Re: Caesareans on the rise again ? (long)
From: eugene jursek (ejursek@neoucom.edu)
Tue Aug 29 10:02:33 2000
What is the background of Dr. Sidney Wolfe? I have heard that he has not
even had an internship or any medical practice? Any info on this?
>----- Original Message -----
From: RModugno@aol.com
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net>
Sent: Monday, August 28, 2000 10:11 PM
Subject: Caesareans on the rise again ? (long)
> Comments anyone?
>
> Caesareans on the Rise Again
>
> By LAURAN NEERGAARD
> .c The Associated Press
>
> WASHINGTON (AP) - Caesarean sections started dropping slowly in the early
> 1990s after an outcry that American women undergo too many - but now
they're
> on the rise again.
>
> Most puzzling: Why C-sections are increasing in first-time moms, not just
in
> women who previously had one. And where pregnant women live determines how
> likely they are to wind up on the operating table - C-sections are more
> common in the South than out West.
>
> Now, with Caesareans inching back up to 22 percent of U.S. births, the
> nation's leading obstetricians' group is issuing new guidelines to reduce
> unnecessary C-sections and reserve the surgery for mothers and babies who
> truly need it.
>
> There are many suspects in the C-section rise - state-by-state variation
> particularly suggests doctors' habits sometimes can overshadow medical
need.
>
> ``Maybe we've become too technical,'' says Dr. Jean Walker, an attending
> obstetrician at Chicago's Rush-Presbyterian-St. Luke's Medical Center,
which
> is taking new steps to lower C-sections. ``We're going back to natural
things
> like walking more often and birthing balls and really encouraging natural
> descent of the fetus.''
>
> To do that, Rush just began a nursing change - back to more continuous,
> hands-on care during early labor, especially for first-time moms whose
labor
> takes longer, a big reason for C-sections. After all, studies show women
who
> have continual care from nurses or midwives get fewer C-sections than when
> busy nurses just pop by every so often to check how early labor is
> progressing.
>
> Make no mistake: Caesareans can be life- or health-saving for many mothers
> and babies. Fetal distress, disorders that make labor risky for the
mother, a
> baby simply too big or wrongly positioned all are important reasons for
> C-sections - and hospitals that specialize in high-risk pregnancies will
> perform more.
>
> But avoiding unnecessary C-sections also is important. Women's risk of
death,
> although still small, is three to seven times higher than during vaginal
> delivery, says the American College of Obstetricians and Gynecologists.
Not
> to mention increased pain, longer hospital stays and a higher risk of
> post-delivery infection.
>
> C-sections have risen for three years, climbing another 4 percent in 1999
to
> account for 22 percent of live births, the government reported this month.
>
> That's lower than the nation's high of 25 percent in 1988 - but nowhere
near
> the federal goal of a 15 percent C-section rate this year. And it reverses
a
> steady decline in C-sections between 1989 and 1996.
>
> Now look state-by-state: Fewer than 17.5 percent of births in Utah,
> Wisconsin, Colorado, Alaska or Vermont are C-sections. But more than one
in
> four births are C-sections in Mississippi, Louisiana, Arkansas and New
> Jersey.
>
> Worse, the most dramatic variations in hospitals' C-section rates are
among
> first-time moms with healthy babies in the right birth position, says the
> ACOG.
>
> Those discrepancies suggest doctors' habits play a big role, says Dr.
Roger
> Freeman of the University of California, Irvine, who chaired the new ACOG
> guidelines that outline practices and conditions linked to higher
C-sections
> - and urge doctors to check for ways to improve.
>
> Among the list:
>
> A previous C-section is the biggest risk factor for having another. If the
> surgical cut was in the lower abdomen - not the upper - ACOG says most
> healthy women can try vaginally delivering their next baby as long as a
> surgeon is standing by if emergency surgery is needed. Most low-risk
mothers
> who try can deliver vaginally, says ACOG, encouraging women to carefully
> discuss this option with their doctors.
>
> Yet the rate of vaginal births after C-section fell to 23.4 percent last
> year, down 17 percent since 1996.
>
> Slow labor is a big reason for C-sections in first-time moms. ACOG
cautioned
> against surgery too early, and Chicago's Walker also stressed patience,
> saying here that nurses are key. ``With younger nurses, I get more phone
> calls saying, 'Nothing's happening, she needs a C-section,''' while older
> nurses are ``a little more attentive, more patient'' with slow labor.
>
> ACOG says demanding a painkilling epidural too early, before the cervix is
> dilated 4-5 centimeters, increases your C-section risk. But this is
> controversial - Walker urges women to ask for a less potent ``walking
> epidural'' that she says doesn't increase the risk.
>
> For breech, or feet-first, babies, doctors should consider trying to turn
the
> baby headfirst by ``external version,'' pushing on the mother's abdomen
> before automatically operating, ACOG advised.
>
> While ACOG targets doctors, consumer advocates advise pregnant women to
ask
> about C-section rates when choosing a physician and hospital. Pick one
with a
> lower rate, or who's open to a second opinion for nonemergency surgery,
and
> ``it's more likely you're going to avoid an unnecessary C-section,'' says
> Public Citizen's Dr. Sidney Wolfe.
>
> *************************************
>
> Robert Modugno MD MBA FACOG
> Marietta, GA
