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lorene
08-18-2011, 12:56 PM
Article here (http://www.theatlantic.com/life/archive/2011/08/why-hospitals-in-portland-are-banning-early-births/243499/).

I know we've had a few pregnancy and childbirth threads which have gotten heated, but I think this will do fine here.

I applaud this decision. While I think women should have choices in just about every area of reproduction, the decision to induce for non-medical reasons or to elect c-sections is not one I support. I suspect, though, that this will possibly have a flurry of 38-week-pregnant women hounding their doctors to drum up medical reasons to justify going early. In fact, I know plenty of women who already do that and get very upset when their doctors or midwives tell them they just have to wait until baby is cooked.

I guess what I find most encouraging is that all 17 hospitals agreed to this, despite the fact that they stand to lose revenue. Maybe the tide of the business side of babies is turning?

CalMeacham
08-18-2011, 01:28 PM
Are there large numbers of women demanding induced labor or wanting C-sections because it's easier? I hadn't heard anything about it. I suppose it's possible, but it's news to me. AFAIK, everyone I know had non-induced normal births. Except Pepper Mill, whose labor was induced -- but in her case it's because the swelling of pregnancy had reached outrageous proportions , and was threatening to dislocate joints. No joke.

Lasciel
08-18-2011, 01:38 PM
My boss' daughter-in-law is a CFO of some huge financial corporation, and she's had two kids so far. The first was when she was angling for the CFO slot, and the second one just a few months back.

She scheduled both births for a Friday evening so she could be "recovered" and back at work on Monday morning. Apparently the corporate culture mavens informed her that if she missed any work for any form of motherhood-related activities, she'd be straight onto the shit-list, and apparently she wasn't interested in finding out if it was true.

I am usually all for free will and lots of choices, but I really don't think that should be necessary or encouraged.

PeskiPiksi
08-18-2011, 01:42 PM
She scheduled both births for a Friday evening so she could be "recovered" and back at work on Monday morning.

:eek:

redtail23
08-18-2011, 01:54 PM
That's tremendous!

There are* some physicians here that schedule deliveries and c-sections so they don't have to find someone to cover while they take vacation.

No, really.

And yes, those same docs will* perform early inductions/sections for the mother's scheduling convenience also.

I'm glad to see the tide turning on this, even if it will be a slow process.

*TBH, it has been a while since I had these discussions, so I can't swear that those docs are still doing this. But'd I'd bet they'll keep it up until the wave breaks over them.

DianaG
08-18-2011, 02:13 PM
I understand not encouraging induction, but is a non-emergent C-Section considerably more dangerous to the baby than a natural birth? If not, I don't see why women shouldn't be able to choose a scheduled C-Section.

Dangerosa
08-18-2011, 02:14 PM
I've never known anyone who has done an elective c-section or early induction, and I didn't.

But I think it should be my right. Its my body and my child - and the risks associated with either are not more significant than me letting Junior ride his bike.

DianaG
08-18-2011, 02:16 PM
I agree. It seems a little silly to say "I support choice, except in matters of how to deliver a full-term fetus."

pbbth
08-18-2011, 02:24 PM
I've never known anyone who has done an elective c-section or early induction, and I didn't.

But I think it should be my right. Its my body and my child - and the risks associated with either are not more significant than me letting Junior ride his bike.

I agree. It seems a little silly to say "I support choice, except in matters of how to deliver a full-term fetus."

I'm having an elective c-section 4 or 5 days before my due date in November. Partly because I'm due on Thanksgiving and I do NOT want to take a chance on finding a cab on a holiday or potentially navigating icy roads while in the middle of labor and partly because I'm having my tubes tied while they are in there so that I don't have to ever be pregnant again. I am also horrifyingly bad at handling medical situations and it will be much easier for me to be calm enough to handle an epidural or a spinal when I'm not freaking out about contractions and stuff.

I don't understand why this bothers some people. Once the baby is born they are going to let me take it home without so much as giving me a multiple choice quiz on appropriate baby care. For all they know I'm going to bottle feed it Fresca or something but they trust me to do what I think is right for my child...unless, of course, that decision also impacts me, my body, and my personal medical decisions I guess.

miss elizabeth
08-18-2011, 02:25 PM
I support a woman's right to choose how to deliver her baby, and I am against this regulation. Paternalism at it's finest...

Dangerosa
08-18-2011, 02:30 PM
I'm having an elective c-section 4 or 5 days before my due date in November. Partly because I'm due on Thanksgiving and I do NOT want to take a chance on finding a cab on a holiday or potentially navigating icy roads while in the middle of labor and partly because I'm having my tubes tied while they are in there so that I don't have to ever be pregnant again. I am also horrifyingly bad at handling medical situations and it will be much easier for me to be calm enough to handle an epidural or a spinal when I'm not freaking out about contractions and stuff.

I don't understand why this bothers some people. Once the baby is born they are going to let me take it home without so much as giving me a multiple choice quiz on appropriate baby care. For all they know I'm going to bottle feed it Fresca or something but they trust me to do what I think is right for my child...unless, of course, that decision also impacts me, my body, and my personal medical decisions I guess.

That's how I feel.

Best of luck. (And don't feed the baby Fresca - the dental bills even with diet soda will eat into their college funds. Not that I'm telling you how to raise your baby ;))

randomface
08-18-2011, 02:31 PM
My mother was induced 3 days before my due date. Officially it was because there was a forecast for an ice storm. Really, the doctor wanted Christmas off to be with his family.

Hello Again
08-18-2011, 02:33 PM
I'm having an elective c-section 4 or 5 days before my due date in November....
.....
I don't understand why this bothers some people. Once the baby is born they are going to let me take it home without so much as giving me a multiple choice quiz on appropriate baby care. For all they know I'm going to bottle feed it Fresca or something but they trust me to do what I think is right for my child...unless, of course, that decision also impacts me, my body, and my personal medical decisions I guess.

Great post, I totally agree. This banning is shameful and ridiculous. What if a woman elects c-section or induction because it is beneficial to her career, education, or the needs of her other children? Guess she's just fucked then. Thanks a heap, Portland!

CrazyCatLady
08-18-2011, 03:36 PM
That's tremendous!

There are* some physicians here that schedule deliveries and c-sections so they don't have to find someone to cover while they take vacation.

Yeah, that's not why they do it--they have to arrange coverage regardless, for the people who don't want induction/c-section and for emergencies like pre-term labor, and that coverage costs the same whether there are 50 deliveries that week or there are none.

But you're right that a lot of doctors don't really like for big stuff to happen with their patients while they're out of town. You never get as full a picture of what's going on from reading a chart after the fact as you do having been there yourself, for one thing. And you're never 100% certain that when there's a judgment call needed the substitute will make the same call you would, which makes it a real bitch when your patients come to you after the fact wanting to know why Dr. Soandso did thus and such instead of that and the other.

Then too, a lot of patients really don't like the idea of delivering with someone other than their doctor who has done all their prenatal care and knows exactly what's been going on with their pregnancy. And they're often not thrilled at the notion of some random stranger saying "Hi, good to meet you, I'll be sticking my hand in your crotch now while you scream, cry, and soil yourself." Nor are they thrilled at the idea of someone whose philosophy, personality, and credentials they know nothing about being the one calling the shots about their and their baby's care, especially if there has been anything remotely out of the ordinary about their pregnancy.

If scheduling an induction a week or so early alleviates these stresses for both doctor and patient and does no harm to the baby...what's the big freaking problem?

Merneith
08-18-2011, 04:11 PM
For all they know I'm going to bottle feed it Fresca or something but they trust me to do what I think is right for my child...unless, of course, that decision also impacts me, my body, and my personal medical decisions I guess.

I was trying to figure out how I wanted to reply to this, but you said it better.

Sattua
08-18-2011, 04:17 PM
I'm curious... what's the status of elective appendectomies, gall bladder removals, and hysteretomies? It seems to me like a c-section is an equally big deal as all these, and its status as an elective or non-elective surgery should be the same.

(I had an emergency c-section five months ago)

redtail23
08-18-2011, 04:29 PM
I guess that my problem with it here was that at least several women were told "we'll be scheduling you for an early induction, because that fits my schedule better". The women I talked to weren't really given much of an option.

Well, except for a couple who were thrilled that they could schedule a c-section and skip that whole birth thing.

And yes, c-section is more hazardous for both patients. If you actually read the article, that's one of the reasons for the ban. There's also mounting evidence that unnecessary induction is more hazardous for both patients. It's one thing if the mother knows those risks and chooses them anyway; it's something else entirely when scheduling early inductions / c-sections has become routine.

I was thinking also of the articles posted in that other thread where OBGYNs are starting to say "hey, we're getting outta hand with this stuff, gang".

I'll admit I hadn't really thought about it from the other side as far as it being actually banned. I just know several women who have felt very pressured into the induction/c-section route and am happy to see the strong push for induction/c-section getting some push-back.

redtail23
08-18-2011, 04:31 PM
I'm curious... what's the status of elective appendectomies, gall bladder removals, and hysteretomies? It seems to me like a c-section is an equally big deal as all these, and its status as an elective or non-elective surgery should be the same.

(I had an emergency c-section five months ago)Actually, most of those are done via scope these days, so they're not as big a deal as you might think. A c-section is an entirely different level of surgery.

kunilou
08-18-2011, 05:13 PM
My wife had a scheduled C-section with our twins. Both those kids had been big all through the pregnancy and were more than seven pounds (which is pretty damn big for twins) at birth. Her OB was concerned that labor might do some serious damage to either her or the babies.

She was at 37 weeks, so it counts as an early delivery. And since no one can actually say going through labor would have caused problems, it was elective, as well.

Who wants to tell her that she and her OB shouldn't have been able to do it that way?

Kolga
08-18-2011, 05:18 PM
I agree. It seems a little silly to say "I support choice, except in matters of how to deliver a full-term fetus."

Yea, um, choice means "it's the woman's choice." Elective c-sections might not be your cup of tea, but choice means you don't get to dictate that choice to a woman and her doctor.

lorene
08-18-2011, 05:39 PM
And yes, c-section is more hazardous for both patients. If you actually read the article, that's one of the reasons for the ban. There's also mounting evidence that unnecessary induction is more hazardous for both patients. It's one thing if the mother knows those risks and chooses them anyway; it's something else entirely when scheduling early inductions / c-sections has become routine.

I was thinking also of the articles posted in that other thread where OBGYNs are starting to say "hey, we're getting outta hand with this stuff, gang".

I'll admit I hadn't really thought about it from the other side as far as it being actually banned. I just know several women who have felt very pressured into the induction/c-section route and am happy to see the strong push for induction/c-section getting some push-back.

Yeah, I have to agree with what you've written here. I'm not as convinced as I was when posting the OP that the aim of this is what I thought it was. Then again, I do still feel that convenience is not as compelling as medical necessity when choosing something that could potentially pose risks, but I also understand that that's just my opinion.

My wife had a scheduled C-section with our twins. Both those kids had been big all through the pregnancy and were more than seven pounds (which is pretty damn big for twins) at birth. Her OB was concerned that labor might do some serious damage to either her or the babies.

She was at 37 weeks, so it counts as an early delivery. And since no one can actually say going through labor would have caused problems, it was elective, as well.

Who wants to tell her that she and her OB shouldn't have been able to do it that way?

Bolding mine. AIUI, the part I bolded would be sufficient to count as 'medically recommended'. No one is saying that C-sections should only be done as emergency procedures.

Dangerosa
08-18-2011, 05:40 PM
I guess that my problem with it here was that at least several women were told "we'll be scheduling you for an early induction, because that fits my schedule better". The women I talked to weren't really given much of an option.

Well, except for a couple who were thrilled that they could schedule a c-section and skip that whole birth thing.

And yes, c-section is more hazardous for both patients. If you actually read the article, that's one of the reasons for the ban. There's also mounting evidence that unnecessary induction is more hazardous for both patients. It's one thing if the mother knows those risks and chooses them anyway; it's something else entirely when scheduling early inductions / c-sections has become routine.

I was thinking also of the articles posted in that other thread where OBGYNs are starting to say "hey, we're getting outta hand with this stuff, gang".

I'll admit I hadn't really thought about it from the other side as far as it being actually banned. I just know several women who have felt very pressured into the induction/c-section route and am happy to see the strong push for induction/c-section getting some push-back.

Patient choice should be about PATIENT choice - if OBs are pressing for schedules that the patients don't want, that's a problem. (At the same time, if the women you know felt pressured, do they not have backbones? Is "no" not in their vocabulary? Do they not know how to make a complaint to the medical board? Or switch OBs? Is every woman in Portland who can make an informed decision supposed to not have that choice because you know people who don't have a backbone?) But since the OB has the ability to determine medical necessity, this doesn't address that issue.

As far as "more risk" - its more risky to ride a motorcycle than use a car...should we ban them? Its more risky for my son to play football than it is to run track, should we get rid of football? At what point do we have a right to say "oh, you can't accept THAT risk." I'll agree that there are some risks we shouldn't accept - it may be too risky to allow people to freebase coke - but the ones involved in inducing or having a c-section really don't rank.

redtail23
08-18-2011, 05:47 PM
My wife had a scheduled C-section with our twins. Both those kids had been big all through the pregnancy and were more than seven pounds (which is pretty damn big for twins) at birth. Her OB was concerned that labor might do some serious damage to either her or the babies.

She was at 37 weeks, so it counts as an early delivery. And since no one can actually say going through labor would have caused problems, it was elective, as well.

