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Re: VBACFrom: DoctorJoe@aol.comSun Oct 29 06:43:17 2000
In a message dated 10/29/00 1:43:59 AM, el@lisse.NA writes: << In the US I can understand that they need to lower the C/S rate because of the HMO pressure. I am happy that I do not have that pressure bearing on me, but I have also written in the past, that I think that the "emergencies" are the ones one should look at not the electives with an indication. But otherweise, who really cares about the Percentage? >> For each individual patient, there's a logical point at which a c-section may be (or may not be) a good idea. The aim is, of course, to get the baby out before it suffers any permanent damage from the whole pregnancy/labor process. Of course, this may be elective (e.g. prior vertical incision - deliver before rupture) or "emergent" (e.g. "fetal distress in labor"). So EACH c-section should be indicated in some form or fashion. FOR THAT PATIENT, an indicated c-section rate, if you want to look at it that way, should probably be a little over 100% (pardon my math), since you'd probably err a little on the side of doing a few too many than having a few too many damaged babies (or not, depending upon what you think of babies...). But the global c-section rate for all deliveries is another question. WHERE IS IT DETERMINED with any scientific rigor what an "ideal" c-section rate is, when we can't even agree on some individual patients whether they needed one or not? I believe it is logically impossible, at this time, to give a legitimate scientific number, even a close approximation, to the "ideal c-section rate". And to throw a monkey in that wrench, the ideal rate, whatever it is, probably changes with time (at least in any given country) because of changes in the pregnant population and its characteristics. Joe P.
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