The High Cost of Caesarean Sections

Almost weekly now we are reading news stories in North American main stream media about our appalling maternal and infant mortality rates in Canada and the US, which I've written about many times:

*"Canada’s reputation for low infant mortality takes stunning decline"

*Canada gets a "C" for infant mortality

*Amnesty blows the whistle on Maternal Mortality rates in the US

*"Emotional Impact of Caesareans"

This week is continuing the tradition with yet another article on the High cost of Caesarean Sections- both in loss of life and financially.  You have to wonder if the Medical Machine is ever going to wake up and realize that THEY are the problem right now.  Study after Study has been done to show the increased risks that come with Caesarean Section births, especially elective C/Sections. More and more women and babies are suffering from needless trauma, and horrifyingly our maternal and infant mortality rates just keep climbing.  Various medical organizations have pointed fingers at North America's high preterm birth rates and an increase in multiple births due to fertility treatments as reasons for the decline, but they refuse to accept that the biggest reasons are the use of chemical inductions, epidurals and C/Section.

Do I sound like a broken record?   I really hate sounding like a one hit wonder.  But I'll keep roaring from my soap box and hopefully someone will listen. Even if it's just a pregnant first time mom who needs to hear the truth.

(as usual the highlighted areas are my own)

The high cost of caesareans

By Timothy R. B. Johnson and Judy Norsigian June 28, 2010

FOR A symbol of what ails the US health system, look no further than hospital delivery rooms, where costly caesareans, many for non-medical reasons, are inching closer to a majority of all births.

 

Even though caesareans are associated with higher rates of complications than vaginal births, they are becomingly increasingly common. Problems range from infections, including the more serious antibiotic-resistant ones, to blood clots, prematurity, respiratory problems for the baby, and more complications with subsequent pregnancies. There is even a small but measurably higher risk of death for the mother.

Between 2000 and 2006, while the Massachusetts caesarean rate climbed from 16th to 10th highest among all states, the state’s ranking on neonatal mortality has slipped from 4th best to a tie for 9th. Six hospitals in the state have caesarean rates greater than 40 percent for first time mothers, yet none of these hospitals is designated as a high-risk center. So much for the argument that high-risk pregnancies are the reason for these rates.

There are also cost consequences for taxpayers — the caesarean rate for Massachusetts mothers on Medicaid is increasing at a faster pace than among privately insured mothers. Nationally, in 2008, average hospital charges for an uncomplicated caesarean section were $14,894, while such charges for an uncomplicated vaginal birth were $8,919.

What can we do to lower the caesarean rate? Considerable media attention has focused on how extreme obesity can raise the risk of having a caesarean, but more emphasis is needed on these system-based approaches:

■More hospitals need to institute policies that restrict the induction of labor, unless there is a good medical reason. Unfortunately, labor is now sometimes induced solely for the convenience of the physician or the mother, and labor induction increases the likelihood of a caesarean section in many women. Almost all the recent increase in late preterm (34 to 36 weeks) births was related to planned caesareans carried out too soon, and the rise in premature and low-birth-weight babies has required more expensive hospital-based care to address the medical problems of these infants.

■Obstetricians and hospitals should follow the new National Institute of Health recommendations to offer the option of vaginal birth after a caesarean for those women who want to avoid repeat surgery. As noted in a recent NIH press release, “Although as many as 60 percent of hospitals in some states routinely prohibit vaginal delivery by women who have had a caesarean section, that practice is out of step with current medical research.’’

Expanding this option would require that the American Congress of Obstetricians and Gynecologists amend a recommendation that hospitals have 24/7 presence of an anesthesiologist if they choose to offer vaginal births after a caesarean. Because of this recommendation, many hospitals concerned about liability refuse to allow them. Yet those same hospitals find it acceptable to call in an off-site anesthesiologist when mothers need an emergency caesarean for any other reason.

■Hospitals could expand access to nurse-midwifery care. In Boston, statistics for hospitals that care for women facing the same risk of complications show that hospitals with nurse-midwifery services tend to have lower caesarean rates than those without a significant midwifery presence.

 HERE to read the entire article

"Independent Women Will be Cut"

Have I mentioned that I love the Feminist Breeder Blog?!  Gina has a brilliant way to capturing your attention with her words and getting her point across with all the subtlety of a sledgehammer. Unfortunately, when you talk to people about the dangers of medical interventions during child birth and the risks involved in C/Sections, many times a sledgehammer IS needed to wake them up from their zombie like adoration of the medical machine and all the "wonders" that it has to offer to a birthing incubator... I mean, Woman.

