Don't know why women think csections are easier. I had two, due to high blood pressure (first was induction that stalled out, second was straight to OR). It's really not fun at all to have your gut sliced open and sewn back shut. Only reason I did it was for the babies health.

distocia is not the only indication for c section

Previous c section that was not done with a low abdominal horizontal incision, previous uterine rupture, and increased fetal size are only a few of the other indications. So the 5-10% number you quote is probably inaccurate

that being said, the section rate in the US is probably a bit high. I wouldn't blame it all on greedy docs and hospitals though

For one, even if the delivery takes >24 hours, the doctor is not there for the entire time--just the crucial portion, so this scheduling issue you bring up is not as big a factor as you suggest

Also, women often prefer the convenience and relative ease of a section vs a vaginal delivery.

Eric, even the ACOG says that a suspected large, or macrosomic, baby is not an indication for a c-section, especially since late-stage ultrasounds can be off by up to 2 pounds in either direction.

Don't know why women think csections are easier.

I don't think it's necessarily that women think c-sections are easier. A lot (maybe even most) occur because of intervention (induction, epidurals, and other drugs). Women today are so afraid of the pain of labor that they don't think they can deliver without drugs.

And, of course, doctors and nurses don't want a women to have a long, drawn out labor, so they give her pitocin to speed it up. This causes more pain for the woman, so she decides to have an epidural. The epidural and pitocin counteract each other, and that is what puts stress on the baby and makes a c-section "necessary". But, in reality, if the doctors would let the labor progress naturally, and if women would have faith in their bodies, c-sections would be obsolete.

Jedi,

not completely correct

http://www.ncbi.nlm.nih.gov/pubmed/8174008

For the very macrosomic infants (>4500gms) c section is indicated

aphill,

any evidence for the epidural/pitocin interaction? I've never heard of that

How does that put "stress" on the baby

And some women definetely think c section is easier. Because it is. I'm not saying its the right way to go--personally, i think in most cases its not

But a 1 hour procedure is obviously easier than traditional vaginal delivery. I shouldn't need to repeat that

But a 1 hour procedure is obviously easier than traditional vaginal delivery. I shouldn't need to repeat that

And yet your logic is flawed. The trauma to the body of one hour of surgery increases recovery time beyond that of the length of a normal labor and delivery.

eric- at least in my experience, that's true. For my first, they induced me (pitocin) due to high blood pressure. I wanted to go without drugs, but wasn't allowed to even sit up, much less walk to speed the process. They figured out that the pitocin was making me have contractions with no actual break between, and I eventually gave in to the epidural. After that, I didn't make any progress at all, and ended up with a csection.

any evidence for the epidural/pitocin interaction? I've never heard of that

Well, first of all, pitocin works by increasing the intensity of contractions and making them more frequent, which causes a great deal more pain for the woman. The epidural weakens the muscles below the epidural site, which can dampen the strength of the contractions. So, often times doctors will up the pitocin. Some babies simply do not tolerate pitocin-induced contractions, which results in abnormal fetal heart-rate and making a c-section necessary.

For one, even if the delivery takes >24 hours, the doctor is not there for the entire time--just the crucial portion, so this scheduling issue you bring up is not as big a factor as you suggest

Your logic is flawed here as well. It's true that a doctor is usually only present for the delivery (and maybe periodically for checks) of a vaginal labor, but who the heck knows when that will be. Some women are in labor for only a few hours; some for more than a day. The doctor, who wants to spend time with his family or meet his buddies on the golf course, doesn't want to be at the hospital at midnight delivering a baby.

A doctor can perform a c-section, have the baby out, and the woman sewn up in a matter of minutes and be home for dinner.

the idea of physicians spending time on the golf course is old school/out dated. It is the rare physician that has that kind of time anymore. I do believe that induction of labor before 40 wks gestation and high dose pitocin protocol does contribute to c-section rate. Epidurals can actually speed the dialation of the cervix in active labor, probably because relaxation of the pelvic muscles help the baby's head apply to the cervix better.

Erik

Distocia is not the only but is the main indication, Macrosomy is an indication if cephalopelvic proportions are out of range, previous c-section can be an indication if there is less than 3 years between pregnancies, preeclamsia-eclapmspia syndrome is also an indication. The rate of 10% is the one used by WHO and PAHO as the low limit, the high limit is between 15% and 20% depending on the nutritional status of the mother (malnutrition or morbid obesity)

I did not state that greed is the ONLY reason, the main reason is that it is easier and effective for doctors and hospitals, greed is a by product. Also there is the legal issue, if complications rise, the doctor and the hospital can use the c-section as a defense "We did all that is possible". You do not believe on the rates me? easy to corroborate, look at the c-section statistics and you will see two big peaks, one on the weeks leading to winter break and another during summer, reason... yo can make your own conclusions. Also, some mothers to be ask for a C-Section believing that the complications and sequelae are less that from vaginal birth.

On a recent study in Ohio where the rate found was below the national median but still high (15%), thus the doctors were to provide MEDICAL REASONS to each c-section, magically, the rate came down to around 5% in the following 15 months. Conclusion: There are NO MEDICAL REASONS FOR MOST OF THE C-SECTIONS.

It only takes about a week or two to recover from a vaginal delivery and a minimum 6-8 weeks for a c section. My wife was up and walking the next day after a vaginal delivery and it was a difficult delivery. This would have been impossible after a c section... She was fully healed up in about two weeks and went back to work with no issue after four.... A c section is much tougher for the body since it isn't designed for it.

the idea of physicians spending time on the golf course is old school/out dated. It is the rare physician that has that kind of time anymore.

I wasn't really serious when I said they spend their time on golf courses. Maybe some do, but it was meant to be tongue in cheek.

Epidurals can actually speed the dialation of the cervix in active labor, probably because relaxation of the pelvic muscles help the baby's head apply to the cervix better.

I'm sure that epidurals might speed up the process in some women. But, everything that I have read and women that I know who have had an epidural say that it slows it down. Everyone is going to react differently to drug interventions. But, studies have shown that the more intervention, the higher the likelihood of a c-section.

Ramfla - right on. Ignoring all the other work and mess our health care system is in at the moment, there do need to be some rules or something in place that basically state a medical reason for the c-section. Ease or fitting someones schedule (patient, hospital, or doctor) is not a medical reason. This needs to stop and should not be happening. A first world country with rates this high is outrageous. Natural birth should be pushed for, no pun intended, from day one. There is a reason our bodies do certain things or why processes work a certain way and we need to stop trying to change that so much. It may not be that way for everything but the sooner we get that back to making that status quo and find that balance the better off we all are. It is time to find that balance and make sure we stick to it. C-sections need to go back to being an option only when needed and when nature's way isn't working.

Women need to be in more control of their own labors. Women need to educate themselves. You don't think that a doctor can conjure up a medical reason to have a c-section if he wanted to?

An obstetrician is a trained surgeon. In every other civilized country in the world, that's all that they do; they do not take part in a natural childbirth.

eric-2573068,

Your link is outdated...that study was in 1994.

In 2001, the ACOG issued very specific guidelines about macrosomia.

From the article:

“The diagnosis of fetal macrosomia is imprecise . For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold’s maneuvers).

… [R]andomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown.

Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered.”

Also, in a 2001 study (Management of Suspected Fetal Macrosomia), macrosomia is not a good definer of dystocia in and of itself.

