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Tuesday
Jun092009

More Mainstream Media Coverage of Florida, The Cesarean State

This article about the South Florida cesarean fiasco was published yesterday in the Sun Sentinel. Here are a few excerpts:

New state figures show 43 percent of Broward County births and 41 percent in Palm Beach County were done by C-section in the year ended June 30, 2008 — far above the national average of 31.8 percent, a record high. Florida, at 39 percent, ranked second highest behind New Jersey.

The state of New Jersey has a 39.4 percent cesarean rate.

 

“Absolutely, something has to change,” said Lake Worth obstetrician Sam Lederman, chief of OB-GYN at Good Samaritan Medical Center. “The C-section rate is three times higher [than 20 years ago], yet babies are not healthier. It’s not helping.

 

Fear, fear, fear and Florida moms get REALLY fat, really fast.

There are medical malpractice fears. Obstetricians and hospitals in litigious South Florida order C-sections for any irregularity before or during labor, doctors and researchers said. Almost no doctors let women try natural birth after a prior C-section. Also, more moms than ever have diabetes, obesity and other issues that lead to C-sections.

Doctors contend they are under pressure to deliver surgically. If they don’t and something goes wrong, they are sued. As a result, almost no doctors do natural delivery for breech or multiple births.

“If there’s any untoward event, the first thing they ask is, ‘Why wasn’t there a C-section?’” said Coral Springs OB-GYN Bruce Zafran. “If there’s any doubt, there’s no incentive to take a chance.”

Most doctors avoid an immediate risk by doing a C-section, even though it may raise the risk of problems in future births, Lederman said. “The philosophy is, you will never be sorry you did a C-section, but the reverse is not always true.”

 

This is a huge civil right issue. If there is no medical reason for the surgery, it is no different than marking the wrong leg for amputation. Wrong diagnosis, unnecessary surgery, medical malpractice.

But doctors who deliver half of babies by C-section cannot possibly find medical reasons to justify them all, said Eugene Declercq, a researcher at Boston University School of Public Health.

Babies born by cesarean are more likely to go to intensive care for reasons such as lung infections from fluids not squeezed out by natural birth, a National Institutes of Health advisory panel said in 2006. Surgical births, like any operation, risk infections and anesthesia reactions. And mothers who have repeat C-sections are more prone to have abnormal placenta growth that causes bleeding and complications.

 

Insurance companies and this mom say, “ENOUGH!”

Even insurers such as United Healthcare have been pressing doctors to halt excessive C-sections because of the high costs and the chance of more complications in future births.

Hollywood mother Nermarí Broderick said her doctor pushed her toward a cesarean even though she didn’t want it and had no medical risks. So she had two sons at a natural birth center.

“I said I really don’t want a C-section,” Broderick said. “He said, ‘Well, we’ll see.’ I thought, this doctor is not going to do what’s right for me.”

 

While I don’t think that comment threads are a reliable indicator of public opinion, I’m always intrigued by what people will write under the veil of anonymity provided by the Internet.

 

Erika #3

There are usually reasons that people have to get C-sections. If the doctor says one needs to have one, they probably do know what’s right.

Sounds like a dream patient, right? To me, however, Erika is the patient whose blind trust and total disconnect with reality WILL land you in court if anything goes wrong. I would think that doctors without NPD (Narcissistic Personality Disorder) would want to take patients who know their risks and are educated enough to sort out iatrogenic injury and botched care from desperate HUMAN attempts to deal with shoulder dystocia, cord prolapse and other true emergencies. My feeling about hospital birth is that if it could happen at home and a midwife would be making the same attempts to remedy the situation, then give that doctor or hospital CNM a break! Don’t add insult to injury by putting them through unwarranted litigation. Please?

 

Lulu #17

My doctor wanted me to have a c-section, but for what reason I am not sure really. He claimed that the baby would be almost 10lbs, however he actually was only 7.6


My c-section went really well and I recovered easily, but there was no reason to have one.

I would wager that this wrong diagnosis occurs at every large hospital at least daily. What do you think? I’m going to contact WrongDiagnosis.com and try to get unnecessary cesareans based on incorrectly estimated fetal weight added as a section on the site.

 

Slugworth #25

You right wing-left wing political nuts ruin everything with your trolling and posting rhetoric. Make up your own damn mind. Nothing is black and white. C-section saved my wife and baby’s life. Articles like this are inflammatory. 

Inflammatory? Slugworth has mistakenly identified the media or the article’s author as the offender here. Very interesting.

 

Coconut Creek #31

In 1989, My oldest child was born at the Boca Medical Center. My wife’s Doctor was chosen from a list provided by our insurance company.

After my wife initially showed slow progress in labor her Doctor insisted that she needed a c-section. My wife was fine, the baby was fine and even the Doctor agreed there was no danger in letting nature take it’s course.

