Folks, that's more than 50% of the patients on postpartum who were recovering from c-sections. Is this a sign of the times? Possibly.
Our recent numbers for the month of July was a whopping 38% c-section rate for all births. Where we usually average 29-31% per month for c-sections, that is a huge jump!
How many VBACs did we have last month? One. Woo-hoo. (Well, WOOHOO!!! for the mom who did it, by a sarcastic woo-hoo for the total number.) Even ACOG is recommending less restrictive VBAC guidelines (July 21, 2010). Will we ever see a decline in the number of c-sections/unnecesareans? (By the way, best-word-ever!) We have such a long, long way to go before we see the c-section rate begin to decline instead of continuing to rise. Sad, but true. It's such a multi-faceted issue that there is no one way to fix it. We have:
- liability risk
- uterine rupture risk
- insurance company dictates
- maternal desires to have a c-section (primary or repeat)
- maternal desires to have a VBAC
- provider comfort level
- informed choice, or lack thereof
- hospital policies
- lack of access to alternatives to physician care (midwifery care)
27 comments:
I certainly hope it isn't too much longer before the c-section rate reduces. It's kind of scary :(
My friend at work had her unnecesarean a couple of weeks ago. Her water broke at home but contractions didn't start, so she wasn't in labor ( 2 weeks early also, I might add). 4 hours later they hooked her up and let her go 8 hours before they set her to the OR. She says "They said I was having contractions but I could feel them because I was dilated to a 4.." okay...but just because she was dilated to a 4 DOES NOT mean she was in labor, right? Why couldn't they have waited for labor to really start on it's own? They didn't even give her the 12 hours. Baby was not in a good position at all, and the 8 hours on pitocin did nothing but push him worse into that position. Her conclusion (and the doc's)? Her pelvis wasn't big enough.
I guess the hospital just did what they always do, but I was hoping that after all her research she wouldn't be talked into bed so quickly. However her family is very pro-section from what I gathered talking to them, and it seems to me that she always had in her mind that she might end up in the OR. It is really frustrating, and I don't even work in L&D!
sorry, she said she "couldn't feel them"
Especially for first-time moms, if you can't feel contractions, don't go to the hospital!! That's what even the silly pregnancy books say. grr.
Yes Sara, but all the silly pregnancy books also say to go to the hospital if your water breaks. I thought I was informed with my first pregnancy, but I still followed doctor's advice like a sheep. My water broke and I couldn't feel any contractions, and I was induced. Thankfully I did progress (rather slowly I might add) and the doctor was more patient with me than most, and I avoided a cesarean.
After 5 babies I'm much more informed, and I now choose planned home birth rather than the hospital. My last birth was a surprise breech, which I pushed out while in the birth tub in my bedroom. I had excellent midwife care, and would take that any day over an emergency c-section for breech presentation.
I truly hope the tide changes with the loosened restrictions, but I fear it may be a long time coming. I also worry that people (and care providers) are so set in their ways that the trend will continue onward and upward. *sigh*
I'm not anti-hospital, but with the way things seem to be going, it's definitely not where I want to be for normal uncomplicated birth. With the care I had, I never even considered my breech baby to be a complication.
ayc
the problem with the high c-section rate starts with the high induction rate. when yu try to induce an unfavorable cervix... you have a higher chance of a c-section... many patients just want the pregnancy over and think if they hit 36-37 weeks they are good to go!!! we are now trying to educate the patients about late- preterm delivery long term effects...
Cherylyn, after 5 babies, it's time for you to stop. The world is overpopulated. Find a new hobby besides giving birth, cesarean or otherwise.
Ugh, I wasn't going to comment but I can't let that horrible anonymous comment be the last one. Why are people such jerks on the Internet? My biggest fear is that like with breech births c-sections will become so common that OBs won't know how to catch a baby anymore!
Anonymous1, find a new hobby besides trolling the internet and derailing comment threds. The world has too many jerks in it.
