Re: Cesarean Rates in South Florida
From: jay kulkin (jkulkin@mindspring.com)
Tue Dec 30 20:12:52 1997
Is it not our job to paint a clear picture of the increase risk associated
with this procedure? I have wondered when gynecologists will practice like
plastic surgeons and do procedures on request. A hysterectomy to stop
menses, or possibly an ablation. We do tubals don't we- that's a procedure
by request. Why not??? Theoretically, you could do these now, but the fly
in the ointment is -Who pays for it? Is medical insurance to pay for what
you want?
Jay
At 08:52 PM 12/30/97 -0600, you wrote:
>At Tue, 30 Dec 1997, Luis Sanchez-Ramos wrote:
>
>>The real reason for the high rates is the same that exists in many Latin
>>American countries and many US hospitals: PHYSICIAN CONVENIENCE.
>
>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
>
>I apologize, but I am unable to answer personal e-mail
>due to time constraints.
>
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