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----- Original Message -----
From: [EMAIL PROTECTED]
Sent: Thursday, September 23, 2004 11:05 AM
Subject: [BirthRage] controlling delivery pt 3 By John Pope Of New Orleans Times Picayune Contributing : David Wenner of Patriot-News Controlling Childbirth Although the United States has been criticized for its high rate of Cesarean sections, the operation is being performed more in other countries , too, according to the World Health Organization. The rates of Cesarean sections as percentages of hospital births in Great Britain and sub-Saharan Africa are about the same in the United States, but in Chile, the figure is 40 percent. The numbers do not show whether the doctors of the patients chose Cesarean sections. In what may be the first study of its kinds, doctors fround 14.7 percent of the pregnant women at New Orleans' Ochsner Foundation Hospital would request Cesarean sections. For years, that option did not exist for women without strong medical reasons, said Dr. Michael A. Finan, an Ochsner obstetrician- gynecologist who participated in the study. Besides, he said, the American College of Obstetricians and Gynecologists had long pressured its members to bring down the rate of Cesarean sections. Criticism included swipes at doctors for encouraging a practice that was more a convenience for them- and a source of added income - than a medical necessity for women. " The fact that we found that women are interested in having a C-secion as an option was a surprise, " Finan said. " The fact that 14 percent of women want that as an option is news... it may seem small, but it's a huge number . " The report, based on 157 women's responses to questionaires, appeared in the May issue of Female patient, a peer-reveiwed journal. The main reason women would chose Cesareans was to exercise as much control as possible over giving birth because they have become accustomed to planning othe parts of their lives, said Dr. Elizabeth Lapeyre, an Ochsner obstetrician-gynecologist and the study's lead author. Control is the one factor Ellen Manning to choose a Cesarean section when she gave birth to her second child three months ago. She delivered her first child vaginally after 16 hours of labor. Another component in the decision , she said, was her husbands family history of big babies. Her second child was born weighing 10 lbs,5 ounces. " When my doctor opened me up and saw the baby, she said he never would have come out through the birth canal , " Manning said. Despite the six week recuperation period, she said " I like having a Cesarean section because once you get in and have your epidural ( anesthesia) it takes 20 minutes. " Doctors might be more likely to go along with a woman's request or even recommend the procedure if she is expecting multiple births or has had children by Cesareans. Insurers yield to the doctor's decision and do not refuse to pay for the procedure on grounds that it is elective. The American College of Obstetricians and Gynecologist is giving some flexibility to doctors who might not be willing to let women have the last word on how they want to give birth, said Dr. Gariella Pridjian, chairwoman of obstetrics and gynecology at Tulane University Health Sciences Center. " The organization said there are situations when a woman can have more autonomy and choose to have a Cesarean section because there isnt sufficient evidence to show that one is better than the other, " she said, " but physicians don't have to perform them if they don't feel comfortable and if they feel the risks of a Cesarean section are greater ( than those) vaginal delivery. " From a strictly medical standpoint, the risk a Cesarean section poses to mother and child has been lowered to where it is equivalent to the risk of giving birth vaginally, according to the American College of Obstetricians and Gynecologists. The debate over Cesarean section versus vaginal delivery has plenty of opinion but no much science, said Dr. Thomas Nolan, cheif of obstetrics and gynecology at Louisiana State University Health Sciences Center . There are plenty of questions , he said. For instance, Nolan said, a Cesarean section requires anesthesia and can result in greater blood loss than a vaginal delivery, but an elective Cesarean section is cost-effective because no labor -and- delivery nurses are needed. For the physician, the Cesarean is worth a few hundred dollars more in fees than natural birth, Nolan said, but the economic advantage grows given that the doctor can schedule Cesareans with some precision and perform more of them in a given period of time. The back-and-forth has left doctors who delivery babies feeling whipsawed, especially if they have been practising for more than 20 years. " We came through the ' 70's and ' 80's where we had this swing back to natural deliveries, where people wanted to deliver at home and we had birth centersand ( birthing) chairs and Lamaze classes, and now we're swinging the opposite way, " said Dr. Ralph Dauterive, who heads the obstetrics and gynecology section at Ochsner Clinic Baton Rouge. " Where is this heading ? There's no control. I think it's heading to a day when a woman's going to come in and say " I dont want to have a vaginal delivery. I want a Cesarean section, " and we won't have strong enough data to say, "It's not in your best interests. ' " [Non-text portions of this message have been removed] BirthRage webpage- http://groups.yahoo.com/group/BirthRage
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