While she slowly progressed through labor, I learned from the nurses that this particular Doctor was known as Dr. Cut. Not one of the nurses could even remember the last time he performed a normal delivery.

The Doctor eventually tried to strong arm my wife by suggesting he would not perform the delivery unless she agreed to do it his way - via c-section. We refused and he just gave her more time to deliver.

Eventually she naturally delivered a healthy baby. Our second son was also delivered naturally, but we had to interview Doctors before find one that also did not lean on c-sections as his normal method.

Afterward we received accolades from the nurses who saw this as our doing something they thought impossible with this Doctor.

For the record, we never felt that this was in any way connected to the hospital, but rather a quirk of this Doctor. I always knew some Doctors were doing unnecessary c-sections and now here is the proof.

Every comment thread about cesareans features the standard “I had to have all three of my cesareans to save my life. You don’t get a medal for natural childbirth.”

The funny thing is that nurses DO give patients medals and accolades. I need to write about this. I’m not sure if there’s anything more beautiful that the nurses who root for their patients. I’m so glad I have my medical records now so that I can send letters to a few of those awesome women. They might not actually catch the baby, but L&D nurses are midwives.

Coconut Creek, tell Mrs. Creek that she’s awesome.

 

D Rap #32

Erika wrote:

“There are usually reasons that people have to get C-sections. If the doctor says one needs to have one, they probably do know what’s right.”

Not always. When my friend found out she was 2 1/2 months along, the doctor (guy) gave her a date for the C-section. How the hell would he know she’s going to need a c-section in 7 months? Needless to say, she got herself a doctor who wasn’t such an idiot (woman). Really sad part of the story — after the first moron, she had to talk with TWO MORE DINGBATS with the same attitude (guys). She went on to vaginally deliver a healthy baby — 10 pounder!!

No commentary needed.

 

formerPBCmom #38

I had my daughter in Palm Beach County in 2005. An end of pregnancy ultrasound estimated her weight to be over 4000g. The OB talked me into scheduling a c-section saying “You can say you aren’t going to sue me, but you might, so I really need to talk you into this c-section”. He also overstated the risks of delivering a large baby vaginally (as I found out later through my own research). At the time my daughter and I seemed to be relatively healthy, but I had months of PPD and PTSD that were directly related to the c-section. I now feel that my c-section was unnecessary, as several women in my family have vaginally given birth to babies as large as my daughter, if not larger.


In 2008 my husband and I started to TTC our second child. I had a miscarriage in August, and then conceived again in October. That pregnancy turned out to be ectopic, it ruptured my left fallopian tube and I went in for emergency surgery on Thanksgiving. I lost my left fallopian tube. When I talked to the surgeon afterwards he said my only risk factor for it was the previous cesarean surgery. So, my c-section nearly cost me my life and may prevent me from ever having any more children. I would love to sue the doctor for that, but I would guess it is too late now.


C-sections are wonderful when they are necessary, they can save lives. However, unnecessary c-sections can destroy lives as well.

This is so sad. 4000g is 8 pounds, 13 ounces. That doesn’t even meet ACOG’s suspected macrosomia management guidelines. This quack needs to be put out of business. HE IS WORTHLESS and a public health menace.

I believe that in ten years, we will all look back and ask, “Remember when there was no retribution for women like formerPBCmom against aggressive, abusive physicians?”

 

Michelle #39

This is not at all a surprise. I delievered my son almost a year ago (naturally, since thankfully my OB was on vacation when I went into labor….not that I was told about it or anything.) My OB had offered at one of my prenatal visits to schedule a c-section, not for medical reasons, but in case I “didn’t feel like laboring”. He went on to tell me that it’s faster, and it’s my right to decide if I want to have to go through it or just get knocked out and have my son surgically removed. He’s an AWFUL doctor, and for more reasons than prizing his tee time over his patients. 

I wish Michelle posted a name so people would know who to avoid.

 

 

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Reader Comments (16)

This is brilliant - "I would wager that this wrong diagnosis occurs at every large hospital at least daily. What do you think? I’m going to contact WrongDiagnosis.com and try to get unnecessary cesareans based on incorrectly estimated fetal weight added as a section on the site."

I've gotten to the point where I try to avoid those stories because the comments section alone gives me the heaves. "but MY cesarean was necessary - how do I know? My GENIUS doctor said so!" Blah. Blah. Blah.

If women won't wake up and smell the infections, I dunno what else to do.

June 9, 2009 | Unregistered CommenterTheFeministBreeder

I agree with FB. I get sick of all the "how dare you tell me my c-section wasn't necessary" comments. Even on my blog, when I write a huge long post full of research telling how such-and-such a common reason for c-section is invalid, I get commenters who flat-out tell me: "I don't care what the research says. YOU DON'T KNOW ME. And my dr. said it was necessary." Blind, blind, blind.