The Feminist Breeder laments the so called feminist ideology that suffering through birth is anti-feminist, a misguided notion that has to be held accountable for at least some of the percentage of the almost 40% of surgical births that happen in North America.

"So many young women today think that drugged-up births and cesareans are the “feminist” choice, and that labor pains are oppressive or patriarchal in nature.  I understand… I really do.  I once was that girl.  I thought anything that could disconnect me from my biology meant freedom, and even joked about wanting a hysterectomy before I ever had kids.*  I didn’t necessarily want a cesarean (I’m scared of surgery) but when I became pregnant, I had blind faith that the obstetrician I hired could easily and painlessly remove the parasite I was growing in my womb with a nice epidural cocktail and some forceps.  Simple, right?
Of course I had no education whatsoever about epidurals or forceps or cesareans, and how much damage they could do to a woman’s body.  I just assumed that if the technology existed, then they must have perfected it, and if it could keep me from feeling a contraction then by golly, I had to get me some of that."

So, what if you decide to take control over your birth?  Ah, well, The Establishment doesn’t like that.  In this brilliant 2008 expose, Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, Dr. Marsden Wagner pulls back the curtain and shows us exactly how The Establishment feels about a woman who attempts to humanize, personalize, or retain autonomy over her own birth experience.

In his book, Dr. Wagner (an obstetrician and former Director of Women and Children’s Health for the World Health Organization) explains,

“This table heaps contempt on women whose ideas and preferences for giving birth inconvenience the doctor.  Many obstetricians find the table hilariously funny.  Isn’t it frightening that the ultimate weapon obstetricians use to punish overly “independent” women is to cut into their bodies, using a surgical procedure (cesarean section) only obstetricians can perform, which completely deprives the women of control over their own bodies?”

Yes, Dr. Wagner – it IS frightening.  Even more frightening is the fact that so many young women frivolously joke about electing a procedure that you describe as nothing short of violence against women.  All the while, women and babies are dying at a higher rate in the U.S. than in most other developed countries.

HERE to read the entire article on The Feminist Breeder

 And the Maternal and Infant mortality rates in our countries (US and Canada) continue to rise, and WILL continue to rise until women take back their births and stand up- not just for themselves but for their sisters too.

The Brilliant Gloria Lemay posted this on her blog and it is ohhhhhhh so true:

When Good Women Remain Silent

“First they came for the breech birthers, and I did not speak out–because I was not a breech birther;
Then they came for the twins, and I did not speak out–because I was not carrying twins;
Then they came for the high risk women, and I did not speak out-because I was not a high risk woman;
Then they came for the VBACs, and I did not speak out– because I was not a VBAC;
Then they came for me– and there was no one left to speak out for me.”
Taken from a talk by Laureen Hudson of California at the Trust Birth Conference (March 2010).

My new favourite Quote (for this week anyways):

“’If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get
up and go out and have their baby under a tree,’ [Dr. McDonald] said.”
[Neel J. Medicolegal pressure, MDs’ lack of patience cited in cesarean
‘epidemic.’ Ob.Gyn. News Vol 22 No 10]

Don't' let the medical machine fool you into installing a zipper.  Once it's there, it's awfully hard to get rid of. Once it's there, the machine will insist on using it.

Unnecessareans {365/34}, originally uploaded by Trader Photography.

Yet another article pointing out the dangers of multiple Caesarean Section surgeries.   But what is a mother to do once she's already had a previous single Caesarean Section and now suddenly she unable to find a doctor or hospital that will allow a TOL (Trial Of Labour) to have a VBAC (Vaginal Birth After Caesarean section) birth?  Or maybe she finds a doctor that still allows VBAC's after a single previous C/S, but the OB/Hospital throws up so many rules and regulations and interferes with so many medical interventions that a VBAC become insurmountable and she ends up undergoing a second C/S.

Two Caesarean Sections, two uterine scars.

What if she wants more children?  NOW What?????  As a woman who spent 4 months searching for a midwife to support her wish to have a VBA2C I KNOW the stress.  And that was in Canada!  Imagine being in an area of the US where they have banned VBAC births altogether!  So what does a mother do when she wants to have more children only to find out that that very first Caesarean Section has now doomed her to surgical births from now on.  What does a couple do when they want and plan on having a big family, only to discover that each surgical birth will put her and her unborn baby at greater risk- risk of haemorrhage, respiratory  arrest, hysterectomy (which instantly ends her ability to ever have another child), and even death.

We know the risks that come with Caesarean Section surgeries, the studies are very clear and unquestionable.... yet still Doctors are cutting women open for 1 out of 4, and some places 1 out of 3 births!!!  IS NO ONE LISTENING?

