OpEd: There are many things more evil than Trump. The filthy greedy American Medical Industry aka Medical Mafia is one more example of that. The truth is, Trump is a distraction. The filthy dirty media is controlled by forces even more sinister and powerful than the Orange Menace. Corporate media will never bite the hand that feeds it.
The Rise of C-Sections – and What It Means
America’s propensity for cesarean surgeries at childbirth has come with no clear benefit.
Pregnant people get bombarded with seemingly well-intentioned but confusing advice. "Don't eat sushi," for example, "but some sushi, at least certain sushi, is probably OK."
The confusion stems, in part, from muddled expectations for what pregnant people deserve when giving birth. Everyone wants safety, but most are expecting more than simply emerging from the whole process unscathed. They want dignity. They want autonomy. They want choices.
What makes for a good birth is a matter of intensely personal opinion. But in multiple surveys of American mothers, feeling informed about the options that exist appears to be a universal requirement. In this special report, U.S. News shines a light on national, state, county and hospital C-section rates. For the millions of Americans who will give birth this year, knowing the cesarean rate of the hospital where they plan to deliver should spark important conversations with their providers about what type of care they want. Yet the numbers alone can be confusing, particularly without clarity about what cesarean rates truly indicate and why they matter.
Since the early 1970s, the likelihood of a mother undergoing a cesarean in the United States has skyrocketed by 500%. Although cesareans are designed to rescue babies from danger, rates of survival and brain injury among infants born close to their expected delivery date have not changed. Mothers have not benefited either – in fact, the opposite has occurred. Americans today are 50% more likely to die in the period surrounding childbirth than their own mothers were, a risk that has remained consistently three to four times higher for black mothers compared with white mothers.
For obstetricians like me, there is a simple decision threshold we must meet before applying a scalpel to a person's skin: The benefits must outweigh the inherent risks. In the moment of choice, my colleagues and I always believe we are meeting this standard. But conveniently, we never get to observe what would have happened had we not done it. When I do a cesarean and the baby comes out looking great, I think, "It's a good thing I did a cesarean!" And when the baby comes out looking lackluster, I think, "It's a good thing I did a cesarean!" Either way, it's easy for everyone to believe it was the right choice.
With no clear benefit to the inexorable rise of cesareans, our national statistics call this belief into question – and put the risks into stark relief. For mothers, birth complications such as hemorrhage, infection and organ injury are three times more likely to occur with a cesarean compared with a vaginal delivery – risks that increase with each subsequent cesarean a mother has. Even in the absence of complications, taking care of a newborn infant is a much more difficult task when a mother has a 10-centimeter incision on her abdomen.
The challenge is that we have no idea what the ideal target cesarean rate is, and it is unlikely we ever will. Even for the pregnant person directly in front of me, truly knowing if the cesarean was necessary can be impossible. Nonetheless, due to growing concern about the harms of avoidable surgery, and based on near certainty that rates can be safely lowered, the U.S. Office of Disease Prevention and Health Promotion has set a national target of a 23.9% first-time cesarean rate for "low-risk" women. Recently, insurance companies, hospital accreditors and others have begun suggesting that hospitals aim to meet this same target.
It is worth mentioning that applying the same, somewhat arbitrary target to all hospitals may not be fair. Depending on where a hospital is and who it serves, there could be important, legitimate differences in how much surgery is needed. At the same time, even when caring for pregnant people with similar needs, some hospitals still continue to perform way more cesareans than others.
It is plausible that hospitals with very high cesarean rates are not set up as well to support people in labor and therefore deserve our scrutiny. For a well-equipped hospital, cesareans are easier to accommodate than normal labor. They can be scheduled and predicted. They don't take as long as normal labor. They also require less staff time and thus cost less, despite commanding higher reimbursements. In the current system, the scales are permanently tipped toward doing more surgery.
Some hospitals try harder to counteract this pressure than others. In fact, whichhospital a birth occurs at may be one of the biggest determinants of how the birth occurs. From one American hospital to the next, cesarean rates vary from 7% to 70%. Rather than being driven by personal preferences or medical needs, this appears to suggest that the likelihood of getting a cesarean is largely driven by the choice of hospital.
For some Americans, particularly those with generous health insurance and those who live in or close to cities, being aware of the wide differences in cesarean rates may be helpful in deciding where to go or not go for care. Still, many Americans do not have a choice. There may only be one hospital within reasonable driving distance that delivers babies. There may be only one hospital that is affordable. Even in these cases, knowing the hospital cesarean rate is helpful.
Pregnant people deserve to be able to have conversations with their providers about how the hospital cesarean rate may or may not apply to them personally. They deserve to understand how the hospital is taking steps to counteract the rise of cesareans, to invest in labor support, and whenever possible, to avoid the risks of surgery. Improving health care is always easier said than done, particularly in a domain as complex as childbirth. But if more conversations like this occurred, we might see more safety. And more dignity as well.
Read more U.S. News reporting on C-sections in America:
Tags: C-sections, pregnancy, birth, women's health
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If you support Trump you deserve cancer.