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Re: VBAC From: jkulkin (jkulkin@mindspring.com) Sun Oct 29 08:05:55 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DoctorJoe@aol.com: "Re: VBAC discussion" Previous message: Efrain Ramirez: "Re: VBAC discussion" Maybe in reply to: Alana A. Millman: "VBAC" Next in thread: Kathi Wilson: "Re: VBAC" We rank 18th in the world in perinatal mortality and I think 8th in maternal mortality (can't swear to that number...saw it recently and I clearly remember it wasn't very good..........I think I have it at the office, tune in tomorrow) Our C-section rate has increased substantially over the past 30 years. Not solely physicians fault-medical-legal issues, consumer demand etc. Where's the beef? If the HMO's are stimulatng an improvement in this data it may nort be such a bad thing. As I recall, ACOG shares this view. You're right, we should look at emergencies...1/4 of "emergency" C-Sections are done in latent phase. Am I missing something? Jay DoctorJoe@aol.com wrote: > 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. Next message: DoctorJoe@aol.com: "Re: VBAC discussion" Previous message: Efrain Ramirez: "Re: VBAC discussion" Maybe in reply to: Alana A. Millman: "VBAC" Next in thread: Kathi Wilson: "Re: VBAC"

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