.

[Deleted]

A breech baby is only an emergency because we made it one. The actual risks aren't very high... IF you have a caregiver with experience delivering breech. That's hard to find because we (the societal "we") decided to just section breech births for a few decades.

Stuff like that drives me nuts. My sister delivered a frank breech, no complications. But she's in Australia, so I don't know if that was exceptional or normal there.

[Saudade]

Oct 23, 2012 14:57:14 GMT -5 @tokenhoser said:

A breech baby is only an emergency because we made it one. The actual risks aren't very high... IF you have a caregiver with experience delivering breech. That's hard to find because we (the societal "we") decided to just section breech births for a few decades.

Stuff like that drives me nuts. My sister delivered a frank breech, no complications. But she's in Australia, so I don't know if that was exceptional or normal there.

Unfortunately we've made it a problem. Currently in MN (my state) there is one provider that will deliver a breech baby. My hospital has one midwife, zero ob/gyns, and the rest are GPs. It is over 3 hours away from the one person who will delivery breech. I wish there were more providers and I wish it wasn't something that automatically gets "you" a c-section. I would have loved a vaginal delivery instead of the cesarean. Here's to hoping for a VBAC.

I'm sure either malpractice insurance has something to do with it as well.

[Deleted]

Someone on getting pregnant was already planning her c-section and she's not even pregnant yet. A GYN told her her hips are too small to give birth.

I wasn't really sure how to explain to her that should probably make her angry at the low quality of care, not plan surgery.

[pugz]

I wonder if we will ever see a decrease in the rates of elective c-sections in our time.

[fortmyersbride]

I haven't read the article yet, but I will. I do have to say though, that part of why C/S have increased and breech births have died off is fear of litigation. Just look for the day time legal commercials about "brachial plexus injury", "erbs palsy" and the like. I specifically chose each OB I used based on two criteria: their ability to deliver breech and their performance in an emergent c/s. But the art of breech delivery has certainly gone by the wayside with the increase in obstetrical malpractice rates.

ETA- looks like they did address fear of litigation.

[karinothing]

We have one physician here who will delivery breech, but I think only frank presentation. He is highly sought after.

[atouchofklasse]

Besides malpractice worries, I'd imagine very few OBGYN residents are learning how to deliver breech babies vaginally in residency when no or few attendings do so.

If insurance companies want to reduce c sections, they should cover doula services for those who are interested. Mine was $750 and I would have most likely had a c section without her.

[fortmyersbride]

Oct 23, 2012 16:20:54 GMT -5 karinothing said:

We have one physician here who will delivery breech, but I think only frank presentation. He is highly sought after.

I can believe it. My OB in Western NY was one of 3 in a town of 400k. When his 75 yr old partner retired, they were down to two in the city.

[w2w]

Interesting article. I think good, responsible doctors are always trying to walk the fine line of making sure all women who need c-sections get them while not performing unnecessary surgeries. And most probably error on the side of slightly too many c-sections. But that is how it should be, I think.

[Willis Jackson]

I was a double footling breech born vaginally, but that was the olden days.

I was actually born in the hallway on the way to the OR so there wasn't much decision-making happening on anyone's part.

[h]

One of my best friends recently had a breech baby. She wanted a natural birth and looked high and low for a provider who would deliver her vaginally. She couldn't find one. On the advice of a really bad doula, she stayed home until the last possible minute in hopes that her doctor would be forced to vaginally deliver her breech. By the time she got to the hospital she was fully dilated and wound up with an emergency c-section under general anesthetic. In retrospect she wishes she had scheduled a c-section so she could have at least avoided the unnecessary drama and been awake for her child's birth. But obviously it would have been even better if she could have found a provider trained in vaginal breech births.

[h]

Oct 23, 2012 17:42:39 GMT -5 @champagna said:

Oct 23, 2012 17:34:09 GMT -5 Willis Jackson said:

I was a double footling breech born vaginally, but that was the olden days.