From the article:

“Unfortunately, case series indicate that one half of all cases of shoulder dystocia occur at birth weights of less than the most commonly used cut-off—4,000 g. Furthermore, almost one half of all cases of permanent brachial plexus injuries occur in infants weighing less than 4,500 g.”

lets see if i can address all these posters one by one

tx mom:

I never said a c section was less traumatic on the body, only easier on the woman. 1 hour compared to 24 hours is in the short term, easier. I agree that the long term consequences and short term risks are higher. Again, I never stated otherwise. I was only stating what I believe some people's PERCEPTION is

aphill

being paged in for an hour is worse than getting a c section overwith, I definetely grant you that. But you implied that the procedure was 24 hours and didn't mention that the doctor doesn't need to be there the whole time. Its not that my logic is flawed, its that your story has changed

As for the pitocin/epidural interaction, i understand the mechanism of each therapy. What i was asking from you was EVIDENCE that this creates more c sections

ramfla--I can't really honestly find any logical points to debate in your post. You agree with everything I have said yet come to different conclusions. Dystocia is not the only indication for a section, thus defining the rates of sections based on dystocia is imprecise. That was my only claim--it negates your greed argument. As for your other claims--evidence please

eric 97--see above. I never said sections were better or less traumatic than vaginal deliveries

Jedi:

I see that you are selectively quoting. Here's an excerpt from the same paper you cite

Recommendations based primarily on consensus and expert opinion (Level C):

• Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes

At best, we can only say it is controversial at this time

I had my 1st. C-section in Aug. 1968. I had been in hospital for a wk. over July 4th. on strict bed-rest. I had toxemia & pre-eclampsia. ( Still not sure if I went into full Eclampsia, but my mind has blanks from that time-could be the scopolamine.) In those days they did an X-ray to get the baby's position. I tried labor for 24 hrs. after being in hospital a 2nd. time along with Pit. Nothing! I never made it past 3cm. In those days, it was called, CPD-Cephalic-pelvic-disportionment. In others words, my darling little boy whose head was small ( we had a hard time getting hats to fit him & he wasn't microcephalic ) when he was born, just wasn't going to fit through my abnormally narrow pelvis. This was the "classic" REASON C-Sects. were done then. IT WAS RARE! Other than my sister-in-law, none of my friends or relatives had one. I had a Board Certified OB/Gyn. I had a 2nd. one 6 yrs. later after a bad infection from the 1st. when we had been told I couldn't have any more. I didn't care that the uterine rupture rate was <1%, I'd not had the low cervical kind of incision I had when I had my hysterectomy & did not want to take a chance. In those days, they were doing a midline vertical incision.

IT AIN'T EASY! Everyone knows that the rates are too high, but so few truly understand why. The reasons given above all are inclusive in it. But I have always felt I missed out on one of the greatest experiences of my life by not having a vaginal aka "natural" delivery. But my sons were well worth it, anyway.

(Retired Nurse)

Eric,

Basically, you said the same thing I did. We both said that prophylatic c-sections may be indicated for over 5,000 grams. However, how do you figure out what the actual weight of the baby is? From my second link:

"CLINICIAN ESTIMATION OF FETAL WEIGHT

The volume of amniotic fluid, the size and configuration of the uterus and maternal body habitus complicate estimation of the size of the fetus by palpation through the abdominal wall.13 Several studies have documented mean errors of about 300 g (11.6 oz).13,14

ULTRASONOGRAPHY

Ultrasonography has been proposed as a more accurate method of estimation of fetal weight.15 Unfortunately, the typical mean error ranges from 300 to 550 g (11.6 to 19.4 oz).13,14,16 A study comparing fetal weight estimates of clinicians, multiparous patients and ultrasonography found that ultrasound was the least accurate of the three methods.13 Limitations in the sensitivity and specificity of ultrasound have been observed in other studies.15 Despite these limitations, clinicians continue to incorrectly believe that ultrasound is an accurate way of predicting macrosomia.17"

How can it be said that suspected macrosomia is an indicator for c-section when no one can even predict what the weight of the baby will be?

But you implied that the procedure was 24 hours and didn't mention that the doctor doesn't need to be there the whole time. Its not that my logic is flawed, its that your story has changed

When did I imply any procedure that was 24 hours???

As for the pitocin/epidural interaction, i understand the mechanism of each therapy.

Really??? Because when you said:

the epidural/pitocin interaction? I've never heard of that

How does that put "stress" on the baby

That led me to believe that you didn't understand.

EVIDENCE that this creates more c sections

Labor epidurals alter the physiology of labor and increase risk for numerous adverse effects. Undesirable maternal effects include immobility, voiding difficulty, sedation, fever, hypotension, itching, longer length of the pushing phase of labor, and serious perineal tears. Undesirable fetal/newborn risks include rapid fetal heart rate, hyperbilirubinemia, increased workup for sepsis and administration of antibiotics (due to fever in mothers), and poorer performance on newborn assessment scales (Leighton and Halpern 2002; Lieberman and O'Donoghue 2002; Mayberry, Clemmens, and De 2002). The spinal variant of this regional analgesia method is associated with increased likelihood of bradycardia, or abnormally low heart rate, in the fetus (Mardirosoff et al. 2002). Under some conditions—when initiated early in labor or when used with low- as opposed to high-dose synthetic oxytocin—epidural appears to be associated with increased likelihood of cesarean section (Klein 2006; Kotaska, Klein, and Liston 2006).

The reasons for the high rates of C-sections are exactly the same as they were 20 years ago:

1) A c-section brings in more revenue than a vaginal delivery. There is intense pressure from hospitals and physicians' practices themselves to do more c-sections to produce more revenue. There is even pressure from drug companies and even medical supply houses because more C-sections increase all their revenue streams.

2) A c-section is less time consuming. You wheel her into the operating room on a schedule, you "pop the kid" and you wheel her out. All done on a neat schedule with more "efficient use of expensive resources" such as operating rooms and staff. None of this old-fashioned waiting around on Mother Nature to do her job.

3) This is less upsetting to the OBGyn physician's schedule allowing him to see more than twice the number of patients. It also minimizes disruptions to their gold games.

4) Even insurance companies LOVE c-sections. Insurance companies make their money by taking about 30% off the top of each health care dollar. the more dollars spent the more they make. It is a fallacy that insurance companies do not favor expensive treatments for common ailments. They best like to contain costs in cases, such as terminal cancer, where it is all payout and no future income due to likely mortality.

5) Physicians find it exceptionally easy to talk pregnant women into c-sections. They tell them horror stories about vaginal deliveries and shame them with "Don't you want what's best for the baby?" and tell them of "possible" problems if they don't have a c-section.

6) And the biggest and best is last --- physicians are trained that "once a c-section, always a c-section." This is complete nonsense and strongly contradicted by scientific or medical evidence. These are4 the same physicians that believe that a person should drink 8 big glasses of water a day and that the "normal" human temperature is 98.6 degrees. Poor training makes physicians do stup[id things.

C-sections are often cited in attempts to explain why the United States has the poorest infant mortality in the Western Hemisphere. Infant mortality is often cited as the "gold standard for health care delivery" or "the canary in the mine" for the health of the health care system. The US has slipped from 37th to 50th in overall health care rankings and from 50th to "unranked" in infant mortality. (The unranked rating comes from the refusal of the CDCP to provide any infant mortality statistics for the past 7 years. Their strategy seems to be that if they keep the numbers secret that no one will notice that we have third-world health care)

jedi,

Im not an ob-gyn. I honestly have no idea about pre-delivery estimation of fetal weight. The only thing I said was that dystocia was not the only indication for c-sxn, which we agree upon. Im sure that errors of 10% at most are acceptable to most ob-gyns to proceed with c sxn if they feel its necessary.

The problem is is that most lay people think medicine is a much more exact science than it actually is. Margins of error of 5-10% are not uncommon at all in practice

aphill,

Not hearing of something is completely different than not understanding.

As for the problem of reducing contractions with an epidural, you just need to make sure you don't administer the epidural before full dialation and your supposed interaction is much less of a problem

Eric,

As far as the epidural goes, you can't dilate all the way before giving it. If the baby is going to be born very soon, it often will be withheld because of respiratory depression in the baby (per L&D RN).

eric

Epidurals are not the only factor that contribute to c-sections. It's like a domino effect or the perfect storm. Interventions lead to more interventions which make it more likely that you will have a c-section. Are you of the opinion that a vast majority of c-sections that are performed in the U.S. are medically necessary from the start? That is, that the woman would have been unable to give birth vaginally under different circumstances (no interventions)?

jedi,

when i was delivering babies we always waited to full dilation. The baby will not be born soon if the cervix isn't dilated--for example, youre going to have a real tough time pulling a baby through a 4cm opening. I'd be interested in what your RN thinks of that

In fact, fetal respiratory distress in a non dialated woman is an indication for c section :)

chris,

I don't even know where to begin. there's as much evidence for your claims as for the existence of bigfoot.

No one puts pressure on obgyns for c sections.

Show me the revenue difference and prove to me its substantial

as far as your paranoid thoughts about ob-gyns--you act as if they are completely inhuman greed monsters that are slaves to the almighty dollar, and the health care empire in the US

I always ask people that share your opinion, "what would you do if you were the doctor?" If the answer is treat people kindly rather than rip them off blindly, then I ask you why you accuse doctors of doing otherwise

What makes you so much better?

aphill,

show me where I said epidurals are the only factor contributing to c-sections. In fact, show me where I said anything even close to that

show me where I said epidurals are the only factor contributing to c-sections. In fact, show me where I said anything even close to that

I was not trying to imply that you said that epidurals are the only factor. I was merely emphasizing my argument pertaining to interventions, in general, leading to c-sections. Now, perhaps you could address the question I asked in #1.25.

