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Rural Doc Alan's avatar

Thanks Liz, you have brought up many important points. I would not dare to speculate about the reason for female OBs raising the C-section rate. Most of us have known for many decades that the EFM increases the rate for C-sections and the cost of OB care without any benefit at all. EFMs are sometimes hard to watch. One must be very calm, confident, knowledgeable and compassionate to resist the temptation to do a C-section. There are two HUGE problems which you have NOT listed. The doc is the captain of the ship, but there is often nursing mutiny. While some some nurses listen and fall in line with the care being given, others are either incompetent or hysterical. If they are incompetent you can't trust their judgment, and if the are hysterical that spreads to the patient and her family. The MD can't have either situation. They are both intolerable. Nurses today are trained to sabotage care IF they think there is a reason to, but that is just my experience and might not generally be true. I have also worked with exceedingly good nurses...most of the time, but I've had some nurses who threaten to call in a doc who they know will do a C-section if I don't. That's also intolerable. My son, who is also an obstetrician has actually removed hysterical or sabotaging nurses...I have not, because one needs to understand that there is a great likelihood of working with that nurse again.

Yet another very real reason, seldom discussed, is that juries LOVE C-sections, as do liability insurance carriers. Their idea is that the doc has done everything that needs to be done or can be done to have a good outcome. So no matter the outcome the general idea is that nothing more could have been done, so a bad outcome is "forgiven" and penalties are a lot less. Then there is MD convenience. A C-section is more money and a lot less work. So rather than being up all night and all day, it might be easier under some circumstances to do a C-section at 0100 hrs (1:00am). My own C-section rate varies between 10% and 15%, but sometimes taking care of OB patients is very lonely. I take great pride in having a healthy vaginal birth.

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Jenny F.'s avatar

And… the cesarean rate was 5% in 1970 - a 500% increase over about 50 years.

I read an interesting book on the history of cesarean by a medical historian (Jacqueline Wolf) who traces the explosion in the rate here in the US to some interesting factors, including the rise of female OBs and of course EFM; which lead to being sued for cat II tracings; which lead to cesareans done defensively to avoid being sued.

I often wonder if the widowers of accreta patients who bled to death in the OR could sue the OBs who roundly assured their wives cesareans have virtually no risks.

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