Re: Caesareans on the rise again ? (long)
From: james connerth (babydoc@apex.net)
Tue Aug 29 11:30:10 2000
Have already been contacted by local TV to give statement regarding this issue
this AM(wonder if they're lurking on the list?)
eugene jursek wrote:
> 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
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