Portland hospitals banning elective c-sections and early inductions

[lorene]

Article here.

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]

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]

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]

Originally Posted by Lasciel

She scheduled both births for a Friday evening so she could be "recovered" and back at work on Monday morning.

[redtail23]

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]

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]

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]

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

[pbbth]

Originally Posted by Dangerosa

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.

Originally Posted by DianaG

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]

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]

Originally Posted by pbbth

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]

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]

Originally Posted by pbbth

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]

Originally Posted by redtail23

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]

Originally Posted by pbbth

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]

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]

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]

Originally Posted by Sattua

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]

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]

Originally Posted by DianaG

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]

Originally Posted by redtail23

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.

Originally Posted by kunilou

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]

Originally Posted by redtail23

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]

Originally Posted by kunilou

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]

Originally Posted by Dangerosa

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]

Originally Posted by redtail23

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]

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]

Originally Posted by Dangerosa

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.

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]

Originally Posted by Sattua

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]

Originally Posted by PeskiPiksi

I When I read that too!

[Lasciel]

Originally Posted by etv78

I 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]

Originally Posted by Sattua

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]

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).

Originally Posted by the article

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]

Originally Posted by MsWhatsit

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]

Originally Posted by Dangerosa

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]

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]

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]

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]

Originally Posted by lorene

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.

Originally Posted by redtail23

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]

Originally Posted by kunilou

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.

[Implicit]

Originally Posted by redtail23

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.

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]

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]

Originally Posted by Implicit

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]

Originally Posted by kunilou

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]

Originally Posted by Crown Prince of Irony

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.

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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]

Originally Posted by Crown Prince of Irony

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]

Originally Posted by Crown Prince of Irony

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]

Originally Posted by pbbth

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]

Originally Posted by MsWhatsit

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]

Originally Posted by Hello Again

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]

Originally Posted by Hello Again

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