I am not a clinician. I have worked in major medical facilities in both PA and in FL in HIM, coding, breast imaging and admitting at one time or another. Each of my three children have been delivered by c-section for varying medical reasons, not for convenience or scheduling purposes and IMHO the rate is too high for any other explanation than the amount of money involved. Women have paid a steep price with respect to anything and everything related to ob/gyn issues by not doing enough of our own research on everything from the safest method of delivery for both mother and baby to birth control pills to the more invasive types of birth control devices. From pills and patches to lessen the number of menstual cycles. We should stop being so willing to be guinea pigs and lab rats. The least invasive, the better unless absolutely necessary. It has been said that Ethel Kennedy had all of her children by c-section. 11 or 12 kids they had! And she has one of the most widely recognized names, not to mention access to the best medical care, around. If this could happen with all of her vast resources, one can only imagine what goes on with Jane Doe. I find it hard to believe that 1 in 3 women have sufficient medical needs for a c-section. 1 in 3!?!?

I will never believe that a c-section is easier then a vaginal birth...that it just insane. I had my daughter...no drugs and totally natural and was pretty much back to normal life in about 2 weeks...my son was breech, I chose to labor did not want c-section, did so for 15 hours prior to having an emergency c-section...it was absolutely the worst experience of my life and took almost 3 months to get back to a semi normal life and to this day I have resentments about that birth. In my view...c-sections should only be performed when absolutely necessary!

aphil "if the doctors would let the labor progress naturally, and if women would have faith in their bodies, c-sections would be obsolete."

and if men had babies, there would only be c-sections.

I find it funny that its mostly men commenting on this page. and it sucks that we can never now how true my statement above is - and men, will undoubtedly hang their hat on that when telling women what they should and shouldnt be doing...just like abortions.

Eric,

Sorry, I was not very clear in my post. I meant that the epidural would be withheld if birth was imminent (ie, full dilation) because of respiratory depression in the newborn baby, often resulting in resuscitation and NICU stays.

Also, you said:

No one puts pressure on obgyns for c sections.

The doctor in this story was told by the hospital she worked at to double her c-section rate. So yes, it does happen.

Sorry, here is the link. It wouldn't let me post...

@eric,

The cost differential between an uncomplicated vaginal delivery and an uncomplicated c-section is about $3,000-3,500 versus $26,000-30,000. This would mean about $300 "overhead" for an insurance company versus about $10,000, even though the paperwork would be nearly identical.

My wife has sat in clinical meetings where pressure was applied to OB-Gyns to do more c-sections versus vaginal deliveries. We have friends who are health economists and they report that it appears to be simple greed. My wife is not a physician but has served in a number of medical schools including Penn and Emory, (she does outcomes research) two who promote "enhanced c-sections" as an "important revenue source subject to being grown considerably."

Nowhere did I say that I was better or thought that I was better. But I WILL say clearly that we have a third-world medical system and this country, despite its wealth, has the worst infant mortality in the Western Hemisphere -- the best is the much-maligned Cuba. Americans seem to live in a medical fantasy world where all physicians are kindly and where all illnesses are cured. The truth is that the system is badly broken. Medical malpractice is the 5th leading cause of death in this country which also has the highest malpractice rates in the world. If the United States cannot have a medical system that is even close to that of Cuba, why do people still have any confidence in it? That's the main reason for the medical fantasies --- people are simply to face the facts (per Pew research.)

There are lots of great physicians. People who sincerely felt a calling and responded. People who would never question a patient's ability to pay as a reason to withhold treatment. People who are conscientious in every way. But there are more who are concerned with the guarantee of $250,000 a year to start and who complain about everything having to do with oversight and who consider poor patients as something to be rid of quickly. They never make great physicians, not matter how much money they make. They just don't have the "right stuff."

You have to remember before you dismiss the for=profit health care industry as something benign --- 60% of all bankruptcies are caused by unanticipated medical bills and of that 60%, 40% have what they termed "adequate" or better health insurance. You yourself are but one illness away from bankruptcy --- and out medical system placed our healthiest people more in risk of bankruptcy than death. Not a bad thing to do if you're a greedy, self-serving for-profit medical industry.

Oops, that was supposed to be $900 not $300, Wireless keyboard with batteries getting low.

The US does not have third-world health care. I'm not sure what quacks or hospitals Chris is visiting.

The claim that the U.S. has "worst infant mortality rate in the western hemisphere" is completely false. It is an old canard that has been debunked.

There are several reasons cited for higher infant mortality.

1. More high risk women get pregnant through fertility treatment.
2. Discrepancies between countries reporting infant deaths.
3. US has a liberal definition of live birth, single heartbeat outside the womb regardless of birth weight or gestation. Other countries have a tighter criteria including minimum birth weight, length, or duration of life to be counted as "live birth".

But back to the original topic. I haven't seen anyone mention the advancement and safety in the C-section procedure as a reason for the increase. Mothers could be opting for the procedure as the risks to complications drop.

Also, who can say what the exact ratio of vaginal birth to c-section should be? Maybe 20 years from now it will settle at 50%.

@theAntisocialist

The US, indeed, does not have a 3rd world healthcare system, provided you have the money to pay for it. If you don't then the system is worse than many 3rd world countries I personally know (I work in the healthcare environment internationally).

As for the assertion "The US has the highest mortality rate in the western hemisphere" it is obviously a false generalization made on the common use of Western Hemisphere as Europe and the USA/Canada. This has not been debunked, not at all. From the CIA world factbook (which I believe you cannot state as a liberal source) the US ranks 46, and yes, it is the highest of the traditional Western hemisphere.

The discussion is on the unnecessary c-sections, not on the undeniable advancement of the medical arts. and this has nothing to do with Liberal definitions, who shall say which ratio should it be? it is established as around 20% according to international medical organizations

a lot of people have commented here that there is pressure on obgyns to do more c sections

Let me tell you the easy response: "or what?"

What can a hospital hang over a dr's head to get him to bend to their will? Drs are independent contractors in a hospital. Believe it or not, they need drs more than drs need them, especially with private same-day surgery centers.

Even drs working for a hospital wouldn't bend to that, because that kind of behavior is grossly unethical and would get the CEO, CFO, President, VP, and janitor fired.

Come on guys, think about these scenarios you are outlaying for 2 seconds

chris,

This website shows the medi-cal reimbursement for vaginal delivery for c section vs vaginal delivery

http://www.chcf.org/~/media/Files/PDF/C/PDF%20ComparingCPTCodePayments.pdf

Vaginal delivery 59409 480.80

Cesarean section 480.64

Virtually the same. Your argument does not hold water

Ram Fl....You state that the poor in our country are facing a 3rd world care system....Have you ever seen the conditions of hospitals and clinics outside of the US? I have...and on the worst day of the worst Hospital in the Untied States we still have better options for people than many countries. We actually have better care facilities than the NHS system in the UK. I haven't seen the French system. I understand from a relative that the care in Canada is good but then he was a critical case and spent 24 hours sitting in a chair receiving care while he was bleeding out. He was insured and they accepted his insurance but still no beds. 24 hours in what amounts to a dinette set style chair...is that actually good care. On the up side after several days in the hospital they did find the bleed and repaired the problem. Mexican hospitals are really raw...Guatemala is a third world country and certainly lives up to their title...Costa Rica has reasonable care standards with nice facilities and competent Doctors.

So what do you base your American has 3rd world care for the poor on?

Txmom

Did you read my whole post?

(I work in the healthcare environment internationally).

It is part of my job to not only see but interact in a daily basis with a vast majority of hospitals throughout Latin America and the Caribbean. I am in constant touch with most western European systems and with some Asian ones. So I can attest to the quality of care.

I still state and will defend my view that the uninsured and the poor in the USA have a 3rd world country healthcare. Even more, this is the best country to have an exotic disease, but try to get treatment for a common illness and you will not get it.

RamFla...Please defend your statement. What about US care is third world? Certainly not the practitioners that are licensed for care in the United States. Our Hospitals serve first and get paid later. Most Cities are not void of minor emergency clinics...Rural communities offer care. The Government is very generous with Medicaid for the poor. States offer very inexpensive or free insurance coverage through SCHIP for kids which has also been expanded to some adults. The Government has made access available to people through Federal Funding. The medical industry provides a network of care. If people are barred from care it is of their own choosing and personal neglect for their own health.

At some point individuals must take responsibility for their own care. Low income has in some ways better access than those insured but the adult in the family must do their part to assure they are covered.

