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Re: epidurals ... and NY C-section ratesFrom: Geffrey H. Klein, MD (anonymous@obgyn.net)Sat, 28 Feb 1998 12:11:10 -0600
On 2/28/98, Amy wrote this: Q> Thank you for your straightforward answer! I agree with you, that it is Q> based on cultural beliefs, education, and experience. I wonder, then, Q> if the problem (if you believe that a 92% rate is a problem... and I Q> think it is) is with women, and what kinds of backgrounds they are Q> coming from. I think that the majority of women today are coming from a Q> background that teaches them that birth is a painful, fearful event. Despite never having given birth myself, I cannot directly comment, but I infer from discussing the matter with people who have given birth that it is indeed a painful experience. The amount of fear that is generated is an individual response to this perception or anticipation of its perception. Perhaps as medical professionals we can counsel to alleviate the fear, but this will mainly be established by experience and personality. Q> I Q> know this was the case for me, and I also had an epidural. But I also Q> think that this was the start of the cascade of interventions that led Q> me to a cesarean. Perhaps if I had been raised to believe that birth Q> was normal and not to be feared, I might have gone into my situation Q> without fear, and not have had an epidural... I do not know the events that surrounded your birth experience. The important thing is to look at research instead of anecdotal experience. Some research does suggest an increased risk of operative intervention. Some does not. Please see my review of a recent journal article on just this topic. http://www.obgyn.net/jr/jr.htm (look in the archives it is not the current one). There may be no increased risk if the epidural is placed after the patient is in well established labor. (probably because that selects out some destined for cesarean for dystocia). Even if there is a slight increase in risk, after counseling some women may still choose this because they are unable to tolerate the pain and are willing to trade relief for a slightly increased risk. Q> Q> I believe that education is the key. I hope that I can help women along Q> that path, to self confidence, and self discovery, so that their choices Q> may truly be thiers. I hope other caregivers feel the same, and are Q> willing to take the time with their patients to help them find out what Q> is right for them.
>From a medical provider point-of-view, all you can do is present a Other changes you suggest go to altering the fabric of society and are harder to affect. ---------------------------------- Geffrey H. Klein, MD ---------------------------------- gklein@bcm.tmc.edu -- ---------------------------------- http://members.aol.com/gklein01/geff.html List-owner OB-GYN-L co-moderator sci.med.obgyn Advisory Board Chairman OBGYN.net http://www.obgyn.net/medical.htm OBGYN.net Journal Review Editor http://www.obgyn.net/jr/jr.htm Office: 2200 Nasa Rd #1 Houston, Texas 77058 Tel 713 741 2273 x2628
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