Tuesday, September 14, 2010

Cesareans for Profit?

As some hospitals' cesarean rates meet or exceed the 50% mark, several media outlets have asked the question: "Are hospitals doing cesareans for reasons other than a medical reason?"

It is important to unravel the layers here. First, hospitals do not, themselves, do cesareans. Physicians do. Obstetricians are, after all, surgeons. So it is the obstetricians that have privileges in those hospitals that do the cesareans who contribute to the cumulative cesarean rate.
Secondly, all hospitals are for profit. That means they are businesses that care for a large group of individuals and they expect to make a profit off of the illness or condition for which the individual is admitted. Oftentimes, it is the oncology department, the anesthesia department or cardiac departments that bring in the most dollars toward this profit.

Even if their designation is nonprofit, they must still pay their employees, still pay for supplies and still renovate and build. But the question is, does this have to be on the backs of expectant mothers and babies? (One private Southern California hospital has a 47% cesarean rate while a nonprofit hospital in Northern California has a 38% rate – both are unexceptable).

That being said, what is being fed to the media regarding maternity care in our country needs examination also. Cesareans are done because the U.S. has more obese expectant mothers, more older expectant mothers, more mothers likely to engage in litigation and more mothers who want cesareans due to a myriad of reasons.

Really? It is all patient/expectant mother driven?

If this latter explanation is in fact accurate, where is the Hippocratic oath here? You know, the old “First do no harm”? Wouldn’t physicians find it desirable to provide information regarding nutrition, advanced maternal age, litigation and those myriad of reasons why women want major abdominal surgery?

The uncomfortable truth is that more and more physicians take less and less time with their maternity patients and discourage childbirth education classes – both opportunities of educational enlightenment.

We should also examine the current rate of 44% induction of labors in the US. Really? Are only 56% of US women capable of going into normal labor by themselves? Is 44% of the US women’s bodies broken and need to be induced? I think not, considering that research shows that induction with a questionable Bishop Score may, in fact, lead to a cesarean. This begs the question, “why are there so many inductions?”

As a professional birth researcher and educator, I do not think there is ONE answer to the rise in cesarean question. I believe it is a multifaceted question that needs to be attacked, YES ATTACKED, on a multifaceted level. From physician education (and reprimand for doing unnecessary cesareans) to more robust expectant parent education to giving the nurses the knowledge they need to assist in a NORMAL birth ~ we need to step up and begin an educational revolution.

And we need it now.


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