No one has the right to say that i couldn't have a c-section if i wanted one. i dont think it's fair for doctors to say that either. it's my body, i should be able to deliver which ever way i choose.

unless of course it would be lethal to the baby or myself.

but saying someone should stop unnecessary c-sections is like saying, you shouldn't be allowed drugs during labor.

No one has the right to say that i couldn't have a c-section if i wanted one. i dont think it's fair for doctors to say that either. it's my body, i should be able to deliver which ever way i choose.

I agree with you. If you want a c-section, that is your choice. But, the sad thing is that so many women who get c-sections didn't want them in the first place. Women need to educate themselves about the labor process and the choices that are available to them. The hospital industry is taking advantage of our ignorance and fear.

also true aphill!

If you demand vaginal delivery and overrule the doctor then why even have a doctor in the delivery room?

Under Obama-care you would probably have to go to the nearest Post Office or IRS office and discuss your options prior to the birth. They may or may not allow a C-section depending on the expense involved. If the national debt grows Obama-care may demand home deliveries only and have the father serving as the midwife. It would save a lot of money. And there have been millions of deliveries outside of hospitals that were successful.

If you demand vaginal delivery and overrule the doctor then why even have a doctor in the delivery room?

That is a very good point, Bill. The fact is you don't need a doctor for a low-risk natural birth. When is a doctor in the hospital room anyway? Is he/she there with you the whole time? No, the doctor is there to catch the baby and be alerted by nurses if something goes wrong. Doctors are hardly there for the process at all. Hospitals provide low-quality, unpersonalized care when it comes to childbirth.

I realize I'm at risk of stirring the pot here, but I find it interesting so many people insist we must stop these unnecessary c-sections like it's their God given right to dictate their opinion on others, yet will scream until their last dying breath that it's my body, my choice when it comes to abortion. This is a choice between a woman and her doctor. While I'll agree that it seems an insane choice to OPT to have your belly sliced open to do what our bodies are designed to do quite effectively without any sort of intervention at all, that's my choice. If my doctor agrees and either I or my insurance company is willing to pay for a c-section, why shouldn't the option be available? Its my choice to take the risk associated with major surgery. It's my choice to opt for the longer recovery time. Its my choice to risk limiting myself to c-section deliveries only for future pregnancies. If I have a choice to end a pregnancy before a live birth, why should I have fewer choices available to end a pregnancy resulting in live birth?

Suzy, a huge problem with the c-section epidemic is that women are not given any choice in the matter. “Informed consent” in the birthing world has fallen by the wayside in a lot of cases. When an OB says “you need to have x procedure,” how often do they actually explain the risks to you? In my experience, they don’t, even when asked. And don’t even get me started on the court-ordered c-sections and CPS threats if the mother refuses any test/procedure, even if she doesn’t have the risks…

Lets see, if you "choose" to do a c-section, and it is not a necessity, then you should have to pay out of pocket. Here are some reasons why: You are in the hospital an extra day, the next time you get pregnant, you cause a risk of that incision scar bursting open, it makes it riskier to develop placenta previa your next pregnancy, should I keep going on?

Unnecessary C-sections= higher risk consecutive pregnancies= more money dished out by insurance companies. Your decision effects MY health insurance. So before you start with "its my body", yes it is your body, but its everyone else's money, as well. Think about that.

Steph, this is why there are some insurance companies who are refusing to take on women who have had c-sections unless they get their tubes tied...higher risk for the insurance company.

Aphill, no one knows for certain that any specific birth will be low risk. Any birth can quickly go from normal low to high risk at any time in the during the process.

no one knows for certain that any specific birth will be low risk. Any birth can quickly go from normal low to high risk at any time in the during the process.

I would say that no births are no-risk. Sure, there are low-risk labors in which problems arise, but they are rare. I think that midwives are a safe (and better in many ways) alternative to doctors in the traditional hospital setting. Midwives are trained to facilitate natural birth and to recognize when complications arise so that a doctor can step in only when necessary.

I just feel like doctors and hospitals have a one-size-fits-all approach to childbirth, and it just doesn't (or shouldn't) work like that.

The epidemic to me is the rise of C-sections. Like some of the comments to mine, it is currently a choice people make. I firmly believe that choice should be protected.

What I would like to see is better options and education for pregnant women. I don't think the whole story is presented to pregnant women before they make the choice. Epidurals, pitocin, and other interventions are often pushed on women and these can then result in the need for a C-Section.

We have heart healthy campaigns, exercise advertisements, and other health related messages to help people make better choices. When the C-Section rate is around 33% and over 50% in some areas, we have an epidemic that has tipped. It will take an aggressive campaign across multiple channels to reverse this trend to more reasonable levels.

@Jedichick, you ALWAYS have the final choice even if it's against medical advice. While I'll entertain an argument that many "emergency" c-sections are done by use of fear (scaring mom & dad into believing tragedy will occur if we don't rush you right to the o/r and do a c-section), I'd also entertain a notion that this is done out of defense on the doctors part- if he doesn't recommend the c-section and something happens, how many people turn around and sue him for it? Speaks to a deeper issue in our medical care system than this issue specifically. I'd love to see documentation on the CPS claim. I'm surprised anyone would stand for a government agency forcing a woman to have a c-section ever so you've piqued my interest there.

@StephAce, there isn't a single thing in your argument that couldn't also be said about abortion. They, too, create risks for future pregnancies and there is also a good chance of complications which equals more of other peoples money. This is exactly my point- you (and I mean the greater you, not necessarily you specifically) don't want me to intervene in your choice whether to have a child or abort it but you're totally fine with telling me how I can give birth to said child if I've chosen not to abort. Quite ironic from where I sit.

If I may weigh in on this, my wife gave birth to our first child last year, and between what I gleaned from observations at the checkups I attended, what she said about the ones I missed, and the experience at the hospital, many medical personnel, and doctors particularly, have a barely-hidden disdain for the hoi polloi, their wants and opinions, what with being the highly-educated and sophisticated demigods that they are....

It went on and on throughout the whole pregnancy and 8 days spent in the NICU. My wife was adamant about natural birth with no drugs. And she did it, never took anything stronger than Motrin. But it was always "are you sure," everything second-guessed. "No c-section, are you sure?" FOR MONTHS. After the third time the pill-pushing prick OB/GYN asked my wife are you SURE you don't want any vicodin for the post-delivery pain I was ready to punch him in the face.

This was the same a$$hole who felt the need to discuss "family planning" with my wife and I, who are married and have it under control just fine, even suggesting BIRTH CONTROL PILLS and looking rather shocked that we said no. Same guy who said my wife's PUPPS rash was stretch marks. I said "ON HER FOREARMS???" I mean I tried to maintain respect for this guy's position but I make junk mail for a living and even I could tell those were not stretch marks.

I found out later that this moron is actually the head of obstetrics at the hospital where my son was born. Needless to say we won't be using him again. And they weren't all like this, the NICU staff was great but once again I had to resort to a little self-deprecating humor after a couple days to get the robotic forcefield to drop and see the people that were in there.

Point of this rant is that the attitude and mentality of many medical professionals precludes them from interacting on a meaningful level with the rest of the proletariat. My aunt is an oncology nurse and has many of the same kinds of stories. It's the same with a family friend I grew up with who is now a doctor. She's not any smarter than she ever was but now that she's a doctor her word on any subject, be it economics, public policy, military strategy, the friggin front office moves of the Seahawks during the off-season, is THE WORD.

Well...because she's a doctor, that's why. How could she be wrong?

I hear you. One request though. Please stop making junk mail, I hate it! LOL

I know, it's worse than telling people you are a banker or a politician.

Awww the cost portion...I believe if you voluntarily choose to have a c-section over a natural birth with no medical reason...you can pay the difference in childbirth costs out of your own pocket...why should my insurance be higher to pay for all these unnecessary surgeries!

Suzy, no, you do not always have a choice. You may have the illusion of a choice, but you do not always have the final say. Ask any of the women who have been forced into court-ordered c-section or bed rest. Ask any of the women who have had procedures done to them while they are screaming “I do not consent.” Ask any of the women whose doctors have lied to their faces to get them to consent to a procedure, or bullied them until they lay on the floor sobbing. I have been one of these women. I have found that informed consent and choice is a joke in a lot of medical offices, especially in women's health.

If you are not educated on your options, its your fault.

I mean seriously, who decides to have a kid but doesnt bother to educate themselves about the process and what could be expected, and what to do when or if complications arise?

The reason doctors treat the "smart and prepared" ones like they are stupid, is because the vast majority of their patients ARE STUPID...and you, the informed and prepared one...are like an alien in thier hospital. Its hard to break habit when you've got someone with all their ducks in a row.