I was actually born in the hallway on the way to the OR so there wasn't much decision-making happening on anyone's part.

One of my friends describes her delivery the same way! Her foot was dangling out of her mom while she was on a gurney in the hallway.

I think I have posted about her on here before, but the attorney who used to be in the office next to me had a vaginal breech birth at home, unassisted. She went into labor and had no idea that the baby was breech until she felt the baby descending and yelled for her husband and he started freaking out and yelling "it's a foot!" It was a crazt story, but everyone was fine. (She had planned a homebirth with a midwife, but the midwife didn't get there in time.)

[h]

Oct 23, 2012 17:49:23 GMT -5 @champagna said:

Oct 23, 2012 17:47:03 GMT -5 h said:

I think I have posted about her on here before, but the attorney who used to be in the office next to me had a vaginal breech birth at home, unassisted. She went into labor and had no idea that the baby was breech until she felt the baby descending and yelled for her husband and he started freaking out and yelling "it's a foot!" It was a crazt story, but everyone was fine. (She had planned a homebirth with a midwife, but the midwife didn't get there in time.)

I am freaking a bit just reading these! lol.

I'm glad that I'm done with childbirth now.

No offense, hens.

I have had two nice, non-complicated vaginal births, and now I am totally freaked out about something crazy going down this time, since three good births seems like too much to hope for. I really, really don't want to have a breech baby alone in my bathtub!

[karinothing]

Oct 23, 2012 17:54:01 GMT -5 h said:

Oct 23, 2012 17:49:23 GMT -5 @champagna said:

I am freaking a bit just reading these! lol.

I'm glad that I'm done with childbirth now.

No offense, hens.

I have had two nice, non-complicated vaginal births, and now I am totally freaked out about something crazy going down this time, since three good births seems like too much to hope for. I really, really don't want to have a breech baby alone in my bathtub!

Ha, our birth center gave us all this paperwork including a neon colored sheet about how to deliver a breech baby (it included turning the baby vaginally!). I was like umm please don't let this be me!

[SusanBAnthony]

Oct 23, 2012 15:18:50 GMT -5 Saudade said:

Oct 23, 2012 14:57:14 GMT -5 @tokenhoser said:

A breech baby is only an emergency because we made it one. The actual risks aren't very high... IF you have a caregiver with experience delivering breech. That's hard to find because we (the societal "we") decided to just section breech births for a few decades.

Stuff like that drives me nuts. My sister delivered a frank breech, no complications. But she's in Australia, so I don't know if that was exceptional or normal there.

Unfortunately we've made it a problem. Currently in MN (my state) there is one provider that will deliver a breech baby. My hospital has one midwife, zero ob/gyns, and the rest are GPs. It is over 3 hours away from the one person who will delivery breech. I wish there were more providers and I wish it wasn't something that automatically gets "you" a c-section. I would have loved a vaginal delivery instead of the cesarean. Here's to hoping for a VBAC.


I'm sure either malpractice insurance has something to do with it as well.

Where are you in MN? There is a dr. in Hudson (Dr. Hartung i think) who will deliver breeches, but based on your description of the hospital I am guessing you aren't near the twin cities. But I know people who know they have beeches in advance will come down to the cities and have him deliver, if you can logistically arrange to stay with family or in a hotel or whatever while waiting to go into labor. Sounds like your baby turned too late for that to be a choice in any case though.

[Saudade]

Oct 23, 2012 18:41:26 GMT -5 SusanBAnthony said:

Oct 23, 2012 15:18:50 GMT -5 Saudade said:

Unfortunately we've made it a problem. Currently in MN (my state) there is one provider that will deliver a breech baby. My hospital has one midwife, zero ob/gyns, and the rest are GPs. It is over 3 hours away from the one person who will delivery breech. I wish there were more providers and I wish it wasn't something that automatically gets "you" a c-section. I would have loved a vaginal delivery instead of the cesarean. Here's to hoping for a VBAC.


I'm sure either malpractice insurance has something to do with it as well.