Anonymous#1 who are you to tell someone to stop having babies? That is a choice between Cherylyn and her husband and how many children they want, can afford and can love. Besides for every family who chooses to have multiple children there are others who choose not to have any so in the end it all balances out.
To Anonymous #1: Oh my goodness, what would I do without good people like you who stick their nose in my personal business and tell me how to live my life? Thank you SOOOO much, because without you I would have no idea what to do. /sarcasm. You don't know me or my family, or anything about me other than what you may find on my blog. I'll thank you for showing a little tact and respect toward others, anonymous or not.
To Anonymous #2 & Melissa: Thank you.
"I brought children into this dark world because it needed the light that only a child can bring." ~ Liz Armbruster
What scares me the most is I see my friends and acquaintances having babies and they are demanding induction and scheduling their births, c-sections included. This needs to be addressed by Dr's - patients will always demand unreasonable things. It's up to the Dr to say no - this is not medically necessary or advisable.
Anonymous #1 - no personal attacks please! Without knowing someone's personal situation, making judgments and criticisms like that are unwarranted and uncalled for.
R. May - yes, we need to take a good look at what women are requesting/demanding for their births. TOBP - tired of being pregnant - is a common underlying reason for many inductions that I see at work. Which of course, leads to unneeded inductions and unnecesareans!
my very pro-VBAC OB, while pleased about the new ACOG recs, isn't optimistic about any real change in the way most OB's will practice.
combo of lack of maternal desire for VBAC and OB fear of liability.
oh and he believes the risk of repeat C-section is severely played down to the risk of VBAC.
s'alright cheryle-i just had my ninth.
anon can be all brave behind a computer screen and tell us what to do.
Back in the day when I worked night in OB on the Navajo reservation, we had few C Sections and very few episiotomies even. That is because we nurses delivered most of the babies and we weren't allowed to cut or sew. Therefore we had to get those babies out vaginally and intact. There was a house officer who might be the ENT guy or the opthalmologist, and a surgeon/OB on call for sections. The midwives were too few, so they didn't work nights. We had some hair raising experiences, but any C Section was absolutely necessary, no ifs, ands or buts about it. Those were the good old days, and there was no fear of a lawsuit in a IHS hospital. The care was excellent as were the outcomes.
On the other hand, it was awfully reassuring to be able to call for help in an emergency, and have that mother in the OR and that baby out in a few minutes.
It seems if only care was delivered (pardon the pun) on the assumption everything was going well or going to go ewll until proven otherwise vs. the current assumption that every pregnancy is high-risk, needs to be managed, a tragedy waiting to happen until proven otherwise.
Doesn't mean not acknowledging there are serious pathologies in pregnancy that sometimes require many levels of intervention but the majority do not. And what does all that fear in the birthspace and prenatally do to birthing women and outcomes, I wonder? I know my level of stress and tension is definitely heightened when I feel that someone who is supposed to be providing my care is fearful.
Cherylyn: Actually it's everyone's business how many children people have because we all have to share this shrinking planet.
K: Nine children? Eww.
To anonymous #1: please....Wouldn't it be funny if one of my six daughters had to care for you in your old age?!
Anyway - many, many more insurance-reimbursed birth centers staffed and run by midwives and Madison Ave-worthy ad campaigns about the beautiful benefits of delivering in a birth center! If we put childbirth in its proper medical context, or, really, de-medicalize birth significantly and take so much fear out of childbirth, perhaps the consumer demand for more midwifery care will change things....Again, I have 6 daughters a decade away (or so)from having babies and I'm motivated to fight for changes!
Anonymous #1 - if you're so terribly concerned about overpopulation, actions speak louder than words.
Think about it.
Funny how all those hysterical about overpopulation think that their right to life should supersede everyone else's.
I'm a proud mom of three, all vaginal, drug-free hospital births -- and I hope to have more, both in terms of kids and natural births. :)
JoAnna, I agree completely about actions being louder than words, that's why I don't plan to give birth. I hope to build a family one day through adoption. I'd encourage anyone who desires to be a parent to look beyond their own genitals and consider the world they're bringing a potential child into. Peace.