Who wants to tell her that she and her OB shouldn't have been able to do it that way?No one. This would be a medically necessary elective surgery. Not a problem under the Portland rules.

lorene
08-18-2011, 05:48 PM
As far as "more risk" - its more risky to ride a motorcycle than use a car...should we ban them? Its more risky for my son to play football than it is to run track, should we get rid of football? At what point do we have a right to say "oh, you can't accept THAT risk." I'll agree that there are some risks we shouldn't accept - it may be too risky to allow people to freebase coke - but the ones involved in inducing or having a c-section really don't rank.

As I posted above, I am seeing the points many of you are making. I'd like to point out, though, that part of the reason behind this is to control healthcare costs. Banning motorcycles and football wouldn't have those added benefits.

Implicit
08-18-2011, 05:50 PM
No one. This would be a medically necessary elective surgery. Not a problem under the Portland rules.
Only if the designated arbiter agrees.
The story goes on to note that "induced births even one day before 39 weeks will now require patients to present their case to a designated arbiter at the hospital and prove that there is a medical reason why the early birth should take place."

Sattua
08-18-2011, 05:51 PM
Something to keep in mind is that this isn't a law that has been passed making elective inductions and c-sections illegal, it's an agreement that the area hospitals have come to. If women really want the elective options, they can arrange to have it done at a hospital outside Portland. And since the elective procedures aren't emergencies, they can suck up and deal with that extra inconvenience, to get their convenience.

I'm a little bewildered when I read about all of these elective births, quite frankly. I live in not-very-progressive Illinois and, without medical recommendation (such as twins, a very large baby, etc), my hospital will not induce before 41 weeks 1 day. They also won't schedule a c-section for a woman who has had only one previous c-section. You have to do a trial labor.

Inductions and c-sections are more expensive than natural deliveries. If you are paying for these elective procedures out of pocket, have fun. If you're billing it to your insurance, I hope you have a good reason.

By the way, having been recently pregnant, I do support an attitude that will take any little medical thing seriously during a pregnancy. I do support scheduled inductions or c-sections for twins, large babies, babies more than week overdue and all that. There's a point where the babies are just safer out than in. I just don't want convenience births to be billed to insurance.

redtail23
08-18-2011, 05:56 PM
Patient choice should be about PATIENT choice - if OBs are pressing for schedules that the patients don't want, that's a problem. (At the same time, if the women you know felt pressured, do they not have backbones? Is "no" not in their vocabulary? Do they not know how to make a complaint to the medical board? Or switch OBs? Is every woman in Portland who can make an informed decision supposed to not have that choice because you know people who don't have a backbone?) Don't even get me started on people's lack of spinal support when dealing with doctors. And doctors who take advantage of that tendency. You don't want to go there, trust me. :p

Aside from that, I already said that I hadn't thought of the other side of this (i.e., patient choice) when first posting. My second post was explaining where I was originally coming from.

I would have to say on re-consideration that I'm not in favor of an outright ban on "convenience" births. But I do think that routine scheduling of early deliveries is a bad thing.

Implicit, that's a pretty standard medical necessity situation. If you want to try to go all slippery-slope on this, at least pick something plausible.

Avarie537
08-18-2011, 06:02 PM
I just don't want convenience births to be billed to insurance.

BINGO! A c-section is about $10k in my area. Since people aren't forking over that much money out of pocket, the money has to come from somewhere. Sure, hospitals have agreements with insurance companies about how much is actually covered, but the overall cost is pretty damned high. OTOH, a vaginal delivery with an epidural bills out at $5500 or so.

etv78
08-18-2011, 06:05 PM
:eek:

I :smack: When I read that too!

Lasciel
08-18-2011, 06:19 PM
I :smack: When I read that too!

From what I've heard from my boss, D-I-L is a little bit of a scary person when she decides she wants to go for something.

And reading through the thread, I'm totally not against avoiding ice, making sure the kid comes out without taking half of mom along with them, or any other medical or somewhat-forethought plan for making birth less potentially pear-shaped. I AM against the idea of people thinking that it's just as ok a choice to pick a random day 6 months out to schedule their birth like its plastic surgery or a day-trip to the mall. There's every chance that those kids of Scary D-I-L weren't entirely done baking!

I don't know that I think bans are the right way to go, but really - I have to wonder if she'd been able to give her company a doctor's note saying she had to have the kid whenever it naturally wanted to come, maybe she would have liked that option better if she had it?

Dangerosa
08-18-2011, 06:52 PM
Something to keep in mind is that this isn't a law that has been passed making elective inductions and c-sections illegal, it's an agreement that the area hospitals have come to. If women really want the elective options, they can arrange to have it done at a hospital outside Portland. And since the elective procedures aren't emergencies, they can suck up and deal with that extra inconvenience, to get their convenience.

I'm a little bewildered when I read about all of these elective births, quite frankly. I live in not-very-progressive Illinois and, without medical recommendation (such as twins, a very large baby, etc), my hospital will not induce before 41 weeks 1 day. They also won't schedule a c-section for a woman who has had only one previous c-section. You have to do a trial labor.

Inductions and c-sections are more expensive than natural deliveries. If you are paying for these elective procedures out of pocket, have fun. If you're billing it to your insurance, I hope you have a good reason.

By the way, having been recently pregnant, I do support an attitude that will take any little medical thing seriously during a pregnancy. I do support scheduled inductions or c-sections for twins, large babies, babies more than week overdue and all that. There's a point where the babies are just safer out than in. I just don't want convenience births to be billed to insurance.

I'm fine with the insurance company not paying for an elective procedure. I'm not fine with the hospitals deciding not to perform them. When the hospitals stop providing the choice, then women stop having the choice. If I'm willing to pay OOP and sign off on the risks, they shouldn't care.

MsWhatsit
08-18-2011, 07:08 PM
I'm generally okay with medical providers deciding what procedures they will and will not perform, as long as the decisions are for medical reasons (and not, say, that they are morally opposed to a particular procedure or whatever).

California watch found that hemorrhaging from C-sections "is one of several possible factors in the state's increased maternal death rate," with the main risk coming in women who have multiple c-sections. And other recent studies have found that early birth by c-section or inducing labor can do damage to infants, whose brains are developing right up until the end.

So outcomes are better when they don't allow early elective C-sections. Seems like a perfectly good rationale to me. Yeah, it's restricting "choice," but this particular choice is one that is medically contraindicated.

And "full term" is just a guess, anyway. Your "full term" 38-week baby might be ready to be born, or it might not.

Dangerosa
08-18-2011, 07:25 PM
I'm generally okay with medical providers deciding what procedures they will and will not perform, as long as the decisions are for medical reasons (and not, say, that they are morally opposed to a particular procedure or whatever).



So outcomes are better when they don't allow early elective C-sections. Seems like a perfectly good rationale to me. Yeah, it's restricting "choice," but this particular choice is one that is medically contraindicated.

And "full term" is just a guess, anyway. Your "full term" 38-week baby might be ready to be born, or it might not.

But we get to make medically contraindicated choices all the time. My sister was given the choice between a partial and full mastectomy when she had breast cancer and whether she wanted to have or skip radiation. Radiation and a full mastectomy gave her better survival chances, but it was her choice.

MsWhatsit
08-18-2011, 07:34 PM
But we get to make medically contraindicated choices all the time. My sister was given the choice between a partial and full mastectomy when she had breast cancer and whether she wanted to have or skip radiation. Radiation and a full mastectomy gave her better survival chances, but it was her choice.

I'm guessing that the choice was given because the better survival chances also included some pretty nasty side effects, and loss of the breasts. The side effects of not having an early elective C-section are having to stay pregnant a little longer and maybe experiencing some inconvenience in scheduling.

Dangerosa
08-18-2011, 07:35 PM
I'm assuming that these hosptials will stop doing all medically contraindicated procedures that carry risk but aren't necessary. No more plastic surgery. And they'll tell people who want gastric bypass to go for the natural method because gastric bypass carries risk and they could loose weight without that risk.

MsWhatsit
08-18-2011, 07:44 PM
No need to be sarcastic. (Aw, who am I kidding? Sarcasm is always called for. ;) )

Gastric bypass surgery is a bad example, because as far as I know, doctors actually will refuse to do it unless you meet certain guidelines that indicate the benefit to you will outweigh the risk. Plastic surgery is a better example, I guess. I just can't fault a hospital for ruling out a procedure that gives absolutely no benefit, but introduces quite a bit of risk.

phouka
08-18-2011, 08:22 PM
Doctors are responsible for following best practices and held accountable by their hospitals and their peers. There's some evidence that medically-unnecessary induced labor and c-sections have a higher risk of complication and poor outcome than waiting for natural, vaginal birth.

Obstetrics has the highest incidence of malpractice suits and the highest rates for malpractice insurance. There are states which have a difficult time attracting obstetricians and areas which don't have enough obstetricians to safely treat the population. So, doctors have incentive to regulate against medically unnecessary elective c-sections and inductions.

I'm politically pro-choice, and I don't think this is a matter for legislation, but I don't have a problem with doctors choosing safer though less convenient protocols for best practices. I also believe that a full term fetus that a woman has chosen to bring into the world deserves the same consideration as a child. This board rightly condemns parents who choose not to vaccinate their children because of the risk to the child and the community. While the risk of non-medically necessary induced labor or c-section isn't comparable to the lack of immunization, I think there is a point to take into consideration.

kunilou
08-18-2011, 08:36 PM
Bolding mine. AIUI, the part I bolded would be sufficient to count as 'medically recommended'. No one is saying that C-sections should only be done as emergency procedures.

No one. This would be a medically necessary elective surgery. Not a problem under the Portland rules.

That may be your interpretation, and mine, and my wife's and her obstetrician's, but that doesn't necessarily follow it would be the interpretation of 17 hospital administrators in Portland, and it's their opinion that counts.

redtail23
08-18-2011, 08:52 PM
That may be your interpretation, and mine, and my wife's and her obstetrician's, but that doesn't necessarily follow it would be the interpretation of 17 hospital administrators in Portland, and it's their opinion that counts.As I said before, if you're going to try to slippery-slope it, at least pick something reasonable.

This would be a standard 'medically necessary to prevent likely harm to the patient' situation.

For pete's sake, there are situations listed in this thread that seem reasonable to me, but that would be much, much more likely to be denied as not medically necessary.

These people are not trying to oppress women, they're trying to reduce costs. They're not going to risk a liability suit over something as standard as an early c-section for large twins. :rolleyes:

Implicit
08-18-2011, 09:04 PM
As I said before, if you're going to try to slippery-slope it, at least pick something reasonable.

This would be a standard 'medically necessary to prevent likely harm to the patient' situation.

For pete's sake, there are situations listed in this thread that seem reasonable to me, but that would be much, much more likely to be denied as not medically necessary.

These people are not trying to oppress women, they're trying to reduce costs. They're not going to risk a liability suit over something as standard as an early c-section for large twins. :rolleyes:

It was the example in the thread that you responded to, I didn't pick it and I wasn't looking to slide down a slope.

How early is medically necessary for a C-section for twins? There is research suggesting that inducing twins before 38 weeks isn't ideal. So no, you do not know whether or not they will sign off on a 37 week induction for twins.

I can come up with other examples of decisions made by doctors and patients that weigh the risks to the mother and to the unborn babies, if you want. The point is that those choices are no longer in the hands of those doctors and mothers, now a arbiter is going to decide who can have an induction or C-section.

Crown Prince of Irony
08-18-2011, 09:25 PM
It doesn't surprise me at all that this had been a problem; I also fully support it since it's really for the good of both the mother and the baby.

I live in the Portland area, and work with quite a few women in the tech industry - our office mostly focuses on sales. Of the dozens of mothers I've worked with (most of them very nice people), I can count on one hand the number who didn't schedule their births, some by as early as 2 or 3 weeks prior. Doing everything you can to make quota at the end of the quarter is a huge pressure cooker, and frankly, makes people do stupid things.

I always refused to ask my wife to schedule her deliveries, despite some ever-so-subtle pressure from my sales managers a couple times. I seriously had a manager ask me "Sooo, Crown Prince, you say your wife's due in September..." - the last month of our second half - "Are you guys going to induce?"

To which I replied "No, we're going natural. But she usually goes overdue, so it'll probably be the last week of the quarter. Why do you ask?" :snicker: As it was, I moved into operations before that one was born, or else things might have gotten interesting.

And it's not just my office - Portland has a lot of tech firms and sales offices - most major tech firms have regional sales offices here and we have a ton of local firms too. So I imagine there are a lot of professional women looking to time things just right.

phouka
08-18-2011, 10:45 PM
How early is medically necessary for a C-section for twins? There is research suggesting that inducing twins before 38 weeks isn't ideal. So no, you do not know whether or not they will sign off on a 37 week induction for twins.

I can come up with other examples of decisions made by doctors and patients that weigh the risks to the mother and to the unborn babies, if you want. The point is that those choices are no longer in the hands of those doctors and mothers, now a arbiter is going to decide who can have an induction or C-section.

That's just not true.

The guideline is "no medically unnecessary inductions or c-sections". If a doctor determines that it is medically necessary to deliver twins at 37 weeks because their size would pose a threat to themselves and the mother during a natural delivery, no one is going to argue with him.

There may occasionally be arguments over how to weigh risks, but not if something that clear cut is a risk.

Nava
08-19-2011, 02:31 AM
My wife had a scheduled C-section with our twins. Both those kids had been big all through the pregnancy and were more than seven pounds (which is pretty damn big for twins) at birth. Her OB was concerned that labor might do some serious damage to either her or the babies.

