I love this quote:
“We should do inductions for good solid medical reasons, not for convenience or the day of the week,” Dr. Macones said. “Sometimes patients push you.”
He's suggesting that it's the consumer asking for this! As if. I'm sure there are some pockets of people who want to schedule their birth, but I cannot believe that it's very much.
This is just one of many reasons why midwives should get more acceptance in mainstream medical practices. This is why midwives should attend all low risk births. It would be safer for everybody involved and they would be cheaper for health insurance companies. And most of them agree that higher risk cases should be attended by a Dr.
6 comments:
Patients are DEFINITELY asking for scheduled C-sections. I'm sure the doctors aren't discouraging it, but between Bill's and my families, there are a LOT of scheduled C-sections. It's so weird. I can't believe that it is such an accepted practice, either. It all goes back to the MONEY!!! The doctors get reimbursed much, much more for performing C-sections than doing vaginal births, and the parents can plan.
I'm not so sure about your assertion about midwives. I'm sure they're cheaper but at what risk? In the US home births attended by midwives have double the infant mortality rate of hospital births, according to this this article. Regardless, what happens when you have an emergency with a midwife? Even living in Oakland, we're still 20 minutes from a hospital during rush hour.
Bill, the stats in that article actually show that cnms have a lower mortality rate than drs (.37 vs .61). This is my point of it being safer. Comparing only direct entry midwives with drs isn't really that much of a comparison. This direct entry bucket includes those folks that don't believe in western medical intervention in birth. Whatever happens, happens and it is god's will. Of course this bucket will have a higher mortality rate for obvious reasons. No where am I suggesting that folks should *only* give birth at home. I did it to stack the deck in my favor, and I'm glad I did despite going into NICU with Maddie. I'm just saying if you're a low risk patient, you will be much better served with a trained midwife. Whether that's in a hospital or at home, is up to you. But avoid have a dr who actually has to work less hours and gets paid more to push the birther into surgery.
All valid points.
Just a couple of comments about the data. The MD group includes all of high risk births (c-sections, pre-mature, etc) regardless of whether they started with a midwife or not. Where as the CNM and DEM groups are only low risk births. Therefore, the MD group is going to be higher than the CNM group. What is striking is that even with the difference in risk, the MD group is still half of the home-birth group. The original article also points out that a better comparison would be between CNM and DEM groups. This would mean that the home-birth is 3 time worse. But you're right that the data might be corrupted by quack home birthing mid-wives.
I believe that this does come down to a personal choice issue. Maybe having a midwife has some benefits, but having nurses and doctors certainly has benefits too, especially if something goes wrong.
Regardless, you're likely right that doctors are pushing for c-sections. Dr. Amy suggests that it has more to do with the risk of lawsuits than anything else. "Give me a perfect baby or I'll sue you for not performing a c-section." This expectation would still persist with the use of a mid-wife, therefore the c-section rate wouldn't go down if mid-wives became more acceptable. Her theory indicates that the problem can only be solved by people not suing so much. Maybe tort reform will be in the next health care bill.
The stats for the Drs in this article is actually much lower than it really is. If you have a csection and finally die from a surgery related infection two weeks later after readmittance, you're not counted as a neonatal mortality. It's only if you die on the operating table or during your in hospital recovery period that it will usually count. There's an article that came out about a year ago or so ago where somebody actually sat down and went through every single female death in a particular location (state or some counties) and discovered that the hospital birth related death rate was way higher than the stats that got reported because of these types of issues. They also found that there were cases of some people dieing in surgery and it getting attributed to the surgery and not counted as birth related.
I'll see if I can find this.
The first step with all this is to somehow not make it appear legally that "you've done everything you can do" as a dr when you do a csection, so at least the "cover your ass" types of drs pushing csections will stop. I also think you shouldn't be permitted to request a csection unless you have some real reason. But I'm probably not firm on that because if somebody wants to use technology for birth, why shouldn't they be allowed to? I'm not opposed to plastic surgery either, if you want it. It's just not something I would do. I bet if folks realized it was so much more dangerous they might stop asking for it. Here's an interesting article that talks a little about the collection of numbers and here's a decent aggregate blog about these issues. Here's an interesting quote about it all:
For a healthy woman, a C-section is pretty safe. The consensus is that it may be slightly more dangerous than vaginal birth. But if you look at the second, third and fourth births after that C-section, the risks go up dramatically. That’s because with every new surgery there is more internal scarring, more risk of placenta problems. And a lot of places force you into csection if you've had one before.
C-section=bad
Homebirth=good
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