June 9, 2009 | Unregistered CommenterEmily Jones

What is up with Florida? Craziness. I would be so curious to hear from the nurses who work in FLA. The majority of L&D nurses I know hate going to the OR. They are L&D nurses, not surgical nurses, so they always seem a bit out of their element. I personally hate catching babies in the OR. I hate the cover gowns, the cap that messes up my hair, the mask you can barely breathe in. I hate the sounds of the OR: the counting, the suction machine sucking up blood and fluid, the sound of scalpels cutting open flesh. I hate the smells of the OR: the betadine, the hibiclens, and the lovely smell of burning flesh if they cauterize vessels. I am not a surgical nurse for sure.

June 9, 2009 | Unregistered CommenterReality Rounds

Just wanted to comment and say that as a doctor, the clients like Erika #3 do scare me to death. The ones that come with their list of questions and ask me for evidence for any decision don't bug me at all - I much prefer that my decision making process be transparent and we all know why we are making the decisions we are making! I couldn't agree more that most people are very capable of telling the difference between malpractice and a physician trying their hardest in a desperate situation.

June 9, 2009 | Unregistered Commenterdoctorjen

"have my son surgically removed"
That made me cry.

June 9, 2009 | Unregistered CommenterSonja

I can't believe people like that Erika. There is such blind faith out there. No one researches anything for themselves, and just expects the doctors to tell them exactly what could go wrong and what can go right.

I am baffled we have a state that thinks like this. And people that agree to such things!! I would be more prone to sue my doctor if he cut me open without cause than if he had to use forceps or a vacuum. It's just ridiculous!!

I don't understand the women that defend their unnecessary cearean. It was MAJOR SURGERY!! It's not like they went in and had a mole removed from their stomach. It causes lasting problems, and no one seems to get it.

June 9, 2009 | Unregistered CommenterKayce

Since I had my c-section 2 years ago (my story is in the birth stories section), I have passionately, and perhaps overzealously, told everyone that will listen to me (and lots of people who won't) about the unnecessary c-sections, and all the unnecessary procedures that lead up to them, that we are all susceptible to while birthing in a hospital (I'm not saying "don't birth in the hospital," I'm just saying "know what you're getting into"). I tell everyone about doctors who don't practice evidence-based medicine, who are so busy butt covering that they can't see clearly to give us the best medical care they can, then gasp in horror and tells us we could have killed our babies because we birthed at home, without them.

When I was pregnant with my son two years ago, the obstetrician I was seeing mentioned at one of my early visits that I should consider the possibility of having a c-section because I have a "tight pelvic structure." My son was born c-section at 37.5 weeks after a failed induction for no real medical reason. Yeah, shoulda seen that one coming.

Not a day goes by that I don't want to go and see that doctor and show him the 9 lb 2 oz baby girl I birthed at 42w1d, vbac, at home with a midwife, naturally with no pitocin, epidural, amniotomy, or--amazingly enough--complications. I imagine doing horrible things to him. I hate him. He did this to me. I live every day with a scar on my stomach, I have to fight for every vaginal birth I have, I have to worry at the start of every pregnancy that I'll miscarry or have a tubal, because of my previous c-section. He forgot about me the minute I left the hospital. I'll never forget about him.

I hope someday I get over this. I don't know if I ever will.

June 9, 2009 | Unregistered CommenterKari

Great article and post.

I also can't stand the "MY cesarean was necessary-I would have died!" or even,"You should be GLAD you had a c-section-you and your baby could have died!" This is funny, especially when what I have posted talks about totally unnecessary cesareans. It makes me wonder--if I am posting about unnecessary cesareans, and you be come all defensive about your "totally life-saving and necessary cesarean", would that mean you are second guessing yourself, by any chance?

June 9, 2009 | Unregistered Commentermichele

Great comments. Of course, we think that Florida is weird, but our national rate of 32 percent is just as absurd. It's a national (or worldwide!) problem. Thanks for the great thoughts!

June 9, 2009 | Unregistered CommenterDiana

Wow. These are some great comments. Dr Jen, I'm so flattered that you read this blog. Thanks.

Kari, I can relate to wanting women to know what they're getting into. I am proponent of disseminating accurate information about birth, interventions and breastfeeding. Unmedicated, spontaneous vaginal best is usually the healthiest option for women. I think every woman should have access to information about the risks associated with any alternatives to the above and should be able to count on judicious use of any interventions. If someone has all of the information, understands risks and consents to the use of any interventions then so be it.

I, too, am horrified that covering one's butt legally by unnecessarily dragging babies from abdomens and setting mothers and babies up for long term complications and morbidity has become the medical norm. It actually disgusts me, which is why I often sound really pissed off. I am!

I have a proposition for you, Kari. If you feel up to writing a letter to that doctor, I will post it for you. We can leave names and identifying info out. I *know* that there are thousands and thousands of women who might benefit from reading your raw emotion. Maybe putting it out there might help you let go if that's what you feel you want to do. I'll be here.

June 9, 2009 | Registered CommenterJill
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