She was at 37 weeks, so it counts as an early delivery. And since no one can actually say going through labor would have caused problems, it was elective, as well.

Who wants to tell her that she and her OB shouldn't have been able to do it that way?

In Spain that one would be considered "scheduled but not elective" (specially if the kids are in any position other than "both facing down" - the kids of a friend of mine were both sideways; my cousin's, one faced up; another friend, both faced up). Same as my grandmother's gallbladder for example: it was scheduled, because it wasn't so much of an emergency as to have to do it rightnowinthemiddleofthenight, but it was not elective because it clearly needed to come out, waiting longer would simply have turned it from something that could be done early in the morning to something which needed to be done *now*.

lorene
08-19-2011, 04:10 AM
It doesn't surprise me at all that this had been a problem; I also fully support it since it's really for the good of both the mother and the baby.

I live in the Portland area, and work with quite a few women in the tech industry - our office mostly focuses on sales. Of the dozens of mothers I've worked with (most of them very nice people), I can count on one hand the number who didn't schedule their births, some by as early as 2 or 3 weeks prior. Doing everything you can to make quota at the end of the quarter is a huge pressure cooker, and frankly, makes people do stupid things.

<snip>

And it's not just my office - Portland has a lot of tech firms and sales offices - most major tech firms have regional sales offices here and we have a ton of local firms too. So I imagine there are a lot of professional women looking to time things just right.

I was hoping that someone from Portland would chime in here and explain the climate in which this all was taking place. Thanks! And good for you for not bowing to pressure.

Dangerosa
08-19-2011, 07:07 AM
It doesn't surprise me at all that this had been a problem; I also fully support it since it's really for the good of both the mother and the baby.

I live in the Portland area, and work with quite a few women in the tech industry - our office mostly focuses on sales. Of the dozens of mothers I've worked with (most of them very nice people), I can count on one hand the number who didn't schedule their births, some by as early as 2 or 3 weeks prior. Doing everything you can to make quota at the end of the quarter is a huge pressure cooker, and frankly, makes people do stupid things.

I always refused to ask my wife to schedule her deliveries, despite some ever-so-subtle pressure from my sales managers a couple times. I seriously had a manager ask me "Sooo, Crown Prince, you say your wife's due in September..." - the last month of our second half - "Are you guys going to induce?"

To which I replied "No, we're going natural. But she usually goes overdue, so it'll probably be the last week of the quarter. Why do you ask?" :snicker: As it was, I moved into operations before that one was born, or else things might have gotten interesting.

And it's not just my office - Portland has a lot of tech firms and sales offices - most major tech firms have regional sales offices here and we have a ton of local firms too. So I imagine there are a lot of professional women looking to time things just right.


And? Once again, choosing to take risks is my decision. Not the hospitals. If my DOCTOR was saying "no, you'll need to find yourself another doctor," that's different. All the HOSPITALS in Portland colluding to do this are completely removing a woman's choice.

pbbth
08-19-2011, 08:09 AM
And it's not just my office - Portland has a lot of tech firms and sales offices - most major tech firms have regional sales offices here and we have a ton of local firms too. So I imagine there are a lot of professional women looking to time things just right.

But why shouldn't those women be allowed to schedule a birth if it saves their career? If someone's baby being born a week or two early could mean the difference between keeping your job or being fired at your next review I would say that is an excellent reason to schedule a birth. For some women they are able or willing to walk away from their job and be a stay at home mom or find a part time position but some of those women, especially in our current economy, probably have husbands that are unemployed or underemployed and are not able to support the family. Some of those women are probably single mothers who will be the only source of income in a household. Given a choice between being born a week early and spending the first several years of their lives in poverty I'm pretty sure most people would choose the first option.

If a specific doctor says that something isn't safe and they won't do it that is fine and commendable but hospital admins should not be the ones making that decision. There is a lot of thought that goes into choosing to induce or elect an early cesarean and sometimes these choices are not made solely for medical reasons but that doesn't make them wrong or bad.

MsWhatsit
08-19-2011, 08:19 AM
If someone's baby being born a week or two early could mean the difference between keeping your job or being fired at your next review I would say that is an excellent reason to schedule a birth.

It can also mean the difference between a baby that is born with problems of prematurity and a baby that isn't, and the doctor's job is to ensure a healthy mother and baby, not to protect your career.

Edit: To be clear, our system of maternal leave and the pressures that are put on new mothers to go back to work early makes me completely insane with rage, seriously. But hospitals and OBs have the primary responsibility of ensuring your health and your child's health. Yes, being able to schedule your delivery three weeks early might be very convenient for you and help you greatly in the workplace, but if scheduled early C-sections and inductions lead to increased poor outcomes with no possible medical benefit, I think it's a legitimate and justifiable stance for a hospital to say, "We aren't doing those."

Hello Again
08-19-2011, 08:42 AM
It can also mean the difference between a baby that is born with problems of prematurity and a baby that isn't, and the doctor's job is to ensure a healthy mother and baby, not to protect your career.

Edit: To be clear, our system of maternal leave and the pressures that are put on new mothers to go back to work early makes me completely insane with rage, seriously. But hospitals and OBs have the primary responsibility of ensuring your health and your child's health. Yes, being able to schedule your delivery three weeks early might be very convenient for you and help you greatly in the workplace, but if scheduled early C-sections and inductions lead to increased poor outcomes with no possible medical benefit, I think it's a legitimate and justifiable stance for a hospital to say, "We aren't doing those."

Yes, but you've taken the case where someone wants to schedule an early delivery. What about the case where they just want it scheduled? Not 3 weeks early, just on the due date or in the same week. Imagine the case where a woman has saved up 3 weeks paid leave. She can only afford to take paid leave. her husband has also saved up 3 weeks leave, so the baby can remain in parental care for 6 weeks total if they time it just right. If they don't, the baby loses out. How is it wrong to schedule delivery to maximize the full time parental care the child receives?

MsWhatsit
08-19-2011, 08:45 AM
Yes, but you've taken the case where someone wants to schedule an early delivery. What about the case where they just want it scheduled? Not 3 weeks early, just on the due date or in the same week.

They can do that under the new guidelines. The only restrictions are on elective C-section or induction prior to 39 weeks. Full-term is 40 weeks.

lorene
08-19-2011, 08:46 AM
Yes, but you've taken the case where someone wants to schedule an early delivery. What about the case where they just want it scheduled? Not 3 weeks early, just on the due date or in the same week. Imagine the case where a woman has saved up 3 weeks paid leave. She can only afford to take paid leave. her husband has also saved up 3 weeks leave, so the baby can remain in parental care for 6 weeks total if they time it just right. If they don't, the baby loses out. How is it wrong to schedule delivery to maximize the full time parental care the child receives?

Duplicated what Ms. Whatsit said. NM

Dangerosa
08-19-2011, 08:56 AM
They can do that under the new guidelines. The only restrictions are on elective C-section or induction prior to 39 weeks. Full-term is 40 weeks.

38 weeks. My daughter was born (labor started, naturally) at 38 weeks 1 day. Two days earlier and she would have been technically "premature."

Normal pregnancies are 38-42 weeks.

Hello Again
08-19-2011, 08:57 AM
They can do that under the new guidelines. The only restrictions are on elective C-section or induction prior to 39 weeks. Full-term is 40 weeks.
Ah, gotcha.

DianaG
08-19-2011, 08:58 AM
IThe side effects of not having an early elective C-section are having to stay pregnant a little longer and maybe experiencing some inconvenience in scheduling.
These are the exact same side effects of being denied an abortion, to hear most anti-choicers tell it. :dubious:

Is there a list somewhere of specific instances in which a conscious, sane woman is incompetent to make her own medical decisions? Forewarned is forearmed, and all.

redtail23
08-19-2011, 09:05 AM
Well, the ban is only on *early* deliveries (prior to 39 weeks), so simply scheduling a delivery is still OK.

For instance, pbbth's scheduled delivery (a few days prior to the due date) wouldn't be a problem under this ban.

Lasciel's boss's DiL's scheduled delivery would probably be OK, or could be scheduled to fit within the 39-41 weeks range, if all that was wanted was a Friday evening delivery.

randomface's doc's Christmas would have been safe - 3 days early wouldn't be questioned.

And kunilou's wife's doctor would have to file some kind of form saying 'medically necessary early c-section due to large twins' and then that one would be fine. Y'all can get yourselves all in a lather about how these evil hospitals are trying to kill women by disallowing needed early deliveries, but you're just being silly.

Just so y'all realize - when they talk about hospital 'arbiters' and 'administrators' making these decisions: I'd bet dollars to donuts that those people ARE medical professionals. Many hospital management staff are medical doctors and/or nurses. They're not just random guys with a business degree in basketweaving. Medical oversight staff are almost always actual medical people; frequently it's a committee of specialists that are basically doing a peer-review thing.

Dangerosa
08-19-2011, 09:17 AM
38 weeks. My daughter was born (labor started, naturally) at 38 weeks 1 day. Two days earlier and she would have been technically "premature."

Normal pregnancies are 38-42 weeks.

Google says 37 weeks is full term.

MsWhatsit
08-19-2011, 09:20 AM
38 weeks. My daughter was born (labor started, naturally) at 38 weeks 1 day. Two days earlier and she would have been technically "premature."

Normal pregnancies are 38-42 weeks.

40 weeks is the standard length of a "complete" pregnancy, i.e. that's when your due date is. I know you know this, but I want to be clear for the benefit of anyone else reading. At 38 weeks you are indeed technically considered "full term" although again, that doesn't mean that the second you reach 38 weeks, your child is fully developed and ready to be born. (And on preview, it sure as hell doesn't mean that for 37 weeks.)

42 weeks is generally the point at which most OBs will consider you "overdue" and schedule an induction, since negative outcomes tend to rise fairly sharply after that point.

redtail23
08-19-2011, 09:21 AM
Dangerosa, why should the hospital be forced to allow medically risky, unnecessary surgeries for your convenience? Yeah, you can sign some piece of paper saying that you know the risks - but that doesn't stop people from suing (and winning) when one of those risks actually materializes.

Nava, I *wish* we used that terminology here. The "elective" phrasing is misunderstood by most people IMO. The anti-abortion crowd use it all the time to mean "frivolous abortions" when all it really means is "scheduled, non-emergency procedure". Elective <> not medically necessary.

I do question the 39 weeks cutoff, since Dangerosa is right; a 38-week pregnancy is considered full-term.

Crown Prince, thanks for the actual info on local culture. I wonder if part of the purpose of this ban isn't trying to give people an easier way out of that sort of pressure. Now they won't have to risk their jobs to refuse to deliver early, because no one will be able to do that in Portland.

I just wonder why these people are bothering with having kids. If having a baby is threatening to your career, then just when are you going to have time to actually rear a child?

DianaG
08-19-2011, 09:24 AM
Dangerosa, why should the hospital be forced to allow medically risky, unnecessary surgeries for your convenience?
Um... "forced to allow" doesn't mean "forced to perform", it just means "not banned".

Why not allow both the patients and the institutions choice?

redtail23
08-19-2011, 09:28 AM
Missed the edit window durn it!

See, they've been cutting on the other end also, in favor of inductions and c-sections. I know several people whose doc's have insisted on induction at 40 weeks, because anything past that was "overdue". I understand the need when the baby is large, but not when they're 7 pounds. I don't know anyone that was allowed to go to 42 weeks.

There really has been a huge move in USA obstetrics towards way, way, way too many inductions (which, among the other problems, also increase the number of c-sections).

I think that trend is what this ban is trying to fight. You can disagree with their method, but I think the *intent* is good.

DianaG, it is the hospitals who have decided not to perform early deliveries. They HAVE chosen.

DianaG
08-19-2011, 09:34 AM
Ah, my mistake, I was under the impression it was a legislative thing.

Still don't like it, but different.

Dangerosa
08-19-2011, 09:35 AM
Does the "hosptial" perform any procedure? I thought the DOCTOR performed the procedure. I thought that the DOCTOR/PATIENT relationship, not the PATIENT/HOSPITAL relationship was primary.

More importantly, I have a problem with that patronizing attitude of "we are going to protect you and your baby from yourself." Frankly, if they are going to do that - they'd better be consistent and the hospitals better not do any cosmetic or elective surgery - because there is always risk.

lorene
08-19-2011, 10:00 AM
Does the "hosptial" perform any procedure? I thought the DOCTOR performed the procedure. I thought that the DOCTOR/PATIENT relationship, not the PATIENT/HOSPITAL relationship was primary.

More importantly, I have a problem with that patronizing attitude of "we are going to protect you and your baby from yourself." Frankly, if they are going to do that - they'd better be consistent and the hospitals better not do any cosmetic or elective surgery - because there is always risk.

Well, the hospital has to supply the staff, the facilities, and any needed materials and medications. In the event of a C-section, that includes an OR which, at least where I work, can be very difficult to book.

And again, I don't think this is all about risk. It is also about skyrocketing healthcare costs. A C-section is expensive, but generally covered by medical insurance. Elective cosmetic surgery may be expensive, but it's an expense put on the patient.

pbbth
08-19-2011, 10:11 AM
If their only rule is that they will not allow an elective birth that is being done before the baby is properly developed I can see that as being okay but the 39 week cutoff is a little bit much. 38 weeks would be a much better cutoff date and it would be better still if they allowed women to have a sonogram or other exam to verify that the lungs and everything are fully developed if she wants to have an earlier birth scheduled.

