Consumer Reports & Cesareans

[CTRedSoxMom]

This time they featured "12 Surgeries You may be better off without" and not only do they include cesarean sections, but they also include episiotomies, which have been common practice for a long time in our Obstetric model of maternity care. Some women even getting them without consent or even being told by their doctor that he/she was cutting an episiotomy. Long term studies have shown little to no benefit to having an episiotomy, so it is a wonder why they are still being done in relatively large numbers.
Here in Connecticut alone, we have numbers well over the "recommended" 5%, some hospitals even exceeding 25%!!

As women, and consumers, we need to be educated on the procedures we undergo, the providers we choose for our care, and the risks and benefits that are associated with these choices, which I fully believe are not being truly detailed for many women, and the repeat cesarean section numbers in Connecticut alone show that. The vast majority of hospitals have a 90%-100% repeat cesarean section rate. Don't believe me? I obtained these statistics yesterday from an e-mail directly from the Connecticut Department of Health.These statistics are for low risk pregnancies. Another alarming number is the amount of women in 2007 who were considered low risk, as well as the number of primary (first) cesarean sections that are taking place in our state hospitals.

Now, back to what consumer reports has to say.

"Two of the most frequently performed major operations in the U.S. are exclusively for women: hysterectomy, or surgical removal of the uterus and often the ovaries, and cesarean section. In both cases research suggests that most physicians fail to follow treatment guidelines from the American College of Obstetricians and Gynecologists (ACOG). More than 700,000 women a year are also subjected to episiotomy, a less invasive but even more dubious procedure in which physicians make a short incision to widen the vaginal opening during childbirth."

"Cesarean section. Most C-sections are done because labor is progressing too slowly. But several less-invasive approaches-medication, deliberate rupture of the membranes around the fetus, even a shoulder or foot massage or a warm shower-may be enough to stimulate labor. Physicians also perform cesareans in the vast majority of women who've already had one. But ACOG says that most of those women could safely try for a vaginal delivery, which would succeed about 70 percent of the time; if it doesn't, the doctor could simply switch to cesarean delivery."

Unfortunately for women, and their health, especially here in the state of Connecticut, finding a provider who will attend a VBAC (Vaginal Birth After Cesarean) is almost like looking for a needle in a haystack, especially if you want to have your VBAC in a hospital. If you have had more than one cesarean section, for whatever reason, you have no options if you want a hospital birth, it is repeat cesarean, or do not have any more children in most cases.  But what concerns me the most is what many major health organizations have to say about the growing cesarean sections rates in the United States, which as a whole is at 31.8% nationwide, but here in Connecticut we are higher at 34.6% as of 2007. If we turn the tables back 20 years, the vast majority of women who had a cesarean section at one point in their life went on to have a successful VBAC without having to fight tooth and nail.
The other day I blogged about a woman who was dropped by her providers because she would not consent to a repeat cesarean section, which in turn was completely unnecessary. She went on to have a perfectly fine, uncomplicated, vaginal birth, and her and her 6th daughter were perfectly happy and healthy. She would have been subjected to an unnecessary surgery had she not stood up to the providers she chose, who were supportive of her VBAC her entire pregnancy.  The problem is the ramifications of these cesarean sections that people are not taking into consideration today.

There are so many risks when you start getting into the second, third, or fourth cesarean section.
Here are a couple examples of the risk factors with increasing cesarean section surgeries.

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion's : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion's : 42.2% (2 in 5)

Note : "Major complications" include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

But back to what consumer reports went on to discuss.

"Recommendation. Ask what percentage of normal deliveries as well as births following a prior cesarean the physician delivers by C-section. Ideally, look for rates below 15 percent in women who haven't had the procedure and about 60 percent in those who have. (Those rates can be higher if the physician treats many high-risk patients.) Ask about the doctor's willingness to try nonsurgical steps first. Alternatively, consider delivery in a hospital by a certified nurse-midwife, if available. Deliveries by those practitioners tend to require C-sections less often than those done by obstetricians, with equally good results overall. And nurse-midwives have access to an obstetrician, who can perform a cesarean if needed."

Also remember, your provider, or a provider you may be interviewing as a possible care provider does have these numbers, and does keep track of these numbers annually, not only for their practice, reporting to the department of heath, but also for insurance purposes including medical malpractice insurance. If a provider tells you they do not know their numbers, or do not keep track of it, that is a clear red flag.

Remember, you are a consumer and your health care is important to you.
So many people spend months researching cars, big screen TV's, or other big purchases, but spend no time, or very little time researching their care provider and often go with the first person a friend recommends, or their insurance will cover. Demand better care, in the end it is your choice, and you have the final say.