Where are you in MN? There is a dr. in Hudson (Dr. Hartung i think) who will deliver breeches, but based on your description of the hospital I am guessing you aren't near the twin cities. But I know people who know they have beeches in advance will come down to the cities and have him deliver, if you can logistically arrange to stay with family or in a hotel or whatever while waiting to go into labor. Sounds like your baby turned too late for that to be a choice in any case though.

Yep that is who I was thinking of. If DS had been breech during the pregnancy I would have tried everything possible to turn him and then tried to have gotten in wiht Dr Hartung. Unfortunately he flipped somewhere between 5cm and 10cm and it wasn't feasible. I've heard good things about Dr. Hartung though.

I'm in western MN and have very limited options. Next time I will have to drive an hour one way just to have a VBAC.

[hannamaren]

I had a friend ask her OB for a csection for no reason other than fear. She joked about it at first and then one day he told her that he would drop her as a patient if she was serious. I respect that.

I had a c/s. the doctors seemed scared to suggest it in case I was mad/upset, etc. they were surprised at my "sure, lets do it" reply. The baby's heart rate kept dropping, .i wanted her out.

[SusanBAnthony]

Oct 23, 2012 18:49:47 GMT -5 Saudade said:

Oct 23, 2012 18:41:26 GMT -5 SusanBAnthony said:

Where are you in MN? There is a dr. in Hudson (Dr. Hartung i think) who will deliver breeches, but based on your description of the hospital I am guessing you aren't near the twin cities. But I know people who know they have beeches in advance will come down to the cities and have him deliver, if you can logistically arrange to stay with family or in a hotel or whatever while waiting to go into labor. Sounds like your baby turned too late for that to be a choice in any case though.

Yep that is who I was thinking of. If DS had been breech during the pregnancy I would have tried everything possible to turn him and then tried to have gotten in wiht Dr Hartung. Unfortunately he flipped somewhere between 5cm and 10cm and it wasn't feasible. I've heard good things about Dr. Hartung though.

I'm in western MN and have very limited options. Next time I will have to drive an hour one way just to have a VBAC.

I had a friend who delivered with Hartung, who had a known frank breech, and in labor baby flipped to footling breech and they didn't realize it until there were dangling feet. Thank god she was with a breech-experienceed doc. i hate the idea of ob's not having breech experience bc sometimes babies change position fast.

[Saudade]

Oct 23, 2012 20:18:46 GMT -5 SusanBAnthony said:

Oct 23, 2012 18:49:47 GMT -5 Saudade said:

Yep that is who I was thinking of. If DS had been breech during the pregnancy I would have tried everything possible to turn him and then tried to have gotten in wiht Dr Hartung. Unfortunately he flipped somewhere between 5cm and 10cm and it wasn't feasible. I've heard good things about Dr. Hartung though.

I'm in western MN and have very limited options. Next time I will have to drive an hour one way just to have a VBAC.

I had a friend who delivered with Hartung, who had a known frank breech, and in labor baby flipped to footling breech and they didn't realize it until there were dangling feet. Thank god she was with a breech-experienceed doc. i hate the idea of ob's not having breech experience bc sometimes babies change position fast.

Ahh that is scary!

Do you know anyone that delivered at Health Foundations birth center? I'm trying to convince DH that I can make a 3 hour car drive while in labor to deliver there next time.

[curbsideprophet]

Interesting article. I do think something needs to change and there are unnecessary c-sections being performed. I think moving more low risk patients to a midwife model of care could be helpful. I also like the idea of a doula for everyone who wants one.

[Deleted]

When I was pregnant with my daughter my younger brother was dating an OB/GYN. We were both visiting my parents one weekend and he asked me if I was planning to have a C. I said I hoped not and wondered why he asked, and he replied that his girlfriend had told him I should have one because that way my "junk" would not get "messed up." (I'm sure these were not her exact words.) I was speechless.

Luckily the (now ex-) girlfriend is JUST a gynecologist these days... she dropped the OB part a few years ago. Wonder why.