An elective birth is one of many decisions a woman will make regarding her child's health and well being. We allow people to choose not to vaccinate their kids. We allow people to choose whether or not to circumsize their sons. We allow people to pierce the ears of a newborn baby if they want. People are going to make decisions (http://poorlydressed.failblog.org/2011/07/03/fashion-fail-never-too-young-to-start-wearing-legg-waitthosearentleggings/) we don't always agree with (http://babies.icanhascheezburger.com/2011/08/18/funny-kids-pictures-a-little-light-reading/) regarding their children (http://babies.icanhascheezburger.com/2011/08/10/funny-kids-pictures-pageanty-toddler-is-pageantastic/) and their reasons (http://babies.icanhascheezburger.com/2011/08/09/funny-kids-pictures-occasionally-you-need-a-pet-zombie/) are not always going to be (http://babies.icanhascheezburger.com/2011/08/07/funny-kids-pictures-baby-burrito-3/) ones we will (http://babies.icanhascheezburger.com/2011/08/05/funny-kids-pictures-diaper-thongies-bad-product-idea/) understand (http://babies.icanhascheezburger.com/2011/08/05/funny-kids-pictures-in-soviet-russia/).

Dangerosa
08-19-2011, 10:12 AM
Well, the hospital has to supply the staff, the facilities, and any needed materials and medications. In the event of a C-section, that includes an OR which, at least where I work, can be very difficult to book.

And again, I don't think this is all about risk. It is also about skyrocketing healthcare costs. A C-section is expensive, but generally covered by medical insurance. Elective cosmetic surgery may be expensive, but it's an expense put on the patient.

Than the insurance company should be saying we don't cover it. And the hospital can say "sure - but we want you to pay up front."

If the woman can pay for it, the doctor will do it, and the woman wants it - shouldn't they be the ones accepting the risk?

Moreover, this isn't one hospital saying "we aren't going to do this anymore" - they got together to remove this choice for Portland area women. That's really patronizing.

lorene
08-19-2011, 10:32 AM
Than the insurance company should be saying we don't cover it. And the hospital can say "sure - but we want you to pay up front."

If the woman can pay for it, the doctor will do it, and the woman wants it - shouldn't they be the ones accepting the risk?

Moreover, this isn't one hospital saying "we aren't going to do this anymore" - they got together to remove this choice for Portland area women. That's really patronizing.

I get what you're saying, I really do.

As someone who works in a large city medical center, I can almost guarantee you that this is not the type of decision that was entered into lightly, though. Hospitals do not take actions which will result in a loss of revenue without some really good reasons. Moreover, hospital administration is generally largely made up of physicians, nursing officers, and those with advanced degrees in public health. I have to think that if all of those people in seventeen hospitals were able to reach an agreement on this, it was in response to some very real issues and concerns that they have about the current climate surrounding births in their community.

That said, there may be changes coming up in the reimbursement system that dictate how hospitals will be reimbursed for interventions that are not considered medically necessary. I don't know. I do know that performance-based reimbursement is something we think and talk about a lot at the medical center that I work in, and it's possible that this is the harbinger of something larger than some hospitals getting together to stop non-medically necessary C-sections and early inductions. But that is wild speculation on my part.

redtail23
08-19-2011, 11:12 AM
If their only rule is that they will not allow an elective birth that is being done before the baby is properly developed I can see that as being okay but the 39 week cutoff is a little bit much. 38 weeks would be a much better cutoff date and it would be better still if they allowed women to have a sonogram or other exam to verify that the lungs and everything are fully developed if she wants to have an earlier birth scheduled.I could definitely get behind this. The "due date" is such an iffy thing anyway, I also have some problems with the hard-and-fast cutoff date. I also wonder if it won't just lead to docs/patients 'fudging' the due date.

If the woman can pay for it, the doctor will do it, and the woman wants it - shouldn't they be the ones accepting the risk? There is also a risk to the hospital. When people sue for medical issues, they tend to sue everyone in sight, especially the deep pockets.

Doesn't the hospital have the right to manage their risk? Even if they all decide to cooperate to do so?

Hello Again
08-19-2011, 11:21 AM
I just wonder why these people are bothering with having kids. If having a baby is threatening to your career, then just when are you going to have time to actually rear a child?

I just KNEW someone was going to say this. Goldurn wimmin wantin to work when they should be birthin'! Perhaps the father intends to be the full time caregiver, ever consider that? And maybe it's none of your damn business what they plan to do. Yeah, I'm pretty sure it's that last one.

Are we now means testing whether someone is wealthy enough, or has the "right" kind of job before they're allowed to have children?

Dangerosa
08-19-2011, 11:24 AM
I could definitely get behind this. The "due date" is such an iffy thing anyway, I also have some problems with the hard-and-fast cutoff date. I also wonder if it won't just lead to docs/patients 'fudging' the due date.

There is also a risk to the hospital. When people sue for medical issues, they tend to sue everyone in sight, especially the deep pockets.

Doesn't the hospital have the right to manage their risk? Even if they all decide to cooperate to do so?

I don't believe they have the right to collude with other hospitals in managing risk. Each hospital in the Portland area needs to make that decision independently.

And I believe that where risk is reasonable, their should be the ability for the hospital to have the woman sign off on the risk and accept it. And I think in the face of that signature, it should be DARN HARD to sue a hospital unless there was egregious malpractice.

And I believe that you need to be consistent. If you are worried about getting sued due to elective procedures, you shouldn't offer them. If you are going to let a women get a boob job for cosmetic purposes, but not let her deliver at 38 weeks because she lives an hour outside of Portland with no near hospital and her husband travels a lot, that's patronizing. You may be controlling your risks, but the woman should also be controller HER risks. Her risk might be "my husband will be out of town and there is a good chance I won't be able to get to the hospital during week 39 or 40 if I go into labor."

redtail23
08-19-2011, 01:21 PM
I just KNEW someone was going to say this. Goldurn wimmin wantin to work when they should be birthin'! Perhaps the father intends to be the full time caregiver, ever consider that? And maybe it's none of your damn business what they plan to do. Yeah, I'm pretty sure it's that last one.

Are we now means testing whether someone is wealthy enough, or has the "right" kind of job before they're allowed to have children?Oh get over it. It's not like I'm actually saying that to an individual, it was a snide aside on a message board.

And I'm sorry, I'm not talking about your average working couple, here. I know plenty of working couples, some of whom chose to have one parent stay home, some of whom opted for both parents to keep working. My Bro-in-Law is a stay-at-home dad.

I don't know ANYONE who had to schedule the birth of their child early in order to keep their job. I don't know ANYONE who would even consider having an over-the-weekend-no-time-off birth because "miss any work for any form of motherhood-related activities would put [them] on the shit list".

My parents both worked when I was a kid; I was that horror-of-horrors [i]a latchkey child. Back in the 70s, when that was a major bugaboo. So were most of my friends. We all turned out fine. I got nothing against working parents.

But according to Crown Prince, in Portland the pressure is not only to schedule early births to work around the mother's job, but also the father's. So hey, why not schedule the birth at 5 months, when it's slack season for business, hmm?

Apparently some of y'all think that it's great and fine and dandy that businesses are now coercing employees into risking their (and their children's) health because hey, it's all about your personal freedom and convenience. And any sacrifice for a career is golden.

Some of us disagree.

Hello Again
08-19-2011, 01:32 PM
Apparently some of y'all think that it's great and fine and dandy that businesses are now coercing employees into risking their (and their children's) health because hey, it's all about your personal freedom and convenience. And any sacrifice for a career is golden.

No, I think if the employer is the one doing the coercing, the employee is not the one who should be punished.

I wonder how you think this change will impact the employer who sets the rules negatively? The idea that you'll sock it to those mean employers by forbidding employees from complying with their policies, is an... interesting one. Shouldn't you actually forbid the employers from having those policies?

Dangerosa
08-19-2011, 01:34 PM
Oh get over it. It's not like I'm actually saying that to an individual, it was a snide aside on a message board.

And I'm sorry, I'm not talking about your average working couple, here. I know plenty of working couples, some of whom chose to have one parent stay home, some of whom opted for both parents to keep working. My Bro-in-Law is a stay-at-home dad.

I don't know ANYONE who had to schedule the birth of their child early in order to keep their job. I don't know ANYONE who would even consider having an over-the-weekend-no-time-off birth because "miss any work for any form of motherhood-related activities would put [them] on the shit list".

My parents both worked when I was a kid; I was that horror-of-horrors [i]a latchkey child. Back in the 70s, when that was a major bugaboo. So were most of my friends. We all turned out fine. I got nothing against working parents.

But according to Crown Prince, in Portland the pressure is not only to schedule early births to work around the mother's job, but also the father's. So hey, why not schedule the birth at 5 months, when it's slack season for business, hmm?

Apparently some of y'all think that it's great and fine and dandy that businesses are now coercing employees into risking their (and their children's) health because hey, it's all about your personal freedom and convenience. And any sacrifice for a career is golden.

Some of us disagree.

AND? Here I'm pressing my own beliefs a little, but for the sake of argument, if at five months I am willing to pay for and accept all the risks involved in a pre-term birth - its my body and its my child.

(I think in that case we've crossed the line from "37 weeks is full term and the risk difference between 37 and 39 weeks is negligible" into "child endangerment" - but I don't know what that line is. However, I'm pretty sure that line is at least at a full term 37 week birth.)

DianaG
08-19-2011, 01:35 PM
Apparently some of y'all think that it's great and fine and dandy that businesses are now coercing employees into risking their (and their children's) health because hey, it's all about your personal freedom and convenience. And any sacrifice for a career is golden.

Some of us disagree.
Speaking of bullshit.

Some of us don't think it's dandy for any business to coerce anyone into making medical decisions that primarily benefit the business.

Funny how that works, ain't it?

redtail23
08-19-2011, 01:38 PM
I don't believe they have the right to collude with other hospitals in managing risk. Each hospital in the Portland area needs to make that decision independently.

And I believe that where risk is reasonable, their should be the ability for the hospital to have the woman sign off on the risk and accept it. And I think in the face of that signature, it should be DARN HARD to sue a hospital unless there was egregious malpractice.

And I believe that you need to be consistent. If you are worried about getting sued due to elective procedures, you shouldn't offer them. If you are going to let a women get a boob job for cosmetic purposes, but not let her deliver at 38 weeks because she lives an hour outside of Portland with no near hospital and her husband travels a lot, that's patronizing. You may be controlling your risks, but the woman should also be controller HER risks. Her risk might be "my husband will be out of town and there is a good chance I won't be able to get to the hospital during week 39 or 40 if I go into labor."I can see reasons why the hospitals would choose to do this en masse, but I'd be speculating so I'm not going to. Regardless, that decision is theirs. It may be patronizing, as you feel, but you've got no right not to be patronized, hmm? If you want that conveniently scheduled 36 week c-section, go somewhere that offers one. These hospitals have decided not to accept the risk that is created by unnecessary early deliveries.

You can believe all you want about signing risk releases. The reality is, they don't do jack. I wish an actual lawyer would come in here and explain this to you. Idealistically, this idea would work fine. In the real world, where obgyn malpractice rates are sky-high because people now sue for any and everything imaginable anytime they're unhappy about anything remotely related to the pregnancy, birth, postop, or the actual child - that's not how it works.

Risk of malpractice suits are much higher than the risk for cosmetic surgery, therefore it's consistent for the restrictions to be higher also.

But I'd agree with you that there should be more leeway in their cutoff. Which is why I liked kunilou's suggestion.

redtail23
08-19-2011, 01:40 PM
No, I think if the employer is the one doing the coercing, the employee is not the one who should be punished.

I wonder how you think this change will impact the employer who sets the rules negatively? The idea that you'll sock it to those mean employers by forbidding employees from complying with their policies, is an... interesting one. Shouldn't you actually forbid the employers from having those policies?I doubt there are actual policies. This kind of stuff is usually done one the nudge-nudge-wink-wink level. I'm pretty sure they wouldn't get away with an actual official policy.

But if NONE of the employees can get early-scheduled deliveries because the hospitals won't do them, it kinda takes thre pressure of, doesn't it?

It's like having a subpoena delivered to someone who wants to testify but is worried about backlash. "Oh, look, not my choice, gotta do this, sorry!"

redtail23
08-19-2011, 01:42 PM
AND? Here I'm pressing my own beliefs a little, but for the sake of argument, if at five months I am willing to pay for and accept all the risks involved in a pre-term birth - its my body and its my child.

(I think in that case we've crossed the line from "37 weeks is full term and the risk difference between 37 and 39 weeks is negligible" into "child endangerment" - but I don't know what that line is. However, I'm pretty sure that line is at least at a full term 37 week birth.)IF you are willing to take those risks AND there was actually (in the real world, not utopia-vision) some way to enforce that willingness, both legally and financially, then fine. But it's not that way now, so that's a really a meaningless point.

Yeah, I know, I was exaggerating with the 5 months thing. Sue me. :p

redtail23
08-19-2011, 01:45 PM
Speaking of bullshit.

Some of us don't think it's dandy for any business to coerce anyone into making medical decisions that primarily benefit the business.

Funny how that works, ain't it?Well, I'd have to agree with you there. And what is the price of tea in China these days, anyway?

Hello Again
08-19-2011, 02:00 PM
I doubt there are actual policies. This kind of stuff is usually done one the nudge-nudge-wink-wink level. I'm pretty sure they wouldn't get away with an actual official policy.

But if NONE of the employees can get early-scheduled deliveries because the hospitals won't do them, it kinda takes thre pressure of, doesn't it?

