Rising c-section rates?? Discussion

[Rach08]

Ok- so this is not a thread about birth choices or whether c-sections are "right or wrong". I'm just curious to know other peoples thoughts on why the c-section rate in Australia is rising so high.

Do you think we are following what some people in the USA are describing as "defensive medicine" where OB's are performing c-sections to reduce liability risks- and what do you think of this? Do you think it's within their rights to do this? ( I read an article from the USA that said that in some states 80% of malpractice suits against OB's was for "failure to perform a timely c-section"- often if the baby had some degree of brain damamge caused by oxygen deprivation at birth etc- I also found a case in Aus where someone was awarded millions in damages for the same reason.)

Do you think that the rise in maternal age is having an impact? What about other factors such as the increase in diabeties or obesity related complications? ( I don't know if there is an increase- as I said just looking for other view points)

Or a cultural swing- women no longer trusting their bodies to do the natural thing- more acceptance of c-section births- an unwillingness to accept some of the side effects of natural birth that can occur (medical complications- I'm thinking obstetric fistula's/ incontinence- but you can throw in whatever you like- and yes I know that there are numerous side effects and complication with c-sections too- as with any surgery)- "too posh to push" ( Note- I hate that term but it is one that is often thrown around).

A combination of factors???

As I said- this is not meant to be an attack on c-sections. ( I had one myself) but c-section rates are rising and I thought it might be interesting to get other peoples views on why this may be happening.

Please, please, please keep it nice.

[MelissafromSyd]

Do you think we are following what some people in the USA are describing as "defensive medicine" where OB's are performing c-sections to reduce liability risks- and what do you think of this?

Do you think that the rise in maternal age is having an impact? What about other factors such as the increase in diabeties or obesity related complications? ( I don't know if there is an increase- as I said just looking for other view points)

Or a cultural swing- women no longer trusting their bodies to do the natural thing- more acceptance of c-section births- an unwillingness to accept some of the side effects of natural birth that can occur (medical complications- I'm thinking obstetric fistula's/ incontinence- but you can throw in whatever you like- and yes I know that there are numerous side effects and complication with c-sections too- as with any surgery)- "too posh to push".


Absolutely I think it's about defensive medicine! If an OB detects a problem and they fail to advise a certain path and something goes wrong, they can be sued. They can't be sued if something goes wrong as a result of the intervention because the patient would have agreed to it.

Rising maternal age has nothing to do with it, except that older women are more likely to see OBs who practice defensively, so they end up with more intervention. your choice of care provider (midwife or OB) has far more to do with birth outcome and intervention, that actual risks.

Women no long trust their bodies because they're not encouraged to do so. Current care is around telling women in various ways that their bodies don't or won't work without various forms of intervention. Eg women believe they need an induction or they just won't go into labour, or they won't dilate wihtout an epidural etc.

Re: obstetric fistulas - they're very rare!

Melissa.

[BreechyBabes]

I agree it has a great deal to do with defensive medicine. I had a breech baby as my second and I talked to two different OBs who both said, that I was very likely to deliver normally and that if it was ten years ago they would have done a breech birth without question, but they were both honest and said that they had to write recommend c-section on my notes for litigation reasons, then when I chose the normal delivery the responsibility was on me. I am sure this is not just the case for breech babies, but VBACs and lots of other situations as well.

I also think that we, as mothers, get told every horror story under the sun when we are pregnant, no wonder women are scared of natural birth, and think that maybe they can't do it.

[iMischa]

whenever c sections come up, it is always followed by the risks involved and how the risks are greater than a VB...so howcome these drs are apparently covering themselves by doing something riskier?

it puzzles me?

[MelissafromSyd]

whenever c sections come up, it is always followed by the risks involved and how the risks are greater than a VB...so howcome these drs are apparently covering themselves by doing something riskier?

it puzzles me?
Good question! It's around their mindset and view of risk that's skewed by their insurance companies. OBs can be sued for doing nothing, and anytime they're presented with a risk, no matter how minute, they're obliged to "do something". They cannot be sued (easily) for something going wrong as a reault of "doing something". Eg if the baby is big, there's a risk of shoulder dystocia for which the OB can be sued. In order to protect him/herself legally, s/he needs to recommend CS. If you accept the CS and something goes wrong, it's very hard for you to sue the OB because you had consented to the operation. The OB would have to spell out all the pros and cons, but to not recommend CS for a big baby (or induction) would place the OB in a difficult situation in terms of their ability to be sued. Clear as mud?

[iMischa]

ahhh i see! that does make sense. thanks for that

[KatiesMum]

For most of the things that go drastically wrong in birth, getting the baby OUT ... NOW will fix things.

Issues such as
- cord prolapse
- fetal distress
- pre-eclampsia
- placenta abrupta

basically - if the baby is distressed and the heart rate drops, they need to move things along quicker. In many cases, if a vb continued, everything would be ok .... it is normal for the baby to react to the changing conditions in birth .....

BUT - if things go wrong, they go really wrong, and a c/s is required as getting the baby out will either get the necessary medical attention for the baby or mother, or will fix the problem.

HOWEVER - c/s come with risks of their own. The baby often has fluid on the lungs, so breathing is much more difficult, the baby is often lethargic and reacts to the anasthetic in the epi, the mother faces risks of the epi, reaction to the anasthetic and the risks of major surgery.

If the baby isnt really distressed, or their is no medical reason, having a c/s just exposed mother and baby to substantial additional risks for no reason.

The issue is - deciding exactly WHEN a c/s is necessary.

OBs these days tend to want to whip you into surgery for a c/s at the first little sign of difficulty instead of waiting to see how things pan out. They dont want to wait and try to help have a natural birth, - the chances of things going wrong and not doing a c/s in time are very minimal - but the consequences are great, so they dont want to take that risk.

[Boobycino]

I feel I ended up with a c-section because of the 9-5 mentality. I'm sorry, I cant garentee I'll be in labour and give birth in a conveniant time frame!

Seriously, my midwives were watching the clock, as in, trying to rush me, pumping my body full of drugs (painkillers and synthetic oxytocin) I'd said no to drugs about 4 times before I 'gave in' and took them - only so they could up my oxytocin.

Supprise supprise - Jasper went into distress and I had to have an emergency c-section!

Its a side note that he was undiagnosed breech, they would have performed a c-section regardless, in fact, it was him being in distress that brought them to the realisation that they were forcing me to have a rushed delivery with a breech baby.

I think the rise in c-sections is because of the over the top medical interferrence! No wonder woman dont trust their bodies, woman trust their doctors and their doctors dont trust the womans bodies, so of course we dont feel like we can do it!!!

Sorry, I'm still angry about my labour! I still feel that my c-section was avoidable - he wasn't a big baby, given proper gentle care, I believe I could have delivered him naturally! I managed to progress to 8cms dialated, I believe I could have (maybe with an epi to help, cos... bum first could have hurt like crazy!)

Some people might think I'm crazy to think this, by had I torn, which with proper care, I might not have, the tear would have healed by now, whereas I still have aches and pains with my c-section scar 5 months later!

OKAY - thats my 2 cents!