Connecticut Hospital Cesarean Statistics for 2007

Hospital	Total # of Births	# of C-Sections	Cesarean %
Bridgeport Hospital	2592	1012	39.07
Bristol Hospital	693	201	29.01%
Charlotte Hungerford Hospital	459	171	37.25%
Danbury Hospital	2446	736	30.21
Day Kimball Hospital	577	149	25.82%
Greenwich Hospital	2188	814	34.20%
Griffin Hospital	761	247	32.45
Hartford Hospital	4071	1554	38.17%
Hospital of St. Raphael	1440	463	32.15%
John Dempsey Hospital (UCONN)	850	370	43.35%
Johnson Memorial Hospital	300	87	28.99%
Lawrence & Memorial Hospital	1739	637	38.70%
Manchester Memorial Hospital	1078	296	27.46%
Middlesex Memorial Hospital	1176	441	37.50%
Midstate Medical Center	1082	333	30.69%
Milford Hospital	557	203	36.45%
New Milford Hospital	294	104	35.37%
Norwalk Hospital	1616	519	32.12%
Rockville General Hospital	441	117	26.53%
Saint Francis Hospital	2895	904	31.23%
Saint Mary's Hospital	1298	386	29.74%
Saint Vincent Medical Center	1211	539	44.50%
Sharon Hospital	236	75	31.78%
Stamford Hospital	2638	1002	37.99%
The Hospital of Central CT	1975	611	30.94%
Waterbury Hospital	1311	472	36.00%
William W. Backus Hospital	1046	318	30.40%
Windham Community Memorial	439	129	29.38%
Yale New Haven Hospital	4557	1591	34.91%

Connecticut Hospital Repeat Cesareans Vs. VBAC Statistics 2007

Hospital	VBAC	Repeat Cesarean	Total Previous Cesarean Births
Bridgeport Hospital	3.29%	96.71%	334 Deliveries
Bristol Hospital	7.06%	92.94%	85 Deliveries
Charolette Hungerford Hosp	0%	100%	67 Deliveries
Danbury Hospital	9.06%	90.94%	265 Deliveries
Day Kimball Hospital	0%	100%	54 Deliveries
Greenwich Hospital	7.23%	92.77%	166 Deliveries
Griffin Hospital	9.43%	90.57%	106 Deliveries
Hospital of Central CT	4.31%	95.69%	209 Deliveries
Hartford Hospital	2.0%	98.0%	500 Deliveries
Hospital of St. Raphael	5.52%	94.48%	163 Deliveries
John Dempsey (UCONN)	7.06%	92.94%	85 Deliveries
Johnson Memorial Hospital	14.29%	85.71%	28 Deliveries
Lawrence & Memorial	2.26%	97.74%	221 Deliveries
Manchester Memorial	15.13%	84.87%	119 Deliveries
Middlesex Hospital	1.26%	98.74%	159 Deliveries
Midstate Medical Center	2.5%	97.5%	120 Deliveries
Milford Hospital	6.85%	93.15%	73 Deliveries
New Milford Hospital	6.98%	93.02%	43 Deliveries
Norwalk Hospital	4.76%	95.24%	210 Deliveries
Rockville General	14.58	85.42%	48 Deliveries
Sharon Hospital	5.26%	94.76%	19 Deliveries
Saint Mary's Hospital	5.26%	94.74%	114 Deliveries
Saint Francis Hospital	7.41%	92.59%	324 Deliveries
Saint Vincent's Medical Ct.	0%	100%	157 Deliveries
Stamford Hospital	6.98%	93.02%	387 Deliveries
Waterbury Hospital	10.56%	89.44%	180 Deliveries
William Backus Hospital	9.23%	90.77	130 Deliveries
Windham Community Hosp.	4%	96.0%	50 Deliveries
Yale New Haven Hospital	9.95%	90.05%	583 Deliveries
Total	6.06

93.94%

4,999 Deliveries

[Roadfamily6now]

Nov. 15, 2009 at 3:00 AM

Great blog! You should add this to the VBAC moms group too!

[elleinad]

Nov. 15, 2009 at 2:00 PM

Thanks for posting this! Something REALLY needs to change!!

[mtnmama111]

Nov. 15, 2009 at 2:52 PM

As someone with endometriosis- I can say that adhesions are a very painful and uncomfortable *thing* to have... getting them *on purpose* seems.. dumb...

 

[fairy_fan]

Nov. 15, 2009 at 3:46 PM

Does anyone ever stop and think that Americans have done this to themselves?  Americans are sue happy.  The rates of malpractice insurance have went sky high.  Either way the DR is taking a risk, a VBAC or a repeat Csection.  Guess what?  They're going to push for the repeat Csection because it is less risky according to their insurance providers. 

 

[CTRedSoxMom]

Nov. 15, 2009 at 4:47 PM

Fairy, there will be a change, because with the amount of women being forced into repeat cesareans, when something happens as a result from that repeat cesarean such as a hysterectomy, or the inability to have more children which increased infertility is a risk of a cesarean, women will start suing over these things. Right now there are simply no lawyers willing to take the cases. But the tides are turning.

These "sue happy" Americans have destroyed VBAC, which is no doubltedly safer for all the women who want it.

What we are going to see happen is increased numbers of women having VBAC's at home, or unassisted without a provider because they are scared of or do not want another cesarean. It's already happening.

(Original Poster)

[MoonLover06]

Nov. 15, 2009 at 8:37 PM

I would agree with you fairy except c-section rates were on the rise before we became a society obsessed with suing. 

[AgentBrez]

Nov. 15, 2009 at 11:00 PM

great post. i am a proud VBACer. my friend who lives in CT wanted a VBAC too [she was due 2 months after me] but even her local ICAN chapter said she was not a good candidate b/c of placenta previa and high blood pressure. it is sad how common repeat c/s are. i think people have forgotten it is major surgery. just b/c it is "common" or "routine" doesnt make it less risky.