No, it just makes having children a career-killing decision rather than one you can work around. There will always be childless people availble to fill those jobs. People with children will simply be let go because "they had too much unscheduled absence." They might also "lack the committment and flexibility" for management level positions. Etc. You have quite the rosy view of what a company, one which is already dickish enough to pressure its employees on major life decisions, will do.

"One Sick Child Away From Being Fired (http://www.worklifelaw.org/pubs/onesickchild.pdf)" a report on employment law by Hasting College of Law that focuses more on working class job sites, is quite the harrowing read.

lorene
08-19-2011, 02:30 PM
The second-to-last paragraph in this article (http://www.medscape.com/viewarticle/441201) refutes the idea that an elective C-section is comparable to elective cosmetic surgery.

Some argue that, from an ethical point of view, allowing a patient to choose to deliver by cesarean is not substantially different from allowing her to choose to undergo cosmetic surgery. But cesarean delivery is very different. The benefits of elective cesarean delivery relative to vaginal delivery are not established, and the risks are substantial, especially given the potential for future repeat cesareans. Other elective surgeries are usually meant to be 1-time events.

The article itself discusses risk as compared to vaginal delivery.

In the interest of balance, this page (http://www.thebump.com/stages/topic.aspx?topic=elective_c_section) offers a side-by-side commentary by a pro-elective C-section doctor and an anti-elective C-section doctor.

lorene
08-19-2011, 02:48 PM
No, it just makes having children a career-killing decision rather than one you can work around. There will always be childless people availble to fill those jobs. People with children will simply be let go because "they had too much unscheduled absence." They might also "lack the committment and flexibility" for management level positions. Etc. You have quite the rosy view of what a company, one which is already dickish enough to pressure its employees on major life decisions, will do.

"One Sick Child Away From Being Fired (http://www.worklifelaw.org/pubs/onesickchild.pdf)" a report on employment law by Hasting College of Law that focuses more on working class job sites, is quite the harrowing read.

But again, it's not up to a doctor or a hospital to fix that. A hospital is concerned with the health and safety of mother and baby, with providing care in the most efficient manner possible, and with the fact that the cost of an elective C-section is 76% higher (http://www.newsytype.com/10199-elective-ceasarean-sections-ban/) than that of a natural birth. The article I linked to, about these very hospitals in Oregon, states that one hospital reported a yearly savings of $1million as a result of banning elective preterm c-sections. The fact is also reported in that article that 40% of Oregon births are paid for by Medicare, although it does not state how many of those are in Portland.

Interestingly, I found a similar policy propsed in New South Wales (http://www.hpm.org/en/Surveys/CHERE_-_Australia/11/New_rules_for_caesarean_section.html). Not sure if any of our Australian Dopers care to chime in on this.

redtail23
08-19-2011, 02:55 PM
No, it just makes having children a career-killing decision rather than one you can work around. There will always be childless people availble to fill those jobs. People with children will simply be let go because "they had too much unscheduled absence." They might also "lack the committment and flexibility" for management level positions. Etc. You have quite the rosy view of what a company, one which is already dickish enough to pressure its employees on major life decisions, will do.

"One Sick Child Away From Being Fired (http://www.worklifelaw.org/pubs/onesickchild.pdf)" a report on employment law by Hasting College of Law that focuses more on working class job sites, is quite the harrowing read.No, actually, I quite agree with you.

Hence my comment earlier about having kids when you're working a job that doesn't allow for it. If you can't even take off work to give birth, then when are you going to ever have time for a parent-teacher conference or school activity? Or a sports event or recital or school play?

All the parents I know take off work for those events, at least occasionally, even when there's a stay-at-home or other provision for sick kids, school closings, etc.

I know people who have quit their jobs and figured out how to make do on one income, because it was important to them to have a stay-home parent.

I know people who decided that staying home wasn't for them, and figured out how to balance work and family, even if it's not perfect.

Whatever works for you.

I just don't understand how it works having kids when you're in a job or career that is so anti-family that they'd push all employees to schedule births based on business schedules. Even the places I know that are horrendously uptight about taking off with sick kids, etc., don't expect that.

But really, this is all a bit of a hijack based on one smart-ass comment, neh?

Other than the fact that the Portland hospitals just may have taken the work culture into account when making this policy. Or they may not have, we don't really know.

Hello Again
08-19-2011, 03:06 PM
But again, it's not up to a doctor or a hospital to fix that. A hospital is concerned with the health and safety of mother and baby, with providing care in the most efficient manner possible, and with the fact that the cost of an elective C-section is 76% higher (http://www.newsytype.com/10199-elective-ceasarean-sections-ban/) than that of a natural birth. The article I linked to, about these very hospitals in Oregon, states that one hospital reported a yearly savings of $1million as a result of banning elective preterm c-sections. The fact is also reported in that article that 40% of Oregon births are paid for by Medicare, although it does not state how many of those are in Portland.

I am not necessarily saying that's in any way wrong. I am contesting the idea that somehow this move is a positive for people with particularly assholish employers. It is a real stretch to say it is.

You know, I have a REAL hard time believing 40% of orgeon births are covered by Medicare. Why? because Medicare exclusively serves the population over 55. Medicaid serves the low-income population. Frankly, with quality reporting like that the entire article is thrown into doubt. However, even if 40% of Oregon births are covered by Medicaid, Oregon is free to stop covering elective c-sections under Medicaid if the cost is burdensome. Private insurance companies have the same choice. I'm not really sure why controlling women's choices at the point of service is the better answer.

kunilou
08-19-2011, 03:09 PM
I get what you're saying, I really do.

As someone who works in a large city medical center, I can almost guarantee you that this is not the type of decision that was entered into lightly, though. Hospitals do not take actions which will result in a loss of revenue without some really good reasons. Moreover, hospital administration is generally largely made up of physicians, nursing officers, and those with advanced degrees in public health. I have to think that if all of those people in seventeen hospitals were able to reach an agreement on this, it was in response to some very real issues and concerns that they have about the current climate surrounding births in their community.

That said, there may be changes coming up in the reimbursement system that dictate how hospitals will be reimbursed for interventions that are not considered medically necessary. I don't know. I do know that performance-based reimbursement is something we think and talk about a lot at the medical center that I work in, and it's possible that this is the harbinger of something larger than some hospitals getting together to stop non-medically necessary C-sections and early inductions. But that is wild speculation on my part.

The proper way to decide if a procedure is medically necessary is to review it and the doctor who performed it. If it turns out that a particular obstetrician is inducing labor or performing C-sections of dubious medical value, then you discipline the doctor. The idea that every hospital in an area can get together and require every obstetrician to get approval for every decision in advance either means every obstetrician in Portland sucks, or the hospitals are going way beyond CYA.

lorene
08-19-2011, 03:20 PM
The proper way to decide if a procedure is medically necessary is to review it and the doctor who performed it. If it turns out that a particular obstetrician is inducing labor or performing C-sections of dubious medical value, then you discipline the doctor. The idea that every hospital in an area can get together and require every obstetrician to get approval for every decision in advance either means every obstetrician in Portland sucks, or the hospitals are going way beyond CYA.

Couldn't it also mean that doctors are getting pressured unduly by patients who want to schedule births and this is a way of addressing that? That's a genuine question. I think there are other possible scenarios besides your either/or options. In fact, I'm willing to bet that this is in response to a number of issues, not just one issue.

Steophan
08-19-2011, 03:22 PM
I'm assuming that these hosptials will stop doing all medically contraindicated procedures that carry risk but aren't necessary. No more plastic surgery. And they'll tell people who want gastric bypass to go for the natural method because gastric bypass carries risk and they could loose weight without that risk.

One would hope so in all cases. Plastic surgery should only be available if necessary for health reasons (mental or physical), the same as weight loss surgery.

There's no way that hospitals should schedule a birth for the convenience of the mother when it increases the risk to either her or the child. The same should apply to all medical treatment - it should be the best available, not something "convenient" that is, in fact, more damaging.

JohnT
08-19-2011, 03:31 PM
My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask. And no, it wasn't medically necessary, and it was done for convenience:

Enter hospital: 6:00am
Induced: 7:30am
Contractions start: 11:00am
Baby born: 1:30pm

Awesome. And this was for the first (so far, only) child.

To be honest, I'm completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of "women's bodies, women's choices".

You can decide to kill your child, but you're not allowed to decide as to when to give birth to a child? There aren't enough :rolleyes: in the universe for such a logical disconnect.

lorene
08-19-2011, 03:34 PM
My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask.

To be honest, I'm completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of "women's bodies, women's choices".

You can decide to kill your child, but you're not allowed to decide as to when to give birth to a child? There aren't enough :rolleyes: in the universe for such a logical disconnect.

How many weeks pregnant was she? I am not anti-induction at all. I am "anti-taking the baby out weeks before it is ready to come out". I don't necessarily agree with the 39-week cutoff here, but I have known many a 36- or 37-week pregnant woman, uncomfortable and sick of being pregnant, who gets upset when her OB won't induce, despite there being no medical reason for it.

perfectparanoia
08-19-2011, 03:34 PM
I just don't understand how it works having kids when you're in a job or career that is so anti-family that they'd push all employees to schedule births based on business schedules. Even the places I know that are horrendously uptight about taking off with sick kids, etc., don't expect that.

I don't think these women are doing this because they have to or they will be fired for it (since FMLA in your country would prevent that and we have laws here to do the same). I think we are talking about career oriented women who don't want to end up on the 'mommy track.' They know that they will (subconsiously, at least) be compared to the career oriented men in the company who will often come in the day after their wife has given birth (or stay at the office until the last moment).

Honestly, I probably work for the most family friendly workplace out there (if the kidlet is sick, I just fire off an email. If there is a doctor's appointment, I just put it in my calendar and I make personal calls all the time). However, all the top jobs go to the people who can get on a plane at a moment's notice (usually they have stay at home spouses since they all do seem to have procreated). That's just how it is. To do their jobs, you have to be able to, well, do their job (which means being available often on short notice).

So, I won't have a top job at my company since I can't do that. I could rearrange my life to do so but I choose not to. If I had one of those jobs, you can bet that it would be tricky to carry a pregnancy to term, give birth and some how recover fast enough to be back before my career was damaged.

JohnT
08-19-2011, 03:36 PM
How many weeks pregnant was she? I am not anti-induction at all. I am "anti-taking the baby out weeks before it is ready to come out". I don't necessarily agree with the 39-week cutoff here, but I have known many a 36- or 37-week pregnant woman, uncomfortable and sick of being pregnant, who gets upset when her OB won't induce, despite there being no medical reason for it.

"Naturally", Sophia was due to be born in a few days.

redtail23
08-19-2011, 03:52 PM
See, here's the thing.

Everyone moans about skyrocketing medical costs and malpractice costs. But the minute someone does something to combat risk and costs, everyone starts bitching.

Something like 15+ years ago, Oregon's Medicaid program (whatever it's called; I also wondered just how many deliveries Medicare was paying for :p) decided that they would no longer pay for extreme medical care for very premature babies.

It seems that they could provide pre-natal and infant care and support for 50,000 regular babies with what they were spending on one of these extreme cases. They decided that preventing problems in 50,000 kids was more effective than treating one child with low chance of survival.

I applauded that decision. At the time, I was working in Medicaid billing for similar cases. There are lots of these kids that never leave the hospital. Surgery after surgery after surgery, ICU, various life supports, etc. A few make it for some time - a couple of the kids I saw were 6 and 7 years old and still living full-time at the hospital, maybe with occasional brief visits to their families. A very few make it home (I think the average is something like 17% survival rate) and many of those have severe disabilities - which means, again, that Medicaid is on the hook for the rest of their lives.

I think the policy lasted a couple of months before it was retracted due to overwhelming public outcry about this horrible, evil, horrendous and callous decision.

So you really think that Medicaid or an evil, profiteering insurance company is going to be able to get away with making this call regarding unnecessary early inductions/c-sections? If an insurance company had done this, you'd all be screaming the exact same things about patient rights and women's choices and all of that.

In Utopia-land, parents could sign a release saying that the risk and responsibility was all theirs, and then they could do whatever they wanted. They wouldn't be able to get insurance to pay for it, or hit Medicaid up to cover costs for their disabled child, or sue the hospital and doctors because they wanted to blame someone for their own choices.

But we don't live in Utopia land, and the fact is that these parents *aren't* taking the risks and responsibility for their own choices.

And now y'all are throwing fits because some hospitals decided to control their own risks and reduce costs. Because somewhere, some parent might not get everything their own way.

And then you wonder why we're in such a mess in regards to healthcare.

kunilou
08-19-2011, 04:36 PM
Couldn't it also mean that doctors are getting pressured unduly by patients who want to schedule births and this is a way of addressing that? That's a genuine question. I think there are other possible scenarios besides your either/or options. In fact, I'm willing to bet that this is in response to a number of issues, not just one issue.

I think a doctor should be able to tell a patient that what she wants is medically inadvisable and an unnecessary risk. If there are no obstetricans in Portland who can do that, then it's a much bigger problem than a blanket policy can cover.

redtail23
08-19-2011, 05:00 PM
I think a doctor should be able to tell a patient that what she wants is medically inadvisable and an unnecessary risk. If there are no obstetricans in Portland who can do that, then it's a much bigger problem than a blanket policy can cover.Well, this blanket policy seems to have covered that problem. :p

Seriously - should the doctor be able to refuse the patient's request? Or is s/he required to perform an unnecessary and risky procedure, because that's what the patient wants?

redtail23
08-19-2011, 05:03 PM
My wife did a scheduled induction. It was awesome and the child came out as healthy as we can ask. And no, it wasn't medically necessary, and it was done for convenience:

To be honest, I'm completely puzzled as to how a number of people who I know are pro-choice can reconcile their anti-induction bias with the pro-choice argument of "women's bodies, women's choices".

