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Re: Cesarean Rates in South FloridaFrom: D. Ashley Hill, M.D. (dahmd@gate.net)Tue Dec 30 19:51:46 1997
At Tue, 30 Dec 1997, Luis Sanchez-Ramos wrote:
>The real reason for the high rates is the same that exists in many Latin Dr. Sanchez-Ramos- While I concur that physician convenience plays a role in many cesarean sections, I have noticed that many of our private practice patients refuse a trial of labor after a prior low-transverse c/section, and, in some cases, actually demand a primary c/section for *patient* convenience. Interestingly, I care for a number of doctors and nurses, and find that they are often the most vocal about having a truly elective c/section. They cite scheduling conflicts with their practice, child-care issues, and convenience for relatives who are coming from out of state to help with the new baby. Furthermore, a number of physicians I care for have told me they are seriously considering a c/section to help prevent future urinary incontinence and pelvic relaxation. I recently reviewed our practice statistics and found that about 10% of our c/sections are for abnormal labor. (Our overall rate is about 11-15%). We have a large high-risk practice, so many are for the usual high-risk problems (monoamniotic twins, complete previa, etc.). The bulk of our sections, however, are from declined trial of labor. My colleagues and I make every attempt to encourage a trial of labor. We provide verbal and written information, and support all reasonable attempts at VBAC. Still, a considerable number of women reject this and opt for a repeat c/section, mostly, I think, due to convenience issues. The majority of "resident" patients go for a trial of labor, whereas most "private" patients are opting for a repeat c/section. I'm not sure where the c/section rate is the U.S. is headed, but I suspect many women will be asking for c/sections in the future. As patients perceive c/section as a "procedure" rather than a major surgery, I predict more women will demand a primary elective c/section, and fewer will opt for a trial of labor. Best wishes to all my colleagues on the list for a successful and safe new year. Ashley D. Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida dahmd@gate.net
-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://www.gate.net/~dahmd
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