C-section rates in the US are at an all-time high. “The increase is attributed to fears of malpractice lawsuits if a vaginal delivery goes wrong, the preferences of mothers and physicians, and the risks of attempting vaginal births after Caesareans.”

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Anonymous
Poor Kevin, he’s been reduced to half truths and lies by omission across the board:
“Experts say many factors drove the rate: Mothers increasingly preferred the convenience of C-sections, which could be scheduled. Technological innovations let doctors better see problems before birth.
The trend temporarily reversed in the early 1990s, partly because HMOs pressured doctors to curtail unnecessary procedures. But by the late 1990s, health insurers had cut back their C-section control efforts.
Also, some doctors became worried that women who have had a C-section during an earlier pregnancy can suffer a ruptured uterus if they later attempt a vaginal delivery _ a potentially lethal complication for both mother and child.”
gasman
Easy on Kevin. He did post an article for discussion, but did not author the content of the article.
C-section rates are probably too high, but onlly because the evidence to support most c-sections was never subject to critical analysis.
Now we are stuck with the legacy.
1. Once a section always a section. Not dogma as it was with the classical vertical uterine incision, but inertial prevails.
2. Mothers who previously had a C/S are more interested in repeating that if the experience was positive (rather than try something new such as vaginal)
3. More recent evidence suggests that Vaginal birth after C/S (VBAC) carries more risk for uterine rupture and maternal death than was originally thought when this was initiated in the 80′s.
4. With greater risk for VBAC it is reasonable to attribute some of the increase in repeat C/S rates on informed maternal choice.
What should the C/S rate be based upon best evidences (and free from the legacy of past high rates)? Difficult to say because obstetrics stands out from other areas of medicine as having virtually no meaningful evidence based foundation for current practice. I can understand the reluctance for rigorous investigation because healthy patients often have the lowest interest in participating in clinical trials and the mortality/morbidity can potentially be two people for every subject enrolled.
Anonymous
Anonymous was not criticizing the content of the article or confusing authorship, rather he was pointing out Kevin’s incomplete and misleading quotations.
I routinely read misleading quotations on this blog, which I discover upon skimming the original article. Kevin, you would be far more persuasive if you did not resort to misrepresentation. As they say, if you have to resort to misleading statements because there isn’t enough support for your position, then re-think your position.
Anonymous
Wow, You are more full of shit then usual. “some doctors became worried that women who have had a C-section during an earlier pregnancy can suffer a ruptured uterus if they later attempt a vaginal delivery”. VBAC (Vaginal Birth after Cesarean) wasn’t killed by MD’s worried about Uterine rupture, it was killed by overzealous malpractice attornies scaring the Living Shit out of any poor schmuck who delivers babies. Informed maternal choice? Most hospitals refuse to do VBAC, and with the limited choices available to women these days (again, due to the rape of obstetrics by malpractice attorneys) they go where they can get a delivery. I’m am male, I don’t give a shit that woman have to get their uterus sliced open in the name of defensive medicine. I just get pissed off that you lawyer assholes try to substantiate what you do in the name of science, rather then the utter greed you are all so full of. Why don’t you go on some Legal website and fight the “sliding scale settlements” that you face that gives some of the money to the actual plaintiff.
Anonymous
Give it a rest, Anon 110. Your anal fixations are getting downright tiresome and annoying. If you’ve got something useful to say, say it. Otherwise…do us all a favor and…
Anonymous
“I routinely read misleading quotations on this blog, which I discover upon skimming the original article.”-Anon 9:44
Go back to grade school Anon 9:44 and learn how to read. Everybody knows it’s a quotation from the article, stupid. It’s suppose to grab a reader’s attention to get us to read the article. It may or may not be a summary of the whole article. That’s why it’s in quotation. Now, if you want a summary of an article, go read
“Cliff’s Notes”. Hey guys, don’t you notice, there are stupid people everywhere. Maybe, this guy should have been aborted, instead of delivered.
Anonymous
Almost all aspects of childbirth has been removed from the realm and control of those who do it … the women themselves. Childbirth is not an illness, it is not a medical event. It does not need to be made into one … unless there is money to be made from it, right? Obstetrics is usually the most profitable service in a hospital, isn’t it? Doctors have done a mighty fine job of convincing women that they must be cut somewhere to give birth (belly or the taint), they must be numb from the waist down, their nutrition must be given IV, they must remain in bed, every fetal heartbeat must be recorded throughout labor, and that they cannot do it without the heroic OB all in the sterile(?), cold, alien environment of the hospital. And it is precisely all that interference with the natural process that disrupts it and creates the need for medicalized and surgical birthing.
My first was surgically removed from my uterus in 1985, for no reason, other than the doctor thought I was not moving along quickly enough (IOW, not gonna shove the kid out before the football game starts). I finally gave birth two years later to my second son, but it was a fight all the way. For number three, I gave the medical model the finger, hired a midwife and had a most lovely home birth.
If you put 100 pregnant women on a desert island with nothing but decent shelter, abundant nutritious food and several midwives, you know what you would find 9 months later, most likely? Several exhausted midwives, 100 live and healthy new mothers and at least 101 live and healthy babies.
Sorry docs, 999 times out of 1000, we just don’t need you at all, if you just keep your mitts off of us.
Anonymous
Ignorance is bliss isn’t it:
1: OB is “so” profitable that in my large city we are down to three hospitals that provide the service. The others have given it up.
2:The reason for the increased C-section rate is multifactorial but clearly “medical-legal” reasons ranks highly. Tell me what would you have done to the OB if your first child had been born with cerebral palsy?
3:Clearly nurse midwives have their place in non-high risk pregancies (my own two son’s were born via a midwive in a birthing center with OB backup just in case). That stated high-risk OB is completely another story.
4: With the small but real risk of uterine rupture with VBAC’s I am not surprised hospital’s were leery of your wish. Again, I ask what would you have done if there had been a complication?
Anonymous
the “pro midwife” anonymous poster is a fool. Yes, midwifes can successfully deliver most babies and doctors are not needed.
HOWEVER, you are an absolutely fool if you try to get a midwife home birth if the mother has gestational diabetes, pre-eclampsia, and a number of other comorbid conditions. The incidence/prevalence of those conditions is WELL ABOVE 1 in a 1000 pregnancies, so that ludicrous statement that 999 out of 1000 pregnancies dont need a doctor is just idiotic.
Anonymous
HOWEVER, you are an absolutely fool if you try to get a midwife home birth if the mother has gestational diabetes, pre-eclampsia, and a number of other comorbid conditions. The incidence/prevalence of those conditions is WELL ABOVE 1 in a 1000 pregnancies, so that ludicrous statement that 999 out of 1000 pregnancies dont need a doctor is just idiotic.
Ahh yes, ignorance. Definitely stuck in the thinking that childbirth is a medical event. Get out of that thinking and you will realize just how laughable and ignorant your statement is.
Truth is, most complications of pregnancy and childbirth are iatrogenic. Pre-eclampsia can be avoided with simple good nutrition. Gestational diabetes can be avoided and/or managed the same way. Of course, you will call BS on that because you have been brainwashed into that medical model of thinking.
Bottom line is, if docs returned birthing back to women, there would be a hell of a line of unemployed OBs.
God complex, indeed ..
Anonymous
“Truth is, most complications of pregnancy and childbirth are iatrogenic. Pre-eclampsia can be avoided with simple good nutrition. Gestational diabetes can be avoided and/or managed the same way”
I am sorry. You are an idiot. Goodbye.

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