You can decide to kill your child, but you're not allowed to decide as to when to give birth to a child? There aren't enough :rolleyes: in the universe for such a logical disconnect.

"Naturally", Sophia was due to be born in a few days.

So, once again, this ban would not have affected you. The ban is against EARLY unnecessary inductions.

JohnT
08-20-2011, 10:24 AM
It isn't all about you.

Also, anything to reduce people scheduling births around their work schedules, the better. Work to live, not live to work.

It's not all about your opinion of others lifestyles. :rolleyes:

doreen
08-20-2011, 11:00 PM
And I believe that where risk is reasonable, their should be the ability for the hospital to have the woman sign off on the risk and accept it. And I think in the face of that signature, it should be DARN HARD to sue a hospital unless there was egregious malpractice. IANAL, but I don't it's that simple. You can certainly accept the risk for yourself, but if the child is handicapped as a result of the c-section or induction (or the timing of it) , the fact that you signed off on it won't save the the doctor or the hospital when the child grows up and sues or even when the father sues on behalf of the child.

lorene
08-21-2011, 06:13 AM
It's not all about your opinion of others lifestyles. :rolleyes:

Says the guy who summed up the pro-choice stance as "you can decide to kill your child." I agree with what I quoted above, but...come on.

ecseas
08-21-2011, 06:29 AM
Great post, I totally agree. This banning is shameful and ridiculous. What if a woman elects c-section or induction because it is beneficial to her career, education, or the needs of her other children? Guess she's just fucked then. Thanks a heap, Portland!

If a mother has to schedule her baby's birth around her career, how is she supposed deal with unexpected mishaps that happen with children? If her career is so important that the birth has be fitted around it, I wonder how much attention their poor kids will get...

Things come up with children. They get sick, they get hurt. You will have to take time off to look after them. If you can not afford to take time off/ it's frowned upon to take time off to give birth then it will definitely be frowned upon to leave work early because Junior needs to go to the hospital, because he fell and broke his arm.

I might be missing the point or I might be old fashioned or something, but if your career is more important then your child's birth, maybe having a baby isn't really going to fit with your lifestyle. I have nothing against working mothers, but I believe children should be more important then your job ( to a certain extent)

Shmendrik
08-21-2011, 11:12 AM
I'm a little bewildered when I read about all of these elective births, quite frankly. I live in not-very-progressive Illinois and, without medical recommendation (such as twins, a very large baby, etc), my hospital will not induce before 41 weeks 1 day. They also won't schedule a c-section for a woman who has had only one previous c-section. You have to do a trial labor.

I think that's specific to your hospital. AFAIK patients can have (effectively) elective inductions at 39/0 in Illinois.

perfectparanoia
08-22-2011, 09:41 AM
If a mother has to schedule her baby's birth around her career, how is she supposed deal with unexpected mishaps that happen with children? If her career is so important that the birth has be fitted around it, I wonder how much attention their poor kids will get...

Things come up with children. They get sick, they get hurt. You will have to take time off to look after them. If you can not afford to take time off/ it's frowned upon to take time off to give birth then it will definitely be frowned upon to leave work early because Junior needs to go to the hospital, because he fell and broke his arm.

I might be missing the point or I might be old fashioned or something, but if your career is more important then your child's birth, maybe having a baby isn't really going to fit with your lifestyle. I have nothing against working mothers, but I believe children should be more important then your job ( to a certain extent)

And that's where your spouse comes in quite handy. It has worked the reverse way for decades (that dad was not expected to deal with such things) so if the woman is the high flying career type and the man is not, the dad deals with all these things.

My mom did all that stuff when I was a kid (with some backup from my grandma). I can't think of a single time my dad left work early or took me to the hospital when I injured myself (which was frequent). He would get home from work and check on me but it would be at a normal time.

Mama Zappa
08-22-2011, 11:00 AM
My boss' daughter-in-law is a CFO of some huge financial corporation, and she's had two kids so far. The first was when she was angling for the CFO slot, and the second one just a few months back.

She scheduled both births for a Friday evening so she could be "recovered" and back at work on Monday morning. Apparently the corporate culture mavens informed her that if she missed any work for any form of motherhood-related activities, she'd be straight onto the shit-list, and apparently she wasn't interested in finding out if it was true.

I am usually all for free will and lots of choices, but I really don't think that should be necessary or encouraged.

Yikes. I can't imagine being *capable* of working less than 72 hours after giving birth, with either of my deliveries.

What's frustrating is that if a guy were in the same position, he'd have been expected to miss at least a couple of days - good family men are good for business, dontcha know, and wifey needs his support (but only for a couple of days of course!).

The OP premise is an interesting one. The real question is how do the hospitals determine whether it's early / elective? Do they have a review board? Does the attending OB have to submit documentation on why the induction is scheduled / C-section is requested? There are, after all, lots of legitimate medical reasons for both.

Not that I think it's a bad idea, just curious as to the logistics.

Also, it's hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I've never heard of anyone saying to the doc "Let's skip this whole labor bullshit and do some surgery!".

pbbth
08-22-2011, 12:21 PM
Also, it's hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I've never heard of anyone saying to the doc "Let's skip this whole labor bullshit and do some surgery!".

I did.

I don't do medical stuff well. After performing my colposcopy in January and then watching me cry and scream while having blood drawn when they verified I was pregnant and needed to run some tests I told her I didn't want to give birth and that I wanted a cesarean. She agreed and said that quite frankly she didn't think I would be able to handle a standard labor. I am not going to be happy or comfortable with the birthing process no matter how it happens so I might as well get it done in less than an hour (and get a tubal while she is at it so I don't have to do it again in the future) than spend between 4-48 hours being terrified of everything and everyone around me. It was also discovered that I probably have cervical cancer right now as well so I would rather my cervix be up for a scraping and potential cell removal as soon as possible rather than having to wait for everything down below to heal up before they can remove any dangerous cells. It will take longer to recuperate and I am fine with that because to me the benefits of a cesarean outweigh the drawbacks significantly.

Crown Prince of Irony
08-22-2011, 12:54 PM
Sorry, I kind of made a drive-by post here, and didn't follow up. But this bubbled back up and I saw Dangerosa's comment.

AND? Here I'm pressing my own beliefs a little, but for the sake of argument, if at five months I am willing to pay for and accept all the risks involved in a pre-term birth - its my body and its my child.

(I think in that case we've crossed the line from "37 weeks is full term and the risk difference between 37 and 39 weeks is negligible" into "child endangerment" - but I don't know what that line is. However, I'm pretty sure that line is at least at a full term 37 week birth.)

I think that part of the issue locally is that a firm line had to be drawn as regards mid-to-long term development of the child, in addition to possible complications for the mother.

While a baby born naturally at 37 weeks may be as healthy as a baby born at 39 weeks, pre-term induced labor and c-sections add another dimension to the issue. Induced labor can be more forceful and more traumatic for the baby, and they are more likely to involve painkillers which can affect the baby. Also, pre-term induced labor has been show to increase the risk of requiring a c-section by 2 to 3 times, and c-sections pose some obvious risks, in addition to leading to potential complications for baby - I hesitate to use Wiki (http://en.wikipedia.org/wiki/Induced_labor#Criticisms_of_induction) as a cite, but the linked section has several footnotes on these issues.

I fully support women's reproductive rights, but I also believe that the medical community has an obligation to act responsibly as regards elective procedures. If the patient (or her partner) has a problem with their work schedule, there are labor laws protecting their rights. This should not factor into a decision about what's medically best for mom and baby.

If one insists on having such a medically unnecessary procedure done and is willing to pay for it, there's always Vancouver across the river - I know that comes across as horribly flippant, but there you go.

Crown Prince of Irony
08-22-2011, 01:00 PM
I did.

I don't do medical stuff well. After performing my colposcopy in January and then watching me cry and scream while having blood drawn when they verified I was pregnant and needed to run some tests I told her I didn't want to give birth and that I wanted a cesarean. She agreed and said that quite frankly she didn't think I would be able to handle a standard labor. I am not going to be happy or comfortable with the birthing process no matter how it happens so I might as well get it done in less than an hour (and get a tubal while she is at it so I don't have to do it again in the future) than spend between 4-48 hours being terrified of everything and everyone around me. It was also discovered that I probably have cervical cancer right now as well so I would rather my cervix be up for a scraping and potential cell removal as soon as possible rather than having to wait for everything down below to heal up before they can remove any dangerous cells. It will take longer to recuperate and I am fine with that because to me the benefits of a cesarean outweigh the drawbacks significantly.

pbbth, assuming you're responding to Mama Zappa's comment about choosing a truly elective c-section - IMO, there's nothing elective about yours. Sounds like you've got a lot of reasons to have one, and your doc agrees with you. Although you'll be surprised at how you might learn to deal with all the poking and prodding in the coming months. Congratulations on your preganancy (it does get easier, my wife can attest to that), and good luck with everything else.

Crown Prince of Irony
08-22-2011, 01:02 PM
Someone offline reminded me that I'm using the phrase "pre-term" wrong - technically it means "labor before 37 weeks". So mentally find-replace "pre-term" with "non post-term", which is what the Wiki article discusses anyway.

lorene
08-22-2011, 01:22 PM
Also, it's hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I've never heard of anyone saying to the doc "Let's skip this whole labor bullshit and do some surgery!".

Well, this WebMD article (http://www.webmd.com/baby/features/elective-cesarean-babies-on-demand) states that there are few women actually intiating elective C-sections. The article reminds us that 'elective' just means 'not medically necessary' and claims that it is rarely the mother who initiates the request.

redtail23
08-22-2011, 03:18 PM
I did.
<story snipped>See, *I* would call this medically necessary. But THIS is one that I would be worried about having to take before a review board, because ya never know. Unlike the case of the twins mentioned before, which would have no problem passing any review board anywhere.

But as long as it was scheduled for 39+ weeks, you wouldn't have to worry.

I must say that this thread has made me rethink a bit on scheduled deliveries.

Crown Prince of Irony
08-22-2011, 03:25 PM
Well, this WebMD article (http://www.webmd.com/baby/features/elective-cesarean-babies-on-demand) states that there are few women actually intiating elective C-sections. The article reminds us that 'elective' just means 'not medically necessary' and claims that it is rarely the mother who initiates the request.

I think complicating the issue is the fact that c-sections required as a result of complications during elective induced labor are likely not considered elective in and of themselves.

Condescending Robot
08-22-2011, 06:02 PM
If the hippie fascists could have their way we'd all be required to give birth in a bathtub at home with some stoned "midwife" dancing a prayer to The Goddess the whole time. Then we could go back to having fifty percent of babies and mothers die as a result of birth, just like nature intended.

MsWhatsit
08-22-2011, 06:22 PM
Holy shit, pbbth, you have cervical cancer!? I'd be freaked out too. Are you doing OK?

Mama Zappa
08-22-2011, 06:44 PM
pbbth, assuming you're responding to Mama Zappa's comment about choosing a truly elective c-section - IMO, there's nothing elective about yours. Sounds like you've got a lot of reasons to have one, and your doc agrees with you. Although you'll be surprised at how you might learn to deal with all the poking and prodding in the coming months. Congratulations on your preganancy (it does get easier, my wife can attest to that), and good luck with everything else.
Ditto!!!

My remark was made in mind of the "too posh to push" attitude I've heard of.

I didn't notice the bit about *current* cervical cancer until I reread just now. Ouch :(. One more fun thing to worry about during your pregnancy :( :(.

A friend of mine was diagnosed with an unusual variety - during a prenatal check! She wrestled with some very unhappy-making options, including pressure from some family members to terminate the pregnancy. Fortunately she sought better medical advice, from several Big Name specialists who both said "terminate? bwuh??? This isn't that urgent!".

Nonetheless, the specialists both also said "but let's not delay things any longer than necessary". She had amnio testing at about 36 weeks to make sure the baby's lungs were matured enough, then she actually had a c-section and hysterectomy the same day - they delivered the baby, and then put her under and did the rest. I don't recall the details of why they did a hysterectomy vs. just cone slicing or whatever, may have had to do with the apparent stage, or the variety.

Her son is 12 now and she's as healthy as a horse - as is her son :).

Mama Zappa
08-22-2011, 07:08 PM
BTW - you'll get a lot of hits if you google the phrase "too posh to push". Wikipedia mentions that in Brazil, the rate in private hospitals (i.e., I guess, mothers who have the means to pay for whatever treatment they want or "need") it may be 80% (though there's no citation).

Having personally had a hellish induced labor and vaginal delivery, and a pretty easy urgent-but-not-emergent C-section, I'd definitely elect for the latter if it had ever been an issue (wasn't, fortunately!). But it'd have been a VBAC and so I probably wouldn't have had any problems even in Portland.

pbbth
08-22-2011, 07:37 PM
Holy shit, pbbth, you have cervical cancer!? I'd be freaked out too. Are you doing OK?

Ditto!!!

My remark was made in mind of the "too posh to push" attitude I've heard of.

I didn't notice the bit about *current* cervical cancer until I reread just now. Ouch :(. One more fun thing to worry about during your pregnancy :( :(.