Full disclosure.  I have a very hard time believing that every single woman who has had a C/S has been given a full disclosure of the FULL risks of a surgical birth- not just the risk for that birth, but the risks for every single birth after that surgery!! 

I spent 4 months searching for a care provider to have a VBA2C- which ended in another caesarean section.  I search for even longer to have my VBA3C.  I had to tell the hospital that I refused a C/S, sign a billion forms, and had to fight tooth and nail every step of the way, but I finally did it!!  But there are hundreds and thousands of mothers out there that are not as fortunate as I was.  The only way to get out from under the knife is to fight for your Rights, and for the Rights of your sisters, friends, cousins and neighbours.

Dangerous delivery shows peril of multiple C-sections

By Alex Friedman

For The Inquirer

The worst surgical case of my residency came when we delivered my patient's baby by cesarean - her ninth cesarean birth. The baby came out fine, but for the mother we suspected one of most feared complications in obstetrics - that her placenta had burrowed deep into the muscle of the uterus.
To get oxygen and nutrients to the fetus, the placenta needs to attach just a few millimeters deep into the uterus. We worried that hers had gone much farther and might eat through the entire thickness of the uterus, keeping it from shrinking back to its normal size after delivery and causing a massive hemorrhage.
We gave a gentle tug on the umbilical cord. Usually the placenta peels off with such gentle pulling, but hers remained stuck - an ominous sign.
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."
Repeat C-sections pose more risk than a first section for many reasons. One factor concerns anatomy. When a doctor performs a first cesarean, the layers of tissue look and feel very different from each other. These visual cues and textures guide the surgeon, indicating exactly where to cut.
The surgery is simple: the surgeon cuts, spreads, and pokes, layer by layer, until reaching the baby. The surgeon first opens the skin a few centimeters above the pubic bone. The fat underneath easily gives way until the connecting fascia is reached. The tough, fibrous fascia, which holds the intestines in the abdomen, is cut at the midline and opened in either direction. The beefy abdominal muscles beneath are spread.
Finally, the glossy peritoneum, the last layer of the abdomen, is entered, and only the uterus lies between the doctor and the baby. In a term patient, the maroon, swollen uterus, flanked by finger-size veins, fills almost the whole abdomen, pushing the intestines up. The surgeon moves the bladder out of the way, cuts the lower uterus open, and is met by a baby's foot, face, elbow, or behind, depending on how the baby is positioned.
The surgeon loses the advantage of good anatomy after the first section. The tissue undergoes scarring, toughens, and blends together as it heals. The variations in color and texture disappear. The intestines and bowel sometimes stick to the healing wound, putting them in harm's way the next time surgery is performed.
These changes increase the chances of an unexpected injury. "Her belly was cement," we'd say to one another during residency after a tough section.
A study from 2006 published in the journal Obstetrics and Gynecology compared C-section complications in more than 30,000 patients. Risks of requiring a large blood transfusion, incurring a bladder injury, needing to be on a ventilator, and ending up in intensive care all increased significantly with the number of sections after the first.
The study also showed greater risk for my patient's complication. Scarring on the inside of the uterus after a cesarean causes the placenta to attach abnormally in future pregnancies. During a first section, the risk of this complication was less than 1 in 400. After a sixth section, the risk ballooned to more than 1 in 15.
So we knew the risks my patient faced from her ninth cesarean and prepared the best we could. We matched extra blood, placed additional IV lines, and arranged for expert surgeons to back us up.
But with my patient's placenta stuck and bleeding, only one option remained: removing the entire uterus with the placenta still attached. Because the pregnant uterus is large, swollen, and filled with blood, a hysterectomy after a delivery is very dangerous and performed only as a last resort.
By the time we finished the surgery, blood covered the floor. Blood filled suction buckets, and saturated our sterile gowns and drapes. Blood-soaked sponges piled up in the corner.
My patient lost three times the entire blood volume of a normal person, sixteen liters in all. Only a massive transfusion kept her alive. Anesthesiologists pumped in 51 units of red blood cells and seven six-packs of platelets.
Vessels deep in her pelvis refused to stop bleeding, and instead of closing her, we packed her abdomen with surgical towels, hoping the pressure would stanch the slow, steady flow. She left the operating room and headed to the intensive-care unit with her abdomen still open.
After a reoperation the following morning and days in the ICU, she stabilized and slowly recovered.
With a first cesarean, the up-front costs - a few more days in the hospital, a longer recovery - may seem reasonable. Only in retrospect can the true costs become apparent.

HERE to read the original article