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C-Section ratesFrom: Robert Brenner (robbrenner@earthlink.net)Sat Dec 14 11:34:37 1996
At 06:12 AM 12/9/96 -0600, you wrote: >In thinking about "ideal" cesarean rates, my admittedly limited experience >suggests there are significant variations by population group, which we (if >not the insurers) should not forget. > >Cynthia Flynn, CNM, PhD >Private Practice, Kennewick WA USA >FlynnCNM@aol.com Along these lines, the Green Journal (Obstetrics and Gynecology) this month has an article by Frigoletto's group showing a fourfold increase in C-sections in nulligravidas with epidural anesthesia vs non epidural. So isn't it interesting that the C-section rate started to increase in the mid 1970's around the time epidural anesthesia came into vogue as well as the increasing use of the fetal monitor. This would also explain why many midwives claim to have lower section rates (since most of their patients don't have epidural anesthesia. This being the case, then perhaps lowering section rates by increasing VBAC deliveries with the small but significant risk of uterine rupture is not the right approach. Certainly we can't and shouldn't deny patients epidural anesthesia but if we want to lower section rates, we should be working on better types of anesthesia management. Secondly, we are probably going to find in the future that the cost of elective repeat C-section is less than the cost of all VBAC's when failed VBAC's and their complications are included. So to be the devil's advocate, perhaps a section rate of 20-25% isn't that bad after all. Certainly, a section rate of under 20% gives an Obstetrician some mighty good bragging rights and gives many department chairmen a cause d'etre but is lowering the C-section rate truly in the best interest of each and every patient? I'll just stand back now as the brown stuff hits the fan ;).
-- Robert Brenner MD FACOG Baltimore MD Robbrenner@earthlink.net
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