A friend of mine was diagnosed with an unusual variety - during a prenatal check! She wrestled with some very unhappy-making options, including pressure from some family members to terminate the pregnancy. Fortunately she sought better medical advice, from several Big Name specialists who both said "terminate? bwuh??? This isn't that urgent!".

Nonetheless, the specialists both also said "but let's not delay things any longer than necessary". She had amnio testing at about 36 weeks to make sure the baby's lungs were matured enough, then she actually had a c-section and hysterectomy the same day - they delivered the baby, and then put her under and did the rest. I don't recall the details of why they did a hysterectomy vs. just cone slicing or whatever, may have had to do with the apparent stage, or the variety.

Her son is 12 now and she's as healthy as a horse - as is her son :).

I'm okay. My doctor wants to do a pap a couple of days after the baby is born to verify that the results of my last test are correct before she starts cutting parts out of me. She knows it is not going to be an easy thing for me to handle and wants to be doubly sure before she makes me go through a cone biopsy or anything. She was afraid I was going to kick her during the colposcopy and a biopsy will be much worse than that. After the birth and the tube tying and the cancer cell removal I'm not going back to the doctor unless I'm dying for at least 2 years. I've had quite enough of this medical-needle-poking-invasive-bullshit to last a lifetime.

Mama Zappa
08-22-2011, 09:39 PM
I'm okay. My doctor wants to do a pap a couple of days after the baby is born to verify that the results of my last test are correct before she starts cutting parts out of me. She knows it is not going to be an easy thing for me to handle and wants to be doubly sure before she makes me go through a cone biopsy or anything. She was afraid I was going to kick her during the colposcopy and a biopsy will be much worse than that. After the birth and the tube tying and the cancer cell removal I'm not going back to the doctor unless I'm dying for at least 2 years. I've had quite enough of this medical-needle-poking-invasive-bullshit to last a lifetime.
Now that raises a question: can't she just do it while you're "on the table" - as in, numb from the epidural so can't feel a thing, and maybe even a little loopy if they give you a li'l happy juice once the baby is out? (they gave me something to relax me once Moon Unit was disconnected.... as the stress of the whole procedure had me quite reasonably jitterly).

Of course there may be many very good reasons why that's not a great idea. Still, there's some appeal to it :).

Sattua
08-23-2011, 08:52 AM
Also, it's hard to imagine the rationale behind a truly elective c-section. While I do believe our c-section rate is too high, I've never heard of anyone saying to the doc "Let's skip this whole labor bullshit and do some surgery!".

To be honest, c-section recovery didn't seem so awfully awful to me after a few hours of natural labor (that the nurses thought was pitocin labor... with a face-up stuck baby). At the time I called it "a cakewalk". I kinda hope that I get a (medically recommended) c-section with the next kid too.

MsWhatsit
08-23-2011, 09:09 AM
Personally speaking, I've had one C-section and two natural deliveries, and by far the natural deliveries were way easier to recover from. Way, way, way. That said, the C-section wasn't any worse than any other abdominal surgery. I was up and walking the next day and the incision pain cleared up after a week or so. I could live without the permanent numbness that I have where the scar is, though.

Anaamika
08-23-2011, 09:26 AM
March of Dimes is hugely pushing the "40 week" pregnancy, which is the correct pregnancy time. You can go onto www.marchofdimes.com to find some stuff, but I'll post a few links.

Article discussing C-section rates (http://www.prnewswire.com/news-releases/march-of-dimes-centeringpregnancyr-grants-show-progress-in-reducing-c-sections-preterm-birth-and-low-birthweight-babies-90933484.html)

Another article (http://womenshealthnews.blogspot.com/2006/03/efforts-to-reduce-unnecessary-c.html)

But I think you women here on the Dope forget something very basic. You all think you are educated and know what you are doing and are totally confident - and the fact is, you probably are! The average woman going in for childbirth isn't. And teen and young moms aren't at all. March of Dimes did a survey recently amongst teen moms and something like 70% of them thought that 35 weeks was more than enough time for the baby to cook. I'll see if I can dig up a cite.

Here is a link that will tell you a little more about it. Please note none of the links I have posted are from March of Dimes - I could post that, but I'd prefer unbiased posts.

Health concerns of the late preterm infant (http://preemies.about.com/od/preemiehealthproblems/a/LatePretermBirth.htm). "The risk of health problems due to prematurity starts to decline around 37 weeks, but doesn't level off completely until 39 weeks gestation."

Serious research has been done recently that significant changes happen to the brain of the baby in the last five weeks.

March of Dimes has a new model they are testing called "Centering Pregnancy" - in which women meet together with a qualified practitioner to discuss pregnancy issues. In the arenas it's been implemented, premature birth has dropped by as much as 30 percent. Here's a better link on Centering Pregnancy. (http://www.marchofdimes.com/virginia/6736_14515.asp)

The rate of C-sections has increased 40 percent since 1996. What percentage of those are voluntary? We just don't know. The data is not there, and that is another thing that is being worked on - better data. 30% of all births in NYS are C-sections, for example. There has been no research done to quanitify the risck of elective C-section compared to vaginal birth, so really there's no way to say "C-sections are just as safe".

I know you all think it's about money and the bottom line but that's really not all that's at the heart of this, I swear. It's coming to light more and more that baby needs every moment of time of the 40 weeks. And the fact is, people do not know this. I'm sure Dopers do, but the average woman on the street? Studies indicate it is not so. On top of it all, the second link I posted up there says that half of women who are having a vaginal birth after C-section (which is quite possible) were denied the option from their physicians because the physicians were not willing to do it.

Choice is already being taken away from women. We have no idea how many of these C-sections are warranted or even wanted. Premature birth is a huge problem and costs millions of dollars, and even babies slightly premature often have problems. Please read MarchofDimes.com for more information.

Mama Zappa
08-23-2011, 09:33 AM
Sattua and MsWhatsit: It can vary so widely.

My "natural" delivery - which had to be induced when my water broke (thanks, I'm pretty sure, to an extremely rough internal exam 2 days before from the Nazi Doctor From Hell, whom I also got stuck with because the good doctor was out of town, and whom I regret hitting... well, more accurately I regret that I only hit her **once**)...

... led to the cascade of agonizing labor, a wait for nearly 3 hours for ANY pain relief when we found that the default preparation contained a preservative that stood a fair chance of making me stop breathing, a BOTCHED epidural (you're not supposed to jump and scream in AGONY when that needle goes in) which didn't work... then forceps and 3rd degree tearing that made pooping pretty much impossible without major intervention, and sitting up similarly impossible for something like 2 weeks (I ate my meals either draped across an easy chair with the plate on my chest, or lying on my side in bed). Once, I nearly passed out in the shower, I was in so much pain.

By comparison: my second delivery was an urgent-but-not-emergent C-section (baby was doing fine, but I was thinking about dying in a few days and for some reason the doc thought that was a bad idea and I didn't have the heart to argue with her :D). So the epidural was administered more carefully, by someone competent who had actually READ my files... which meant it felt weird but didn't hurt... the doctor had time to do things carefully without doing any excessive damage (a slash-and-grab c-section might have been very different).

Now, my recovery was helped by the fact that I didn't have to care for the baby 24/7 within 3 days (she spent 17 days in the NICU)... and also by the fact that obviously I had a pretty major incentive to get on my feet so I could see her, on another floor of the hospital.

But all in all it was a much, MUCH easier recovery. FAR less painful both during the birth and afterward. I took precisely ONE narcotic pain pill after my c-section (in fairness, I had a dose of long-acting morphine in the epidural), while I was on a stiff dose of Tylenol 3 for most of a week after the vaginal.

Oh - and even tho the epidural didn't work too well THAT time either, the pain was a) less severe, and b) lasted far less time, than with baby #1. The skin / muscle was numb so I didn't feel the cutting, just very very painful jostling while they were rearranging my innards.

So my takeaway lesson was: "take your time and do it right" c-section > induced labor, "take your time and do it right" c-section > emergency c-section, natural labor >= induced labor (I assume, never having had natural labor).

And if I ever need surgery on the lower part of my body, where epidural is advised to avoid general anesthesia, I'll say not just no but HELL no because they don't fucking WORK on me :(.

Oh, and as an aside, if you list your religion as Catholic, the hospitals have sensors in the patient rooms so that they WILL come and offer you Communion.

While you're in the shower.

Yep, both times, in TWO different hospitals. :smack: Next time I'm in the hospital, I'm listing Pastafarian. At least if they offer me a bowl of macaroni while I'm in the shower, I won't feel like I'm going to hell for it!

Not that this is on-topic for the thread, just a random semi-funny thought :).

Cat Whisperer
08-23-2011, 01:34 PM
<snip>
Choice is already being taken away from women. We have no idea how many of these C-sections are warranted or even wanted. Premature birth is a huge problem and costs millions of dollars, and even babies slightly premature often have problems. Please read MarchofDimes.com for more information.
Well said, Anaa. I've been reading this thread and been quite surprised by the support for major abdominal surgery when the human female comes equipped with an opening that can be used. I've done a little research into this issue, too, and see that it's both the women and the doctors that sometimes select this option without a medical reason. The issue, to me, doesn't seem to be women's choice - that's sounding like a red herring to me. I would have hoped that the issue would first be the health of the baby and the mother, and convenience and choice would be much further down the list.

Anaamika
08-23-2011, 02:01 PM
Well said, Anaa. I've been reading this thread and been quite surprised by the support for major abdominal surgery when the human female comes equipped with an opening that can be used. I've done a little research into this issue, too, and see that it's both the women and the doctors that sometimes select this option without a medical reason. The issue, to me, doesn't seem to be women's choice - that's sounding like a red herring to me. I would have hoped that the issue would first be the health of the baby and the mother, and convenience and choice would be much further down the list.

Thank you. I don't mean to tell women their business but it isn't so simple as "Momma wants to have baby and mean old doctor won't let her" but more like "Momma isn't quite sure and doctor nudges her, or momma suggests it and doctor just goes along with it."

The thing is, that health professionals of all stripes agree this is the way to go. Hospitals are going to come to a hard stop - basically, the only way to get a C-section now is to submit the case to the head OB-GYN in the hospital, who will compare the case to a list of requirements and decide if a C-section is medically warranted. I am involved in this field and trust me, the people involved really really are concerned for the health of baby and momma.

Mama Zappa
08-23-2011, 03:02 PM
The thing is - I think you're preaching to the choir, Anaamika.

I 100% support the Portland hospitals' decision, actually. As long as the early inductions / c-sections do have a sufficiently streamlined and rapid review process, so things aren't delayed to the point where they cause problems.

There are, however, plenty of legitimate medical reasons to opt for an "elective" c-section; even the poster who had other health issues, including some that were "just" a severe stress reaction to any major gyn stuff. A lot of the examples cited in this thread could perhaps try a challenge by natural childbirth, but stand a significant enough risk of converting to a c-section (possibly on an emergency basis, which is not optimal).

Do I think there are too many "elective" procedures (induction and/or c-section)? Sure. I don't know that there are necessarily all that many planned c-sections with no genuine medical need (I truly don't know - have there been any retrospective studies reviewing such things, like "yep, warranted" or "nope, coulda avoided that one") but I think there's a very strong tendency to jump to the knife when things go the least bit wrong, without trying alternatives.

And elective inductions are, I suspect, far too common. I nearly had one myself - baby was looking BIG, so they were looking at inducing at 39ish weeks (when my body jumped the gun and it was no longer elective). And as a result of that induction, I had a pretty awful experience, a fair bit of physical damage, my kid was in significant distress and I nearly had cuts in my stomach AND my crotch (if the forceps had failed....).

irishgirl
08-23-2011, 03:48 PM
Emergency c-section- one that has to be performed ASAP. Usually in labour, but occasionally not. Always medically necessary.

Elective c-section- never performed during labour, scheduled in advance, but not always without a medical indication.

I had irishbaby at 39weeks in a planned c-section.
It was my choice, but based on the advice of my obstetrician.

My daughter was born on the 9th of July- avoiding the 2 public holidays, hospital understaffing, rioting and general chaos that accompanies the 12th of July here.

It also meant I avoided what would almost certainly have been a difficult labour and an instrumental delivery or emergency c-section, based on several medical issues I have.

I have no intention of attempting a VBAC.

Vaginal delivery comes with risks and benefits- as does c-section. I believe in an informed choice.

In the UK it is almost impossible to have a purely elective "book me in next Friday- it's the only space I have in my schedule" c-section on the NHS. The UK still has a 30% c-section rate.

I have a feeling Portland will find itself making a more flexible protocol after a few lawsuits.

perfectparanoia
08-24-2011, 09:21 AM
In the UK it is almost impossible to have a purely elective "book me in next Friday- it's the only space I have in my schedule" c-section on the NHS. The UK still has a 30% c-section rate.

I have a feeling Portland will find itself making a more flexible protocol after a few lawsuits.

Lawsuits about what? Not being allowed to put another human being (their child) at risk by forcing the hospital to schedule their warranted c-section earlier than 39 weeks?

They are still doing c-sections. They will still schedule them. However, the baby needs to be full term first.

I am not seeing what is to sue about here.

lorene
08-24-2011, 10:07 AM
The thing is - I think you're preaching to the choir, Anaamika.



Which choir might that be? In the first half of the thread alone:

But I think it should be my right. Its my body and my child - and the risks associated with either are not more significant than me letting Junior ride his bike.

I agree. It seems a little silly to say "I support choice, except in matters of how to deliver a full-term fetus."

