Hospitals insisting on cesarean sections contrary to the mother's wishes - PeachParts Mercedes-Benz Forum

#1 11-29-2004, 03:22 PM

I'm concerned at an apparent erosion of patient choice in many aspects of medicine due to managed care plans and associated cost-cutting, and liability risks to physicians and hospitals. Here's an interesting example of it... I've snipped some parts of the article, fyi.

Quote:

'Once a C-section, always a C-section' ringing truer
By Denise Grady, NEW YORK TIMES

The notice, posted in her obstetrician's office in Lancaster came as a shock to Danell Freeman: The local hospital would no longer allow doctors to deliver babies vaginally for women who, like her, previously had had a Caesarean section.

Unless she changed doctors and hospitals, Freeman would have to have another Caesarean, something she had hoped to avoid...

"I don't like the idea of being cut open again," she said.

...The rate of vaginal births in women who have had Caesareans has fallen by more than half, to 10.6 percent in 2003 from 28.3 percent in 1996. About 300,000 women a year have repeat Caesareans.

Major medical centers still perform such deliveries, but many smaller ones have banned the practice, saying that it is riskier than once thought and that they do not have the staff to handle emergencies that may arise.

Obstetricians estimate there is about a 1 percent chance that the Caesarean scar will cause the uterus to rupture during a subsequent labor, which can cause dangerous blood loss in the mother and brain damage or death in the baby.

A decade ago, the risk of rupture was thought to be 0.5 percent or less. The percentage of babies injured after a rupture is not known but is thought to be low.

Many women are willing to take the risk, and the hospitals' stance has become a charged issue, part of a larger battle over who controls childbirth.

Some women say their freedom of choice is being steamrolled by obstetricians who find Caesareans more lucrative and convenient than waiting out the normal course of labor. Doctors say their position is based on concern for patients' safety.

On a practical level, many women prefer vaginal birth because they recover more quickly and with less pain than they do from a Caesarean.

In addition, each Caesarean increases the risk of complications in the next pregnancy, so women who want more than two or three children often hope to avoid the operation.

...A study published in an obstetrical journal in 1997 found that when women with a previous Caesarean were offered a natural delivery, 30 percent to 50 percent wanted it.

sfloriII · #2 11-29-2004, 04:14 PM

"Some women say their freedom of choice is being steamrolled by obstetricians who find Caesareans more lucrative and convenient than waiting out the normal course of labor. Doctors say their position is based on concern for patients' safety."

Yup. In too many cases, it's about making more money and limiting your liability.
The needs/wants of the patient take a back seat. :wtf:

BobK · #3 11-29-2004, 09:04 PM

RE: Major medical centers still perform such deliveries, but many smaller ones have banned the practice, saying that it is riskier than once thought and that they do not have the staff to handle emergencies that may arise.

UH, do I really want to be in a place that "do not have the staff to handle emergencies that may arise". If ever there was a sign that you were in the wong place, this is it! And yes, that probably is a good reason to find a new doctor and hospital.

BTW, OB/GYNs pay the third highest malpractice insurance costs.

mzsmbs · #4 11-29-2004, 11:54 PM

mid-wifeing has been on the rise in recent years... i wonder if that's related... hmmm? seems to me the trend is into more natural not less. personally I'm not that surprised with all the other things going on in this country..

#5 11-30-2004, 12:11 AM

I used a midwife, although I was also in a 'normal' hospital at the time and there was a doctor available 'just in case'. With midwives there is less likelihood of things like episiotomies and cesarean sections, plus, I personally preferred having a female 'helper' there to having some cold, distant physician who would look at me as a medical problem and be quick to wield a scalpel. I'd recommend the midwife paradigm highly, and I'm no granola tree-hugger.

Zeitgeist · #6 11-30-2004, 12:24 AM

Granola tree hugger reporting: All three of my kids were delivered with the help of a midwife, the last at home on the couch. The first two births ended up in hospitals due to overly long labor (dilate to 8 cm, then stop), but were in birthing rooms, rather than factory grade delivery wards. Hospitals these days are so damned pinched for profits or suffer from tight budgets that they try every trick in the book to load up the expensive procedures, while shipping the patients out in an expedited fashion to free up more space. It's really quite "sickening".

jjl · #7 11-30-2004, 07:15 AM

Caesarians will grow in the future for another reason in addition to the unpleasant reasons mentioned: Women and children who would otherwise die in childbirth are saved by surgery. Some of this inability to have a normal birth is inherited, so the predisposition is carried into future generations.

This is a specific example of a very general process: medical intervention is changing the population via natural selection to make future generations more and more dependent on doctors.

Botnst · #8 11-30-2004, 07:32 AM

Quote:

Originally Posted by jjl

Caesarians will grow in the future for another reason in addition to the unpleasant reasons mentioned: Women and children who would otherwise die in childbirth are saved by surgery. Some of this inability to have a normal birth is inherited, so the predisposition is carried into future generations.

This is a specific example of a very general process: medical intervention is changing the population via natural selection to make future generations more and more dependent on doctors.

The unspoken secret is out. The fear people have of mentioning this exponentailly growing problem is the other secret, "eugenics".

But those are topics for another thread.

We did the Lamaze thing with our three. Young guys, take some advice from a veteran of delivery wars and let the doctor/midwife/nurse practitioner/elevator/whatever do the thing. You go to the lobby and smoke cigars or something. Its a gawd-awful mess. Plus everybody that walks in the dang door checks on wifey's dilation. "7 cm" "8 cm". "9 cm". Its like a damned handshake or something. They walk in, flip back the sheet and do the thing. Hey, welcome clubmember.

You did your part nine months ago. Congratulations, now step aside.

#9 11-30-2004, 07:35 AM

Quote:

Originally Posted by jjl

Caesarians will grow in the future for another reason in addition to the unpleasant reasons mentioned: Women and children who would otherwise die in childbirth are saved by surgery. Some of this inability to have a normal birth is inherited, so the predisposition is carried into future generations.

This is a specific example of a very general process: medical intervention is changing the population via natural selection to make future generations more and more dependent on doctors.

That effect would take *much* longer to manifest than the change we're seeing. The sudden increase in the last seven years is an economically and socially driven change.

Botnst, I see where you're coming from, but in my mind, the least the guy can do is be there to support the mom, and it does make a difference. I would really have to think twice, three, four times about a guy who wouldn't do that for me, in the unlikely event I go through the whole thing again!

Botnst · #10 11-30-2004, 07:45 AM

Quote:

Originally Posted by webwench

...Botnst, I see where you're coming from, but in my mind, the least the guy can do is be there to support the mom, and it does make a difference. I would really have to think twice, three, four times about a guy who wouldn't do that for me, in the unlikely event I go through the whole thing again!

Risky attempt at inserting levity. Sorry.

#11 11-30-2004, 07:59 AM

Hey, I might have outsourced it myself, if it were possible...