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Re: Risks / Benefits of Cesarean -- NEJMFrom: DoctorJoe@aol.comThu Mar 1 15:10:13 2007
In a message dated 3/1/07 3:36:44 PM, dean@thehuffpeople.net writes:
> Interesting article in today's NEJM about risk/benefits of cesarean. And I like the ending. It's the WOMEN who choose to take the risk, for possible benefit for the baby. "But the key question centers on both the number needed to treat to avoid one adverse neonatal outcome and the level of risk that is currently considered acceptable. As practicing obstetricians, we find that the risk that women are now willing to assume in exchange for a measure of potential benefit, especially for the neonate, has changed: for many, the level of risk of an adverse outcome that was tolerated in the past to avoid cesarean delivery is no longer acceptable, and the threshold number needed to treat has thus been reset. In the face of the resulting continued increase in cesarean deliveries, our obligation as providers is to educate patients about the trade-offs entailed in choosing a particular course or intervention and to ensure that their choices are congruent with their own philosophy, plans, and tolerance of risk. In areas in which there is still uncertainty, we must organize clinical trials that will produce the data we require for counseling patients. For the moment, however, few of the relevant factors seem likely to change, and the cesarean rate can be predicted to continue its climb." Of course, if we're harassed by 3rd party insurers, busy-body regulators and societies, and the like, if WE shy away from a C-section, it's ultimately the WOMAN who doesn't get her wish granted. So regulation of the doctor is an indirect way to coerce the woman to take what she perceives as more risk for her baby. Talk about insidious. Joe P. "There are only two things that can cut diamonds: other diamonds, and Chuck Norris."
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