I support a woman's right to choose how to deliver her baby, and I am against this regulation. Paternalism at it's finest...

Great post, I totally agree. This banning is shameful and ridiculous. What if a woman elects c-section or induction because it is beneficial to her career, education, or the needs of her other children? Guess she's just fucked then. Thanks a heap, Portland!

If scheduling an induction a week or so early alleviates these stresses for both doctor and patient and does no harm to the baby...what's the big freaking problem?

Yea, um, choice means "it's the woman's choice." Elective c-sections might not be your cup of tea, but choice means you don't get to dictate that choice to a woman and her doctor.

Patient choice should be about PATIENT choice - if OBs are pressing for schedules that the patients don't want, that's a problem. (At the same time, if the women you know felt pressured, do they not have backbones? Is "no" not in their vocabulary? Do they not know how to make a complaint to the medical board? Or switch OBs? Is every woman in Portland who can make an informed decision supposed to not have that choice because you know people who don't have a backbone?) But since the OB has the ability to determine medical necessity, this doesn't address that issue.

As far as "more risk" - its more risky to ride a motorcycle than use a car...should we ban them? Its more risky for my son to play football than it is to run track, should we get rid of football? At what point do we have a right to say "oh, you can't accept THAT risk." I'll agree that there are some risks we shouldn't accept - it may be too risky to allow people to freebase coke - but the ones involved in inducing or having a c-section really don't rank.

But why shouldn't those women be allowed to schedule a birth if it saves their career? If someone's baby being born a week or two early could mean the difference between keeping your job or being fired at your next review I would say that is an excellent reason to schedule a birth.
<snip>
There is a lot of thought that goes into choosing to induce or elect an early cesarean and sometimes these choices are not made solely for medical reasons but that doesn't make them wrong or bad.

More importantly, I have a problem with that patronizing attitude of "we are going to protect you and your baby from yourself." Frankly, if they are going to do that - they'd better be consistent and the hospitals better not do any cosmetic or elective surgery - because there is always risk.

Clearly there are a lot of posters who feel that the choice of whether or not to take the risk is more important then the nature of the risk.

irishgirl
08-24-2011, 10:39 AM
There will be a case- and it is only a matter of time before the case occurs- where delaying delivery to 39 weeks will have a poor outcome, and where the decision to delay will be based solely on hospital protocol.

A true knot in a cord that wasn't present at 37 weeks, a stillbirth due to placental insufficency, a shoulder dystocia or 4th degree tear where the size of the baby was a factor...it'll happen eventually.

I firmly believe that while the baby is still inside you should be able to decide whether your health takes precedence over your child's, and what risks you are and are not willing to accept.

For some people that will mean they choose to have a home birth with minimal intervention, for other it will mean a planned c-section.

I don't really feel being judgmental about the choices of others without knowing their unique motivations and situation is an appropriate starting point.

IF you have the information and the ability to weigh up risks and benefits, and are competent to make decisions, I believe you should be allowed to make those decisions- and that includes decisions about childbirth and pregnancy.

Coming from any other starting point suggests that pregnant women deserve less respect for their autonomy than any other competent adult...which, IMO, is not a morally defensible position.

lorene
08-24-2011, 11:20 AM
There will be a case- and it is only a matter of time before the case occurs- where delaying delivery to 39 weeks will have a poor outcome, and where the decision to delay will be based solely on hospital protocol.

A true knot in a cord that wasn't present at 37 weeks, a stillbirth due to placental insufficency, a shoulder dystocia or 4th degree tear where the size of the baby was a factor...it'll happen eventually.

<snip>

IF you have the information and the ability to weigh up risks and benefits, and are competent to make decisions, I believe you should be allowed to make those decisions- and that includes decisions about childbirth and pregnancy.

Coming from any other starting point suggests that pregnant women deserve less respect for their autonomy than any other competent adult...which, IMO, is not a morally defensible position.

I can certainly see that happening, the first part of your post. I agree that it is likely to happen, but lawsuits happen for a lot of reasons in healthcare. Again, the fervent wish is that those making the evaluations do so with clear knowledge of the individual cases in front of them.

As for the second part...I'm very torn here. I know that choice is important, I really do. But I think that the statistics and information that Anaamika posted give us an indication of what's behind this new policy that the hospitals have adopted, and it makes me realize that I believe that sometimes things are not so clearcut.

I'm not surprised that 70% of teen moms thought that 35 weeks was a perfectly fine time to have a baby. At 35/36 weeks, I was describing myself as "150 months pregnant" and I had relatively uncomplicated pregnancies during which I gained weight within the recommended range. 3/4 of a year is a long time to be pregnant, and some people just want it done. In the case of non-medical inductions, if they are initiated by woman, I suspect that pregnancy fatigue is a motivator.

As I said in an earlier post, I know several women---educated, well-resourced, with stable home lives---who were asking for inductions earlier than full term because at the end of pregnancy they were simply too uncomfortable to go on. Tired of being pregnant. These weren't cases like CalMeacham's wife where uncontrollable swelling was presenting physical risks. One woman I can think of thought the fact that she was barely getting any sleep at night was a good reason for her OB to induce, and she was enraged when the OB refused. And this was someone who had been through pregnancy twice before, so she knew that that's just how the later stages of pregnancy are.

I think that doctors and hospitals have the right and the responsibility to manage risk and cost in cases like this. C-sections cost more. There are longer hospital stays, which cost more in terms of staffing and services, but also present risks to the patient for hospital-acquired infection. Doctors should be able to say no if something is not medically indicated if it is not a legal right granted to a woman (e.g., the right to a safe abortion).

A doctor would not perform a gastric bypass on someone who wanted to lose 30 pounds because it is not a sound decision and it would present more risk than it solves problems. Presumably that slightly overweight person who wants a gastric bypass is competant to make decisions, but the asnwer is still no.

So when I ask myself what I, personally, mean by choice, I have to say that I don't think blanket "choice is choice" works for me. To look at another area where adults have the choice whether or not to engage in behavior that is known to pose risks---people have the right to smoke. There may be laws now around where someone can smoke, but it is still an individual right. the hospital that I work for, though, has entered into a collaboration similar to the one in Portland where by Spring 2012, hospitals in this area will be completely nonsmoking on their campuses. No more designated "smoking area" by the side of the building, in other words, not for patients and not for staff.

Does this remove choice? It sure does. But smoking has been shown to delay healing from surgeries, to just give one example, and to really drive healthcare costs. Someone early in the thread questioned all of the Portland hospitals doing this together, effectively removing choices for all women who want to deliver in Portland. The thinking behind all of the hospitals doing the nonsmoking initiative together is that this way we all stand the same chances of losing business as a result of trying to do the right thing. If one hospital in the area continued to allow smoking, there would probably be a number of patients who would transfer their care to that hospital, no matter what the hospital's quality and safety measures are. We're trying to remove that possibility. They can go outside the area, but that's not as convenient as transferring care to the place up the street.

Anaamika
08-24-2011, 02:06 PM
Here is something from March of Dimes:

Why the Last weeks of pregnancy count (http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html)

It has a great brain card, which I have been looking for. They say 39 weeks there.

Here is an article on C-Sections] (http://www.marchofdimes.com/pregnancy/csection_indepth.html)

Here (http://www.csectionrecoverykit.com/blog/c-section-birth/reducing-c-section-deliveries-could-save-billions) is an article that talks directly about the cost of C-Sections.

And another article on the risks of early elective and C-section births (http://www.csectionrecoverykit.com/blog/childbirth-pregnancy/the-health-risks-of-early-elective-and-c-section-births/).

"So significant is this increase [in early elective deliveries] that the average time of fetus gestation has been reduced by seven days in the United States since 1992, according to researchers and data from the Centers for Disease Control and Prevention."

Anaamika
08-24-2011, 02:21 PM
Do I think there are too many "elective" procedures (induction and/or c-section)? Sure. I don't know that there are necessarily all that many planned c-sections with no genuine medical need (I truly don't know - have there been any retrospective studies reviewing such things, like "yep, warranted" or "nope, coulda avoided that one") (snip)


I meant to respond to this. NO, there are not any studies regarding this. When the 30% rate of C-sections was looked at in NY, people asked - what percent of these are elective? And no one had any idea. The data just isn't there! Part of this whole drive is to get better data, too, and from the data, we can extrapolate. If of that 30% there are hardly any elective C-sections, then no harm no foul. If there are tons and tons we certainly do need to look into why.

Rachellelogram
08-25-2011, 01:07 AM
My boss's due date is in the last week of this year. She has to have the baby before the new year hits, or else she'll have to pay two years' worth of deductibles for a single pregnancy. Before the medical system starts making these decisions, they should analyze how they're going to hurt regular citizens. Yes, the health insurance system is fucked-up. But who is it hurting to induce a baby a few days early?? (or on-time if it's taking longer than expected)

lorene
08-25-2011, 03:36 AM
But who is it hurting to induce a baby a few days early?? (or on-time if it's taking longer than expected)

These new policies do not have anything against on-time inductions or anything after the 39-week period. Again, would not affect her.

chela
08-25-2011, 07:53 AM
For the hospital to outright ban the procedures seems a little over the top to me, but I can understand the concern. In the not too distant past a friend and her Dr opted for a conveniently scheduled C section. Turns out they were wrong about the due date and delivered a preemie that needed the NICU for several weeks.

And I would bet that there are some people out there who would prefer to be done with being pregnant by the end of the second trimester and would be happy to let the hospital fish it out and finish "cooking" the baby for them.

Anaamika
08-25-2011, 08:53 AM
Re banning the procedures: they tried education, they tried limiting it, they tried doing it gently, but nothing changed - the doctors and the hospitals simply wouldn't change their ways. So it was decided they had to come to a hard sotp.

And like I said, of course they are thinking about the consumer. As I said, I know a lot of people who are involved in this decision in NY - I work peripherally to the health industry - and their number one concern is the health of mothers and babies, nothing else.

redtail23
08-25-2011, 10:07 AM
I meant to respond to this. NO, there are not any studies regarding this. When the 30% rate of C-sections was looked at in NY, people asked - what percent of these are elective? And no one had any idea. The data just isn't there! Part of this whole drive is to get better data, too, and from the data, we can extrapolate. If of that 30% there are hardly any elective C-sections, then no harm no foul. If there are tons and tons we certainly do need to look into why.Actually, they need to look at it even if that 30% are all necessary C-sections.

By the data I've seen, it looks like inductions tend to cause a lot more C-sections. If that is true, then doctors and parents need to know that.

Because it seems like these days, at least around here, it's pretty much assumed that your labor will be induced.

Go one day over that imaginary 40 weeks due date? Induce.
Have a largish baby? Induce.
Start contractions somewhere near the due date, but immediate delivery doesn't look likely? Induce.
Early labor for more than a couple hours? Induce.

Seriously, I think every pregnant woman I've known in the last ten years has been induced for one reason or another, except the ones that had scheduled C-sections. At least one of the inductions ended up C-section as well.

And yes, they all agreed to it - but it was docs pushing the idea. (No pun intended. :))

tumbleddown
08-25-2011, 02:09 PM
There will be a case- and it is only a matter of time before the case occurs- where delaying delivery to 39 weeks will have a poor outcome, and where the decision to delay will be based solely on hospital protocol.

A true knot in a cord that wasn't present at 37 weeks, a stillbirth due to placental insufficency, a shoulder dystocia or 4th degree tear where the size of the baby was a factor...it'll happen eventually.
But those only become an issue for a lawsuit if there's a documented wish on the part of the patient or doctor to have an elective induction or section that was denied strictly because of the new standard. Otherwise it's wishful thinking. Anyone can say after the fact "oh, if only we'd..."

I pray that there aren't too many women looking for elective inductions at 38 weeks on the off chance of a frank knot in the cord at 40.
My boss's due date is in the last week of this year. She has to have the baby before the new year hits, or else she'll have to pay two years' worth of deductibles for a single pregnancy.
And what if she was due the second week of January? The third week? At what point in the end of year/start of year cusp do we backburner maternal and fetal health and prioritize deductibles?
Actually, they need to look at it even if that 30% are all necessary C-sections.

By the data I've seen, it looks like inductions tend to cause a lot more C-sections. If that is true, then doctors and parents need to know that.
We know this is true. We do have the data on that, and we know it happens in a few different ways. First, synthetic pitocin, the hormone used for inductions, causes contractions that are longer and stronger than those in a spontaneously occurring labor. Those abnormal contractions increase the risk of fetal distress. Prolonged fetal distress can turn into a reason for a c-section.

Another way is that if the cervix isn't ripe (meaning that the baby just isn't ready to be born) it just won't dilate properly, and you get a "failed induction" situation or a "failure to progress" if labor goes to a certain point then stalls, and a c-section (and a baby who's more likely to need advanced care because they're too early).

The way these things start working one after another has been deemed the cascade of interventions (http://www.childbirthconnection.org/article.asp?ck=10182). Once you interfere with the natural process of labor and birth, other interferences are more likely to occur one after the other down the line until mom ends up in an OR.
Because it seems like these days, at least around here, it's pretty much assumed that your labor will be induced.
Or if not induced, actively managed. Active Labor Management presumes that all women should labor and birth on a time clock (admittance to birth within a period, usually 24 hours and/or a certain rate of dilation per hour) and if they don't, their labor should be augmented artificially with Pitocin, until they're either forced onto the schedule or "time out" as a "failure to progress" which then leads to... a c-section.

And this is why, magically, 1 in 3 women in America is suddenly "unable" to give birth.