Peoples Republic - the reason they asked you 100 times over, is because if they dont and you changed your mind...there'd be hell to pay. They've experienced it enough, there's no need to go there anymore...better safe (and annoying) than sorry. lawsuits are too abundant not to treat everyone like they are mentally handicapped and speak a foreign language.

Your argument holds no water, Suzy. Choosing to have a c-section is like choosing to have plastic surgery. C-sections should be reserved for emergencies only.

Jessica,

I see your point; I thought that at the time and while writing that post and mentioned to the friendlier doctors and nurses that didn't look down their noses at people that I understood their position. I noticed that was about the time they started spending more time in our room talking with us than they had to. They appreciated the understanding I'm sure. The CYA mentality prevails, and not without reason.

But that doesn't explain why SOME doctors treat people from Bellevue with more dignity and respect and save their condescending talk about "family planning" for people from Tukwila. People aren't all "stupid," they just aren't all health professionals that do those things every day. I'm a licensed pilot whereas many doctors are not; if I were to take a doctor flying one day, and said doctor could not tell me how the aircraft's pitot-static system worked, would that doctor be "stupid"?

JediChick, I'm sorry you've had such a rotten experience with the medical profession. I can't imagine what that would be like and I hope I've not offended you and even more, I hope that your situation was the exception, not the rule.

Suzy,

Sorry, I missed some of your previous posts. Here are some links on the CPS and forced c-section claims.

" "

"" (another article about the previous case)

"" (this link has a few more stories about court-ordered interventions)

" "

""

"""

Ok, I'm not sure why my links are not showing up...frustrating! Anyone have any suggestions?

That's no longer true. VBAC's are common nowadays. I don't know of any practitioners nor hospitals that prohibit them as a rule.

I know of hospitals that will not allow VBAC's if you are not already progressed in your labor. They will also not allowa VBAC to be induced.

alot of smaller hospitals still wont allow a vbac, my local hospital wont and i live in a city of a 1/4 million ppl. i am having to travel 30 minutes away to a different city to have my second child vaginally after being told i had to have a second c-section. now i didnt opt to have a c-section my first go round but they arent as bad as everyone would have you believe, yes its major surgery and recovery takes 6 wks before you can go back to work but its not all bad the pain goes away by the 2nd or 3rd week and you dont have to have stitches where you sit because of an episiotomy (sp?)

I had a hard time finding a VBAC friendly doctor in my town (20K population). Also my insurance doesn't cover doula services. I attempted a VBAC after my first child. I labored unmedicated for 12 hours and I had a rupture which lead to an emergency c-section. I still believe a doula would have made a difference. I regret not hiring one. I must say also, the labor pains were nothing compared to my first birthing experience, knowing what to expect and being able to move freely as contractions came made a huge difference. My first doctor got me so paranoid about the pain I was terrified to go through labor. My second doctor was so cool about it, and the nurses were amazing, they guided me through contractions through breathing and rocking my body...talk about 2 opposite experiences.

William is accurate. For the half of the country that live in the more rural and remote parts of the US, repeat c-sections are the only way most hospitals will deliver. The need to have an anesthesiologist on call 24/7 is cost prohibitive for many smaller, independent community hospitals. I have 2 hospitals in my entire county and neither of them do VBACs. My county has about 30k people total and half of them live in my town. We are a small community to say the least. I had to have an emergency c-section with my first and I just learned I would have to have another because my hospital does not allow VBACs. So my husband and I decided just to have a home birth with a CPM/RN.

I also had to travel to do my 2 (successful!!!) VBACs. The reason a lot of smaller hospitals won't do it is due to the lack of 24 hours OR teams. I had to sign all kinds of waivers and endure being talked to like I was a mentally handicapped child because I didn't pick my repeat C-section date. With my last child, they didn't even discuss it with me before they hooked up the pitocin. The nurse kept telling me that it was standard order set. My son was born with no doctor in the room because the nurse told me that there was no way that I was ready to push (without even checking my progress). I was still charged 4 grand for the privilege of being belittled by the nurse and having the doctor step in and say "did I miss it".

But c-sections mean less time off from work, it's better for companies.

Bobby...exactly how does a c-section = less time off of work?

But c-sections mean less time off from work, it's better for companies.

I don't think that's true. C-sections are far more difficult to recover from than vaginal birth.

If time spent in the hospital is any indication, and I believe it would be, then a vaginal delivery is easier. With a vaginal delivery the insurance companies will pay a woman to stay 48 hours, with a c-section that is doubled to 96 hours. I know this from delivering two babies and discussing hospital stay lengths with the insurance companies prior to delivery.

C-sections take longer time to heal after! Trust me I know! It is definitley more painful and a lot more to it than a vaginal birth.

I had a c-section (I had twins, and one was breech) and the recovery was a nightmare. I was in horrible pain for days, and struggled to care for my babies afterward. I've never had a vaginal birth so I don't have that to compare it to, but the recovery time after a c-section is definitely worse. I can't believe anyone would choose to have a c-section just because it's more "convenient!" There's nothing convenient about having your abdomen sliced open and then stitched back together, especially not when you have a newborn to care for.

I would also point out that women who have had c-sections are much less likely to breast feed. This is partially because they are usually taking pain medication that can be transferred to the baby through milk, and partially because it appeals slightly more to women who resist the natural process.

Breast feeding has, since the 1950's, been strongly associated with healthier babies.

Was in a week with each of my 3 sections. The first one was an emergency section as the baby was in trouble. Totally unprepared for that and definitely, totally unprepared for the spinal they tried to give me. In my back twice with what I lovingly refer to as the knitting needle. It didn't work so they thought they would just try it again. I told them that I would sue everybody in the room if someone came at me with that thing again. They put me to sleep. FAST. Then there was the witch who just RIPPED those staples out of my stomach. I break out in a sweat thinking about it even now. The second time, I had air trapped somewhere inside, I thought I was going to faint the pain was so bad. Must be what getting stabbed feels like.When the nurse told me what it was (gas) and that I needed to get up and walk, I wanted to punch her lights out but I couldn't move. The third time, none of us have time for that story! I don't know what it's like to have a vaginal delivery but it can't be worse that having a section.

Thank you Sandie & MzAmber & Brwneyed girl for articulating EXACTLY what I STILL feel about my C-Sects. almost 42 yrs. later. I actually threw the meds. at the nurse when she brought them into me & suggested that I didn't need any "stronger" pain meds. I was enduring a ranging infection that was eating out the little villi that line my tubes & would keep me from having another child-luckily I did-for 6 yrs.

I still feel that way even now & I'm a retired nurse.! lol C-Sections, while improved techniques & meds., still is MAJOR SURGERY. And I had to move 2 & 1/2 wks. after my 1st one with a baby, husband, 2 dogs & a 150 miles ride. I wonder how much easier it would have been if it had been a vaginal delivery?

'But c-sections mean less time off from work, it's better for companies.'

False. You can leave the hospital within 12 hours of a vaginal delivery and go about your day. An uncomplicated c-section means 3-5 days in the hospital and 2-4 weeks of hobbling like an old lady. Speaking from experience, my c-section put me out for almost the full 6 weeks postpartum. A woman that has given birth vaginally can go back to work in a week if she wanted to. A c-section woman will have to wait weeks before she is even okay to drive, much less go back to work.

V.Bevis,

Gosh oh mighty, your post reminded me of my own infection that I had after delivering my first. Could not even see the baby for three days because of it and only saw her in the nursery at that. My ob/gyn stated that I needed to get injections a couple times a day in alternating hips as the shots made my hips swollen and sore. Heck the injections themselves hurt like hell. After 2-3 days, I couldn't take it anymore and asked if there was another delivery method for the medicine, preferably by mouth. My doctor said yes, I could take the meds by mouth but that it would not be as effective so it was his recommendation that I continue the current course of treatment. I said no, give me the pills. He said he would have to remove himself as my doctor if I did not want to "follow his orders". I told him he didn't have to worry about not being my doctor any longer because I decided that he wasn't. My new doc gave me the meds by mouth and I was fine Why do some doctors think they have the right to bully patients? We come to them, sometimes at very low points physically, for their expertise, not looking for an "omnipotent father figure". I had a doctor at the ED at Memorial Hospital in Jacksonville Florida actually PAT ME ON THE TOP OF MY HEAD, telling me everything was going to be ok (I was 40+ years old!) all the while completely missing the fact that I was suffering with a pulmonary embolism. The fool sent me home! If I could have managed it, I would have smacked the crap out of him! Wound up at another hospital for almost a month with that blood clot. Scary! I have had to fight my way through many unnecessary medical battles for myself and my oldest daughter due to physicians whose attitudes consisted of, I'm the doctor, you're just the patient, I'm the one with the doctorate and umm, you're not, so just do as I say. Those experiences empowered me to learn as much as possible about my own healthcare situations and also that I just do not have to acquiesce to everything a doctor says or wants. I'M paying them and I have a voice in the matter as well. Lastly, I should add that I have been the recipient of some excellent medical care from various physicians who are on top of their game and want only the best outcome possible for their patients. Dedicated and hardworking and worth more than I could ever pay them. I would probably be dead today without them. To THOSE physicians and nurses and other healthcare professionals everywhere, thank you and please keep up the good work.

