Re: Caesareans on the rise again ? (long)
From: Efrain Ramirez (eramirez@icepr.com)
Tue Aug 29 20:54:35 2000
I would not be surprised if they do. Is there a hit counter on this
forum? It would be interesting to know how many times this site is
reached per day!
At Tue, 29 Aug 2000, james connerth wrote:
>
>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
--
"Do not take life too seriously. You will never get out of it alive."
Marianne Williamson
