Cesarean Sections - I am not amused

[Case]

Well, the title is quite telling, I guess. See, just a week ago I was visiting my family and one family member was pregnant, in fact she was due about 2-3 weeks from then (we have a history of guess date + 7-12 days in our family). She was happy the pregnancy was coming to an end and was looking forward to delivery. A couple days ago I got a call - she finally had her child, a healthy girl. I was surprised and asked why she delivered a week early, instead of a week 'later', bearing in mind the history of prolonged pregnancy in our family. When I heard she had had a C-section, I cringed. The image of her getting cut open was too appalling. It seemed to be quite hectic over there so the only explanation I got was "they were a bit worried about her blood-test results". I also heard that a call was made to the head nurse not to let them perform a c-section if it wasn't absolutely necessary. I was left a bti bewildered, happy for her as she was, well, alive and the child, apparently, was healthy. I have serious doubts about that 'decision' though.

I recently discovered a site that sounds a bit like [teaveeshag] where I watched the documentary "Pregnant in America", which documents a couple's quest to find out several things about common child delivery practices in the US and other countries. It boils down to the all-too-common picture of insurance companies fucking up everything, and quite frankly, I have no trouble believing that. But I am curious by nature, so I went searching for the statistics. Apparently... in most first world countries, perinatal mortality (death within first year) rates are at about 0.4%. Compared to some African countries (where cesarean section rates are presumably lower) which usually average around 10%, that's quite good. Trouble is: there are lots of confounds involving socioeconomic status and general healthcare, et cetera.

I then went looking for stats regarding c-sections. And well, it's quite disgusting to read this... but pretty much everywhere, the numbers for c-sections are going up. In Germany, it's roughly 30%, in the US it's roughly 30%, in the Netherlands it's roughly 30%,... so I looked up older statistics. In Germany, around 1975 about 15% of all deliveries were via c-section, perinatal mortality rate was at 2% (but these numbers are a bit inaccurate as I'm using FRG c-section data combined with GDR p.n. data, couldn't find p.n. data for the FRG for 1975). All this tells me is that while more and more c-sections were conducted in Germany, more newborns survived. It doesn't tell me anything about whether these two are related. If that were the case, if I could find a country where c-sections went down while the initial trend continued for infant mortality, I might have a case to say c-sections are grossly abused on a whole do not add to newborn survival.

As it happened... I came across a paper that stated exactly that.

This nationwide study examined the annual changes in cesarean section rates in relation to perinatal mortality, the condition of the newborn at birth, and different indications for the procedure in Sweden. Since 1973 all obstetric units have sent copies of medical birth registration forms for newborns to the National Board of Health and Welfare. Information about the cesarean section rate, indications for the surgery, Apgar scores, and perinatal mortality between 1973 and 1990 was obtained from this data base. The cesarean section rate increased from 5 percent in 1973 to 12.3 percent in 1983, and thereafter declined steadily to 10.84 percent in 1990. Perinatal mortality was halved from 14.2 to 6.3 per 1000 live births, and the number of newborns with low Apgar scores (<4 at 1 min and/or <7 at 5 min) decreased from 20 to 14 per 1000 live births. We conclude that it is possible to lower the cesarean section rate on a nationwide basis without increasing risks to newborn infants.

Nielsen, T. F., Otterblad Olausson, P., & Ingemarsson, I. (2007). The Cesarean Section Rate in Sweden: The End of the Rise. Birth, 21, 34-38.

Now I haven't done much research as to how much money the hospitals in other countries make, but in Germany, c-sections are 67% more expensive than regular births (2500 vs. 1500 €, source). The numbers reported in abovementioned movie suggest that the same is true for the US, just that both are ridiculously more expensive (factor 10-20).

What's worse, I came across data that strongly suggests c-sections increase the likelihood of maternal death two- to threefold (link). And that's where I got really angry. Maybe I'm missing a confound (e.g. are c-section women older on average?) but the way I see it, people are playing with the lives of vulnerable women out of greed and convenience (speedy, schedulable delivery, so to speak). Now don't get me wrong, I don't oppose this surgical intervention per se: incidentally, my best friend was delivered by c-section and probably wouldn't be here today if that procedure didn't exist, but thirty percent of all childbirths? You got to be fucking kidding me. I still don't know whether it was absolutely necessary for her to get a c-section, but you bet I'll find out.
Who the fuck are these doctors who don't give a fuck about the woman giving birth? I am really, really furious right now. Who's with me, who opposes my views... and either way, as always - back it up.

 

[PAB]

Well if you live in America?...it wouldn't surprise me if it was linked to insurance companies, ill assume you've watched Michael Moores documentary SICKO.

 

[Andiferous]

Recovery time for c-sections is also much longer than for regular births, and women having c-sections usually have longer hospital visits.

Sometimes they are necessary, but there are a few invasive things done (even in normal deliveries) that are often unnecessary and have become standard practices, often for the convenience of the doctor, or of the patient, or both.

Some obstetricians do literally say "I'm going on vacation when this baby is due, so let's plan an early cesarean."

 

[ImprobableJoe]

That sounds like a lot until you look at the actual figures. The odds of a woman dying in childbirth for ANY reason is something less than 0.018%, and has risen around 0.005% in the last few years(based on 2004 numbers.) The number who die as a direct result of something going wrong with the c-section must be at least somewhat lower than that. Say a third of the maternal fatalities come from c-section, that's like 220 a year in America, which is like two days' worth of vehicular fatalities.

Yeah, surgery is always a risk, and the more surgeries there are the more people will die from basically random stuff as well as medical error. The trick is to keep things in perspective, and not blow the risks out of proportion.

 

[)O( Hytegia )O(]

I was born a c-section because I was choking out on my own umbilical chord (rambunctious little guy, I was).

Interesting finds though. It's relevant to my interests.