I had to have 2 c sections and thankfully my experiences weren't that bad. I was walking the next day( yes hunched like an old woman) and I had minimal pain after a week. I recovered quickly and had no problems after either of my surgeries.

lesi-913. I am glad to hear your recovery was uneventful. But I so DO emphasise with Sandie. I was just thinking of the damned shots in the butt before she mentioned it. That was a long time ago, but fortunately, with good plastic tubing & several ports on them, pain meds. can be given so much easier now.

Although I've never had the problem with the "God " Syndrome as we used to call it with SOME doctors, I know MANY who have. Personally, I think newly trained doctors in the last 20 yrs. or so have gotten far away from that stance.

A pulmonary Embolism is nothing to take lightly. And I'm glad your got through it O.K.

I couldn't agree with you more about the patient being a "person" with different, NEEDS & wants & damn straight we are paying the bills. I have no insurance since hubby retired & I'm now doing my research for an orthopedist to replace my knees in Jan., when HOPEFULLY I will get Medicare. I found an incredible one & am just so pleased with everything about their practice & I KNOW what to look for-lol-good AND bad.

My recommendation to you and everyone else on here is to use the latest "US News & World" report on the best hospitals that comes out each yr. @ this time. It is well-worth your time to peruse what all it has to say & I'm thrilled that my doctor practices at one of the top 10 ortho. places on their list. Years ago, about the only advise I could give was to go to a "teaching" hospital for better docs./care, but the Internet has opened up a wonderful tool IF we use it wisely.

Cheers! To Good Health to ALL!

V. Bevis,

Good luck with your surgery. Glad you found someone you like for the job. I just know you will be a whirling dervish on the dance floor with your new knees! LOL

Things happen very fast indeed.

My wife was very prescient in asking that we hire a doula, and we were lucky that we were at a hospital that weren't threatened by her presence.

I really feel fortunate that we had our own impartial advocate in that room with us. She educated us so we knew what to expect, both when things are going right, and when they're going wrong. There is a lot of decisions that fall in the gray area, and doctors generally strive to eliminate risk, even those that are very small. She made us write out a birth plan ahead of delivery and talk it over with her doctor so that the everyone was well aware about our wishes.

Our delivery luckily went very smooth until the end, and by the time they wanted to intervene, our baby came out on his own.

Take-home message... people might want to consider a Doula if they can find a good one (i.e. well educated on the technical aspects of childbirth, and not just a hippy-dippy holistic c-section prohibitionist type.... although there's nothing wrong with someone who has both attributes). In other words find someone who's going to be _your— advocate, not someone pushing their own agenda.

My cousin is actually a Doula and was there with me but the doctors insisted at the very end that I need a c-section because of his heart rate. I really wonder to this day if I could have gone forward with the vaginal but I will never know. I do know that when it is time to deliver my next child I am going to speak up more and make sure if we do need to have a c-section that it is absolutley necessar because I honestly believe a lot of doctors do the c-sections for non-life threatening reasons but it happens. I am learning a lot with my first child lol

Delivery room definitely doesn't like it when the heartbeat goes down. We had to move from the alternative birthing room to a regular room when our boy's heartbeat was dropping, but the doula kept our eyes on the prize. Our intervention was just going to be the suction cup on the head delivery... but at any rate, it was very helpful that the doula was there.

Don't torture yourself about whether it was the right decision though. All you can do is the best you can with the information you have at the time.

Thanks Mark! I do agree that you can only go off of the information you have at the time. I wanted what was best for my son and thankfully everything turned out to be ok with him. I just know that next time I will be more aware of different situations.

And yes Doula's are definitly very helpful and I would recommend to everyone that they should look into getting one. They are wonderful and very supportive in helping make decisions and to get you through the labor and delivery.

Heart rate is a dubious indicator of a birth going sour. There is little scientific evidence that a falling heart rate means anything at all. This is because the baby is in a hyper-oxygenated state and many think that a heart rate drop just prior to delivery is a way of protecting the baby during delivery by matching the heart rate to the oxygen content and of conserving oxygen by the baby.

To use it as a sole reason for a c-section is dubious at best and criminal at worst and regardless a violation of the physician's oath's first imperative, "First, do no harm." This is compounded by the frequent use of the pronouncement that the baby's heart rate is retreating, or failing, or plummeting by a physician in a circumstance where a second opinion is not possible.

brwn...I don't get the stories correlation to the 10 % rise in frequency.... unless your point is that women are less capable, or typically have weaker babies.

what comes to mind is two explanations...one...defensive medicine (recommended by doctors because of less chance of a problem during birth..hence not sued as much...defense medicine accounts for about 10 % of our health care costs)....two....convience...we have become quite a self absorbed society...who wants to wait for natural birth when we could be up driving around and texting instead (just being sarcastic)

hahaha...50 grand? Any evidence for that number

Or did you get it by rectal delivery?

That's the number Obama used for the surgeon reimbursement for a limb amputation. I just thought it would be in the same ballpark, a baby amputation.

http://www.youtube.com/watch?v=rIVieMfb2SI

I think a lot of it is fear of malpractice lawsuits...

To answer your question (which was probably meant rhetorically): yes, I think defensive medicine is probably an enormous factor influencing the ridiculously high c-section rate in the US. Interestingly, most other developed nations have lower maternal mortality rates and lower neonatal and infant morbidity rates, yet the C-section rates are much lower in these countries than in the U.S.

Those rates represent a complex issue. Abortion rates vary and the demographics might be much different. America has a very large underclass of uneducated and disinterested at-risk cases creating increased birthing risks.

"Defensive medicine" rates have declined greatly in the past few years. This is mostly because of the attention paid to worthless tests. When closely investigated, a great deal of defensive medicine consisted of physicians running unnecessary lab tests or procedures that directly benefited the physician and not the patient. Ten years ago, around 16% of lab test were ever reviewed by a qualified physician or nurse. It is up to around 60% now. Medicare and Medicaid have stopped much of that and people question it a lot more.

Physicians tend to blame everything on tort reform. But 29 states have imposed full medical tort reform and another 14 states some portion of it. In the states with tort reform, medical malpractice premiums have gone up more and faster than in states without it. There has been no movement of physicians to states enacting tort reform. But the big effect of tort reform has to been greatly reduce the amount of payouts to people damaged by medical malpractice, usually leaving people indigent and on Medicaid.

Tort reform is just an instrument to benefit medical malpractice insurance companies in cases of real and serious injuries. Juries are not stupid, they can tell. But you still have to remember that medical malpractice is the 5th leading cause of death (and rising significantly) in this country. It is not even in the top ten in any other country in the world.

chris,

physicians don't get paid for lab tests. That's a huge misconception. Nor does the ordering physician get paid for CTs, MRIs, etc

As far as your analysis on tort reform, you may not be aware, but there is more than one cause for increase in med mal premiums besides tort reform. The number of undocumentated persons for example

Show me any evidence for your claims

I also do not believe Chris.

At a very basic level....any tor reform that is just a few years old will not have any empherical data that would support his claims....such data collection, analysis, and reporting doesn't happen that quickly. Obviously...full tort reform hasn't occured as he said or malpractice insurance would not have increased...that is just silly and made up.

Medical malpractive the 5'th leading cause of death, ....I almost fell of my bar stool laughing at that :) But to be fair I looked it up....accidents (not malpractice) is the 5th leading cause of death. Of the top 15 the only other non disease related one is number 15...homicide.

Chris, you are data challenged indeed.

Chris is likely a John Edwards that benefitted from court theatrics and abuse of the legal system.

As for the issue of data supporting physicians profitability from self-referred tests (both lab tests and procedures.) There is absolutely a huge volume of data on the costs. The VA has done extensive research on this and no longer permits correspondent physicians to do any self-referrals even though the VA is obviously one of the biggest self-referrers in the country. Both Medicare and Medicaid did tons of independent research on the subject before banning payments for over 95% of all self-referrals. (The AMA predicted Armageddon when self-referrals were stopped, but there was no detectable increase in costs.)