Wow. Anon #1 is so bitter, I really don't think that would be good mother material, so maybe think twice about adopting, you won't be doing anyone any favors, least of all the children.
I am pleased someone is having children to support us as we get older, nothing wrong with that....I didn't have any so if it is allotments you want...Cherylyn can have mine! She sounds like a nice,sensible well balanced and good natured loving mother and those are the best attributes for having and caring for children that are responsible and contribute to society. :)
Actually, Anon#1, I meant you should off yourself. Every little bit helps, eh? But of course, your view of the world is that there's too many of everyone else but not enough of you.
Google "overpopulation myth" and do some reading. And ask yourself why countries like Germany and Australia are paying couples to have more kids if there's such a concern about overpopulation. (Hint: it has to do with having enough new workers to sustain a viable economy.)
As for adoption, if you feel called to do so, good for you. But if you hate babies and childbirth with such vehemence, I really don't think this blog is for you.
JoAnna, accusing me of vehemence after encouraging me to commit suicide makes me question your mothering skills. And if you Google "global warming myth" you'll find lots of entries too. (I’m guessing you don’t believe in that either.) Overpopulation, unfortunately, is real. Just look at the floods ravaging Pakistan, Mexico, China, and other countries now, where too many people have ripped the lands bare of trees for farmland. The denuded landscape can’t hold the rains anymore, and thus thousands die while millions more remain crammed into packed refugee camps. It’s a horrible existence.
I’m not anti-pregnancy or childbirth per se. The biological replacement level for a stable population is 2 children (one to replace each parent). It’s those that go beyond that I can’t understand. I love children, and that’s why I can’t stand to see the millions suffering who need homes. For those with the space, income and willingness to parent large families, I can’t see how you can turn your backs to children here and around the world who already exist and are in need, and instead drop litters of 5 or 9 or 22 kids. For each new child you produce, that’s another child already alive that will go without a family. If you think that’s bitterness, fine, I am bitter about children suffering, and I’m trying to do something about it.
There's a big difference between overpopulation and poor distribution of available resources. The problem with the regions you mentioned are the latter, not the former. Moreover, do any of the women commenting here live in those regions? I doubt it. Why don't you travel to one of those famine-ravaged countries and start lecturing the women there about family size? Or better yet, do something to help since you're childless and can travel more readily? I donate to charities that feed the hungry , but unfortunately I'm not a candidate for adoption, nor can I afford to do so.
How about you contact one of the world's billionaires and encourage them to help with famine?
As for global warming, it's not germane to this discussion.
I also didn't encourage you to commit suicide; I offered it as an option for the world's alleged overpopulation issues. Seems that you should set an example if it's truly a concern. But it seems that, again, there's enough of you but too many of everyone else.
I think we have gotten a little off topic. i believe the topic was the high national c-section rate. s can we get back onto how to improve patient education about why early induction ( non-medically proven)puts patients at risk for major abdominal surgery... because that is what a csection is!!!
I actually had 2 c-sections abnormal pelvis trying to pudh a direct OP presentation after 2 1/2 hours of no progress and failed attempt to turn postion with vacuum had a primary c-section. attempted v-bac, (yes even with a known abnormal shape to my pelvis) pushed for 1 1/2 hurs and fetal distress put me back into the OR. After a few days at home, post-op wound dehiscence probably secondary to edema... had to to have incision debridement and packed... an interesting timewith an infant and a toddler...
I do agree that we have an every climbing rate of c-sections.. There is just the automatic assumption that once you have a section, the next one will be a section as well.. My daughter had a section on her first delivery because the doctor stated that the baby was too big and would not pass (or was he missing a golf game-- not sure).. She just had her second daughter and YES another section. The baby was much smaller and I felt could have attempted a VBAC but I am just another FNP without a voice to this particular physician.. UGH..
Most European countries are below replacement rate, and America is edging that way. In Japan there are more adult diapers sold than infant diapers. Do some research before you make a comment like that!
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