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There's a good article in the Philadephia Inquirer by an MFM specialist...
The case points out a fundamental truth about surgical delivery: a first cesarean for most women leads to a cesarean with every pregnancy. And while a first section is quick, easy to perform, and rarely complicated, each repeat surgery carries greater risk.
More and more women are finding themselves on the C-section path. Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available, an increase of more than 50 percent from a decade earlier.
At the same time, it's becoming harder for mothers to avoid repeat surgery. The number of vaginal births after a C-section fell by two-thirds, to fewer than 10 percent, over the same time period. This year, the National Institutes of Health estimated that since 1996, one-third of hospitals and one-half of doctors who offered vaginal births after a C-section no longer do so.
"There can be tremendous morbidity after three or four or five prior cesarean deliveries," said Gary Cunningham, an OB-GYN professor and former department chair at Southwestern Medical School in Dallas, who chaired the NIH panel.
"Women need to be counseled appropriately and accurately so that they can make an informed decision," Cunningham said. "But this doesn't do much good if she cannot find an obstetrician or hospital that will allow a trial of labor."
This might be an odd question, and I'm not sure if any research has been done on it or anything, but it's just a concept that occurred to me. I'm going to school for biology, to eventually end up in a Genetics/Developmental Biology PhD program, and so I've been reading a little about chaos theory. Nature is full of fractal patterns, including the human heartbeat, which was assumed to be rhythmic. When you try to force the human heartbeat to be rhythmic, it can stop altogether and the person will die. This was only recently discovered. So my question is, does anyone know if labor and contraction patterns are actually fractal? And if so, could this be a reason that Pitocin induced labors are more painful, or even a source of other issues that come with induction? This is really just a curious question, but I thought perhaps one of the wonderful commenters here might know of any studies or research done that is relevant to the question.
I've been wondering whether there is a conflict between the interests of malpractice insurance and health insurance providers. On a simplistic level, it seems to make sense that since the conditions of malpractice insurance policies lead to more cesarean sections, and c-sections are more expensive for the health insurance companies, that malpractice and health insurance providers wouldn't be on the best of terms about it. My cynical guess is that the same folks are running both and have set the system up to work for the most profitable ultimate bottom line. If that isn't the case, though, then I find it baffling that health insurance companies wouldn't have a vested interest in more deliveries happening vaginally. While I think money is one of the worst reasons to determine how birth happens, it does seem to be a primary factor. Any readers or contributors here have some insight into insurance land?
Ginny, that is something to think about!!! Well, I am pretty sure pitocin-induced labors usually hurt more because they make the uterus contract harder and faster than it would naturally. But what you said about labor progressing in a fractal pattern rather than a rhythm that doctors tend to want to be able to predict and track... well that's something to think about.
I know we all know about women being refused VBACs, does anyone out there know of a women refused a repeat section? I'm be curious to hear that story!
..."baffling that health insurance companies wouldn't have a vested interest in more deliveries happening vaginally"It seems odd that this would not be the case. Why, for instance, are health insurance companies so hesitant to cover home birth? My mw said that it was because doctors with the ins. co. decide what they do and don't cover, and they are dedicated to keeping home-birth on the fringes and by-and-large refuse to cover it [birth-center births are similar, but to a lesser extent], even though it has equal neonatal outcomes, better maternal outcomes, not to mention costing much less. So "the old boys network" is one factor. The other factor may be that doctors bill most if not all C-sections as ultimately necessary. How can an insurance company prove that a particular FTP/CPD case was inaccurate, or that a baby did not actually have fetal distress, or that a woman didn't suddenly spike high blood pressure, or any other reason or excuse for a C-section? However, with health insurance companies having started to refuse to cover women who have had previous C-sections, it would be hard to make the case that they actually *want* women to have C-sections.
Ginny - I'm very interested now in the fractal idea
Kathy, I spent (too much) time about a year ago reading article after article about the rise in the c/s rate in the mid 80's and the reaction of doctors, "the public" and insurance companies (as filtered through the media). Let me see what I saved on my hard drive because I remember holding it against the same articles that I think you've read over the last couple of years and it was interesting.
On another recent Monday thread, someone posted wondering about her friend having a very small baby, I can't recall if she was induced or had a scheduled c/s. I found this while surfing this morning.... seems related.
mj, it seems to me that no one is turned down for requesting a C-section for any reason, even as an elective primary section. I have heard from a few (very few) women who were pressured by a doctor or nurse about to try a TOL/VBAC instead of the repeat C-section they were seeking, but none of them seemed to have been forced into a TOL they didn't want, so it was only a minor irritation to them.
Come to think of it, it seems like very few women are dissuaded from seeking labor induction at term, either, Bishop's score be damned. It seems we only run into practical roadblocks to delivery when we want to take the time to wait for spontaneous labor to happen and see it through even if it is puttering along. You know, the way it commonly happens when Mother Nature takes her course.