08 January 2009

outrageous AP news headline on c-sections

"C-Sections Best For Babies When Close To Due Date"  Where to start, where to start?  How about comparing it to one recent headline in the Wall Street Journal, "Early C-Sections Can Cause Double Health Risks For Newborns".  Same underlying study, different coverage. Check out the articles & read on if you like.

Notice how there is tucked inside the article the postscript that, oh yes, by the way, there are those pesky breathing problems with all cesareans, especially scheduled cesareans after no labor.  So the thrust of this study is NOT that cesareans are safer than vaginal birth, as the headline seems to indicate, but that it's best not to create premature babies if you are going to take babies rather than letting them come via labor and birth.

The flip nature of the quotes is insane...a doctor says he and a patient "bit the bullet" (of inconvenience) in order to wait a few days to allow the baby to come to term (39 weeks). What an asshat.

This piece boldly just lists myriad reasons for increased c-sections, and unabashedly puts malpractice fears and doctor convenience right up there.  (Though in another WSJ article, one of the quoted doctors says it's really patient-driven - they want their doctor and the doctors magnanimously give of themselves in order to keep the patient happy (and on their patent rolls and to get paid, I imagine, but he doesn't say).

The underlying study looked at when scheduled cesareans were being done and found that contrary to what's recommended (keeping in mind that a 2006 government panel actually recommended not doing cesareans for reasons other than medical indication), more than a third of elective cesareans were performed before 39 weeks.  Babies taken at 37 weeks were twice as likely to have health problems and need intensive care, with 15% of 37 weekers  having complications.  The stats go down to 11% complications when taking babies at 38 weeks, and 8% at 39 weeks.  

Note that this article (and possibly the underlying study - I have not read it yet) looks only at the impact of cesareans on the babies and not at the impact of major abdominal surgery on their mothers.  There is no mention in the article of maternal morbidity such as infection, or maternal mortality. 

One doctor noted that there was even a difference in taking a baby a few days before 39 weeks, and he was surprised and didn't think other doctors would suspect this either.  
Huh - maybe there is a reason that human being are meant to gestate for about FORTY weeks...maybe nature was on to something.  Holy Hubris, Batman!
In an incredibly lame "awe shucks" mea culpa, this physician who took an oath to do no harm states,
"I generally try to wait to 39 weeks, although I confess I'm as guilty as anybody else with a busy practice, scheduling being what it is"..."I really hadn't thought much about it until now".
Wow...just wow.

And to help us know just how long we will have to bite that bullet and wait it out, another physician suggests you "take your due date and subtract seven days and anyone of those seven days is fine"  (gee - I was wondering how to figure out 39 weeks from 40 weeks - subtraction!)

An incredibly sensitive and sacrificing mom, an accountant, reluctantly slogged through a few extra days and gave up on having a 2008 tax deduction in hopes of avoiding that increased chance (over and above the 8% chance she bargained for at 39 weeks) of complications and NICU stay...now that's dedication!

Is it just me - did I wake up on the wrong side of the bed today?  The whole flip nature of everyone quoted in this article, combined with the irresponsible headline, makes me nuts.

In more sensible coverage of the study, a quote from another piece in the Wall Street Journal:
"The study had some limitations.  Many medical experts believe that the longer a baby stays in the womb after 37 weeks, the higher the chance it will die, leading to stillbirth.  There is no definitive data on that rare risk, however, and the NEJM study didn't assess risk of fetal death."

Bottom line, I guess patience really is a virtue.  Just because we can do something does not mean we should.


Elizabeth Gallo said...

OMG! I am so amp'd up! This is RIDICULOUS. And hey-- how about that mental/emotional scarring? (For mom I mean, but we haven't studied what it does to babies, I don't think...) I guess my c-section was medically necessary, but I'm still paying the mental price for it, even after VBACing my second baby.

Sarah said...

Arrgh! That title is terribly misleading. Irresponsible reporting.

Lisa D. said...

WTF?! Unbelievable!

I think we need no less than a second Feminist revolution to address the issues around birth and breastfeeding.

The WSJ's POV, of course, is economic, and everyone you quoted has one thought in mind - the bottom line. The Business of Being Born, indeed.

Elizabeth Gallo said...

I'm with Lisa -- revolution! What is scary is all of those FEMALE OBs who go along with all of this to protect their own bottom lines. Nice.

DoulaMomma said...

Female OBs are reported to be among the most likely to schedule their own cesareans!