I would point out also that medical services are one of the areas that can be almost instantly measured because so much of the system flows through places like the VA, Medicare, and Medicaid where data can be collected by mandate. The outcomes date for these systems is widely available (even to you) and only runs a little over a month behind. Every state and the federal government both summarize all the data monthly and annually as well. Your statements about data collection are wrong.

That's what my wife does research on fir a living and I hear waaaaay more that I want about the subject from her and her cohort. That's also why I know a number of health economists and almost anyone involved in outcomes research in the country. Sometimes I get tired of hearing it at the dinner table, but you do pick up a stray bit of information and it comes in handy.

The AMA predicted Armageddon when self-referrals were stopped, but there was no detectable increase in costs.)

And no savings. It was part of the government campaign to demonize doctors, destroy the doctor-patient relationship, and then government take over medicine as the savior.

Chris,

I ran out to the mailbox today to look for my lab orders reimbursement. Guess what--nothing. And it was the same yesterday, and the day before

Honestly, take it from someone who has been practicing medicine for YEARS--I DO NOT MAKE MONEY FROM LAB TESTS!!! There are strict laws against self referral (google stark laws)

If you want to continue to believe something to support your own point of view, don't let me dissuade you

But show me some of this huge volume of evidence you keep alluding to

you would need those statistics to support your claims, not the other way around

Interesting hypothesis William. So one would assume that countries fully populated by minorities would have noticeably higher rates of C-sections. Care to wager on that? On your claims of some preference to running up Medicaid bills I would assume you are most likely unaware of the fact that private insurance company reimbursement rates on procedures are much higher than Medicaid. No hospital concerned with trying to cover costs is doing anything to "run up the Medicaid bill". But I applaud your choice to put dumping on poor people and minorities above the reality of the situation.

I can't speak for Colorado or Utah, but I can tell you that nearly half of all births in Wisconsin are paid for through public funds (Medicaid mostly) so I'm guessing it has a lot more to do with that than the education level. But I do like the idea that WI is full of better educated folks... Credit for something GOOD for a change, even if it is only a guess.

William, I used to live in NJ and NY. I used to hear about scheduled c-sections for various reasons, most were selfish reasons, a few were due to maternity leave.

There are vain people who don't want the "downstairs" messed up by a baby squeezing out.....so they go for a C-section and get a plastic surgeon to minimize the scar.

The insurance companies make most of their money as a fixed percentage for overhead, including profit. This is regulated by state insurance commissions. For most health insurance companies it is right at 30%. So the more money flows through the system, the more they make. An insurance company actually makes much more money on a c-section than on a vaginal delivery.

Where the insurance companies freak is when it is something like terminal cancer where it will be all payout and no income. This is why they come down so hard on these sorts of things. Because of the "experience-rated" setup, one case of cancer can ruin one medium-sized group's profitability for years to come.

The percentage game is largely responsible for the "couldn't care less" attitude of health insurance companies and many other large corporations such as gasoline companies. They take a percentage of the costs as their own and if costs go up so do their profits. That's why oil companies are silent about rising gasoline prices. They love it!

My OB would have been fine with a VBAC so long as my blood pressure stayed down and labor started on its own, but would not have done a VBAC induction.

Deb W: It depends. Most times, you're absolutely right - previous c-section can be followed up by a VBAC. In other cases, it won't work. I had a lot of complications with my oldest son. I developed pre-eclampsia at the end of the pregnancy, so they induced my labor. There were massive complications during the induction (umbilical pro-lapse, dropping heart and oxygen rates for my son and myself, my pre-eclampsia crossed into ecclampsia and I started having seizures, etc., etc.). So, they did a c-section. Had the complications ended here, I probably could've done VBAC. Instead, during the c-section, my heart and breathing stopped and I was exposed to some pretty nasty bacteria. Suffice it to say - I spent the first 4 1/2 months of my son's life in the hospital fighting for my life. As a result, my uterus is massively scarred. They didn't think I'd be able to carry another pregnancy to term. When I got pregnant the second time, as soon I started having contractions (not Braxton Hicks), my OB did a c-section. The second c-section was done because my uterus is so scarred, it can't handle labor contractions and had an extremely high risk of rupture.

But, yea - many times VBAC is entirely possible.

with modern c sxns, yes. But if you didn't have a low transverse incision, than you are at elevated risk for uterine rupture with vaginal delivery

eric: My c-section is a low transverse incision (my kids are 13 & 7, even when they were born the older vertical incisions were extremely rare even during emergency c-sections as mine were) - and I still had a higher than usual risk for uterine rupture (which is why my second was c-section also). My higher risk was due to a lot of scar tissue from an infection. My c-section got infected, and the infection quickly spread and started attacking my other organs. I still have decreased kidney and liver function, and scar tissue on other organs due to the damage caused by the infection. The guess is that the infection was introduced when one doctor was sitting above me doing CPR while the other doctors were doing the c-section - his feet were basically right next to the surgical field. It's what they had to do to save my life.

Summer: Been in & out today, so couldn't follow this topic as I'd have liked to do. BOTH (1968 & 1974) my C-sects were VERTICAL-ONLY my TAH was low-cervical 25 yrs. ago. X-rays for positioning for the 1st. & a "B" scan for the 2nd. It was the forerunner of today's ultrasounds. This was the "Dark Ages" of OB!

So, I wasn't going to take a chance & had a 2nd. section even though vbacs were just starting to be discussed & occasionally done in a few cases. Like you, I had tons of scar tissues ("Keloid Katy" here-lol) which was cleaned out at my 2nd. section & then again along with the Endometriosis at the time of my TAH. Thanks to an infection that ate out the lining of my tubes (destroyed the villi), we were told that we had a 1 in 10,000 chance of getting PG again not to mention an ectopic PG.. Six yrs. later hubby said he wished he'd bet the Dr. on it-lol. Luckily, no HTN or kidney probs. with the 2nd., but Toxemia/Pre-elcampsia with the 1st. put me near death like you. I'm sure I seized, but my memory deficits could be related to drugs used at the time.

This ain't what I signed up for being "barefoot & PG" in the 60's. lol. But 2 wonderful kids made it all worthwhile. And I'm sure yours did too!

thanks for the info to the above posters, sorry for what you had to go through

V.Bevis: Sounds like you had a rough go of it also. I honestly don't remember most of mine - I was told about some of it after the fact. My mom, who was there through it all, said that there are a lot that everyone there agreed not to tell me. I remember a few things as truly my own memories. I remember, at some point in the labor, telling my mother that I didn't want to do this anymore, take me home, I'd stay pregnant. Then I remember one of the residents telling me that they wanted to try to put me on my hands and knees to see if gravity would help. Shortly after I got on my hands and knees I felt really dizzy, and everything faded to black - I had passed out. Then I remember the nurse telling me that they were going to take me to the OR, assess the situation, and they might do a C-section (this was after 36 hours of labor). I remember seeing my son's beautiful blue eyes a bit later. Then I remember telling the anesthesiologist that I couldn't breathe. He told me I was breathing fine, unstrapped one of my hands so I could feel my breathing. That's the last thing I remember for about 2 months. Then I remember crying because they wouldn't let me have my son at the hospital with me.

My infection went septic and I still have kidney and liver damage and several other organs that have scar tissue. With my second son, they didn't think there would be a place for the embryo to attach properly - or at least a very low change it would find one of the few places that it could successfully attach. Obviously, the implantation occurred and that pregnancy and delivery were relatively uncomplicated, by comparison. Sure I had to have my entire blood volume replaced when I hemorrhaged; sure I had a post-op ileus. But at least I was able to go home a little more than a week later and recovery was uneventful.

You're infection sounds awful - I'm glad you were able to have another child :) "Barefoot and pregnant" - lol. You're right - certainly not what I signed up for even in the late 1990's and early 2000's (when my children were born). But - my two wonderful boys made it all worthwhile. Sure I would've loved to have had an easy delivery - as I'm sure you would've. But, I'd do it over again if I had to, just as long as I ended up with the same wonderful children I have now.

eric - You're welcome. You know as awful as it was, it all worked out. I have to say the doctor's and nurses worked their butts off in taking care of my children and me. A lot of very well trained doctor's and nurses saved my life and my kids lives. They are some of the very reasons why I'm now in medical school.

O.K. Now for a bit of levity which, in our circumstances, was non-existent. Like you, I was "stoned" a good bit of the time, but apparently, (probably scopolamine induced hallucinations), I sat up, pointed my finger at poor, scared hubby sitting at the end of the bed & said: (QUOTE)

"If you don't quit runing around with that German Mistress, we're through!"

Funny now, not then!

V. Bevis: LOL, that is so funny!!! It's great that you lived through it to be able to laugh about it now :) That made my day, thanks for sharing!! I wish I had a funny story like that.

That not what my friends in Europe say about their healthcare.

Jack...NHS...sucks....Better to pay for American Medicine than well die on British.

This website shows the medi-cal reimbursement for vaginal delivery for c section vs vaginal delivery

http://www.chcf.org/~/media/Files/PDF/C/PDF%20ComparingCPTCodePayments.pdf

Vaginal delivery 59409 480.80

Cesarean section 480.64

Virtually the same. Your argument does not hold water

'American Medicine' average per capita $7800

'European Medicine' average per capita $3900

Nuff said.

Which European Nation are you pulling your figures from? It isn't one country each has their own care program.

I'm also in MN, and we went with a midwife group that works in conjunction with PNHS in the western burbs. They in no way put down c-sections, but at the same time use them only when medically indicated along with every other form of medical intervention. We actualy went with the hypnobirth method and were fully supported by the midwives and our hospital and my wife gave birth to a 9lb7oz healthy baby without medication. Did we get some medal for natural birth? No, and I really don't mean to crow about it other than to confirm for those out there than a "pain" free natural birth is possible if pre-natal efforts are alligned properly.

I'm all for whatever is necessary to get the baby out healthy, but rates like 34% are very concerning to me. Scheduling c-sections simply to have control over when a child comes into this world sounds wrong on a base biological level. Not to sound corny, but I think we will lose something as a species if we cease to be able to reproduce without heavy medical intervention. And as to percieved effort of childbirth vs a c-section, there is nothing else in life that is morte worthy such an effort than introducing a new person to the world.

You're right about that. I went to a dermatologist about a tiny, miniscule growth on my face, probably a skin tag. The doctor sprayed something on there to freeze it and said it would just fall off. Well, when I checked my health insurer's website, I learned that she charged my insurance $600.00 for surgery !!! There was no surgery, no scalpel, nothing but the the stuff she sprayed on my face. I called my insurer to complain and they told me forget about it because nothing would be done. What a scam!

Not true. My obstetrician used what he called "husband stitches" on me after the birth of my child. Talk about tight! No loosy goosey here.

True, I don't want my partner with a wadded out cooche! I got a baby due in January and I am going to press for a C section.

really!? i have never heard of such a thing! ill keep that in mind lol! thanks!

but stitches on your cootie? yowza!

Yeah because that giant C-Section scar you will have for the rest of your life, right at your panty line is HOT.

actually my mother has a c-section scar and it's only about 4 inches long. you can't see when she wears a bikini, it's not wide at all. and i'd rather have a scar then a low saggy vagina.

tmf1016: C-section scars can be big and wide, depending on the situation. In 13.2, I very briefly discuss my c-sections. My c-section car goes from ilium to ilium and is about 3/4 of an inch wide in the center, at the edges, it's much thinner. Of course, I had to have mine reopened and allowed to heal on it's own during my first c-section - which is why the scar is so much larger. The point is, c-section scars aren't always flattering, especially if there are complications with the c-section.

i had a c-section almost 4 yrs ago and i guess it depends on the doc but my scar is almost non existent, in fact if u ask my hubby he would tell u even he cant find it. and with the whole stitches on your cootchie thing, i have heard horror stories of how yeah its tight down there but if they dont like skin back up right its jagged and bumpy and just downright nasty. i'll take another c-section scar anyday.

*line skin back up, sorry typo

I call it my "Anchor" scar-midline for the 2 c-sects. & a low cervical for the hysterectomy-lol. And with my propensity for scaring, it is a "doozie."

However, I have the vagina & Kegles of a 20 yr. old-rofl. No kidding. I used to work for an Ob/Gyn in their office practice & I know what I'm talking about.

So, life is full of little trade-offs.

I'm finding this line of conversation a little bit freakish. That people are risking both their lives AND the lives of their babies by having a c-section because they can't stand the thought of a NATURAL change in a very small area of their body? Are we that vain? I'm sorry, but if you're that concerned about your body changing in what really isn't that crazy a way, then maybe you should be rethinking having kids at all.

I'm finding this line of conversation a little bit freakish. That people are risking both their lives AND the lives of their babies by having a c-section because they can't stand the thought of a NATURAL change in a very small area of their body? Are we that vain? I'm sorry, but if you're that concerned about your body changing in what really isn't that crazy a way, then maybe you should be rethinking having kids at all.

Actually that is a big reason why I don't want to have kids. Among thousands of other reasons which I wont get into. But I don't think that's selfish at all. I like my body the way it is. No stretch marks, the hoo-haa is tight (lol), and my boobs are still nice and perky.

Whats selfish, in my opinion, is a woman bringing a child into this horrible world when there are already so many unwated children in the first place.

This website shows the medi-cal reimbursement for vaginal delivery for c section vs vaginal delivery

http://www.chcf.org/~/media/Files/PDF/C/PDF%20ComparingCPTCodePayments.pdf

Vaginal delivery 59409 480.80

Cesarean section 480.64

I completely agree! It's our body, let us decide which way to deliver!

Then maybe you should consider delivering your own baby without the help of a doctor since you seem to know more than they do.

Bill in Huston..... Get a clue and figure out how to post correctly.....

Your response makes NO sense in regards to what I said or what the person who posted a reply to me said.... If you read my post again you will see that I did state I am grateful for my doctors and the fact we can have c-sections when needed. I do however fell that if it was men having babies or a male surgery issue- then these studies would not be done or that there would NEVER be an issue.

Men since the begging of time (both in religious and political arenas) have wanted to control women and it is time it stopped.

Studies like these are done to mostly make women feel less and in less control.

Why don't you try and have a baby you twit!

Eric, what most people here seem to have forgotten is that childbirth is a natural process and not an illness. We need to allow women to do what we're built to do. Yes, after a vaginal delivery, a woman might be sore/uncomfortable, but we can still walk, yes even right away. We do need to spend a couple of weeks intensely bonding and nursing our newborns and need help to do so properly. Help being someone else cook, clean, shop, and care for the other little ones.

I am an OB RN of twenty years and I have five children of my own. I speak from personal and professional experience. What is sorely lacking for our pregnant mom's is the kind of education that will help them to understand and be responsible about their pregnancy and delivery. I would like people to google centering pregnancy and understand how the pregnancy process should be handled.

Pregnancy is NOT an illness, it's a natural process that woman are built to do. Thanks for listening.

eric you are an idiot, 12 hrs after my c-section i was up. i might not have been standing exactly upright for a few days but i was up walkin to the bathroom and taking care of my child. 2-3 wks after i was basically pain free and i didnt take any pain meds after like the first week. sorry you were bedridden for 6-8 wks following you c-section must have layed up in bed expecting everyone to do every thing for you which will cause you to be in pain longer, real women grit their teeth and get through it and the pain passes away really quick

Eric: Doctors have been getting C-sects. up & outta bed ( so they don't "throw" a clot ) since at least 1968 when I had my 1st. section. People heal faster when they are ambulatory. I moved 150 miles 2 & 1/2 wks. after my 1st. C-sect. with a baby, a husband & 2 dogs.

Bill I am NOT fat. I am in great shape and stay active during my pregnancies. I have had 2 C-sections and am scheduled to have one in Dec; NONE of them by choice. Weight has NOTHING to do with it. My s-i-l is 2 times my size and had 4 children naturally!

Bill, actually, a c-section because it is major surgery, is riskier on larger mothers than vaginal birth.

Bill,

I don't think lawsuits or being overweight have anything to do with it. Some women have to have emergency c-sections, some women don't want to go through a long labor, and some women want the ability to choose the due date of their baby.

My first child was an emergency c-section because his head would not fit through my pelvic area but with my second child I was able to give birth vaginally.

Bill: Are you aware that young, obese women OFTEN have a HARDER time getting PG that normal wt. women? I'd KILL to have the shape I had when I had my 1st. section-lol. Like Ashamed About California, I too had my children due to a narrow pelvis & since the 2nd. one was almost a lb. bigger than the 1st. ( & stands a head taller than him today), it was a smart decision. Most times women who have full-term children find that each one gets bigger. I had a hillbilly roommate with the 1st. who was tall, skinny & was the talk of the hospital when she had her 4th & he was 10 lbs. & a half. Go figure?