# Portland hospitals banning elective c-sections and early inductions **URL:** \ **Category:** Miscellaneous and Personal Stuff I Must Share\ **Created:** [August 18, 2011, 5:56pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198 "2011-08-18T17:56:34Z")\ **Posts on this page:** 12\ **Page:** 7
**Author:** ![perfectparanoia](https://avatars.discourse-cdn.com/v4/letter/p/a5b964/32.png) [@perfectparanoia](https://boards.straightdope.com/u/perfectparanoia)\ **Post date:** [August 24, 2011, 2:21pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/121 "2011-08-24T14:21:29Z")
> [@irishgirl](#): > > 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. ---
**Author:** ![lorene](https://avatars.discourse-cdn.com/v4/letter/l/65b543/32.png) [@lorene](https://boards.straightdope.com/u/lorene)\ **Post date:** [August 24, 2011, 3:07pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/122 "2011-08-24T15:07:28Z")
> [@Mama\_Zappa](#): > > 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: > [@Dangerosa](#): > > 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.” > [@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… > [@Hello\_Again](#): > > 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](#): > > 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? > [@Kolga](#): > > 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. > [@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?) 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. > [@pbbth](#): > > 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. > \ > 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. > [@Dangerosa](#): > > 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. ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [August 24, 2011, 3:39pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/123 "2011-08-24T15:39:27Z")
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. ---
**Author:** ![lorene](https://avatars.discourse-cdn.com/v4/letter/l/65b543/32.png) [@lorene](https://boards.straightdope.com/u/lorene)\ **Post date:** [August 24, 2011, 4:20pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/124 "2011-08-24T16:20:27Z")
> [@irishgirl](#): > > 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. > > \ > > 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. ---
**Author:** ![Anaamika](https://avatars.discourse-cdn.com/v4/letter/a/5f9b8f/32.png) [@Anaamika](https://boards.straightdope.com/u/Anaamika)\ **Post date:** [August 24, 2011, 7:06pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/125 "2011-08-24T19:06:49Z")
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](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.” ---
**Author:** ![Anaamika](https://avatars.discourse-cdn.com/v4/letter/a/5f9b8f/32.png) [@Anaamika](https://boards.straightdope.com/u/Anaamika)\ **Post date:** [August 24, 2011, 7:21pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/126 "2011-08-24T19:21:14Z")
> [@Mama\_Zappa](#): > > 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. ---
**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\ **Post date:** [August 25, 2011, 6:07am UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/127 "2011-08-25T06:07:06Z")
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) ---
**Author:** ![lorene](https://avatars.discourse-cdn.com/v4/letter/l/65b543/32.png) [@lorene](https://boards.straightdope.com/u/lorene)\ **Post date:** [August 25, 2011, 8:36am UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/128 "2011-08-25T08:36:33Z")
> [@rachelellogram](#): > > 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. ---
**Author:** ![chela](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chela/32/21582_2.png) [@chela](https://boards.straightdope.com/u/chela)\ **Post date:** [August 25, 2011, 12:53pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/129 "2011-08-25T12:53:38Z")
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. ---
**Author:** ![Anaamika](https://avatars.discourse-cdn.com/v4/letter/a/5f9b8f/32.png) [@Anaamika](https://boards.straightdope.com/u/Anaamika)\ **Post date:** [August 25, 2011, 1:53pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/130 "2011-08-25T13:53:05Z")
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. ---
**Author:** ![redtail23](https://avatars.discourse-cdn.com/v4/letter/r/3e96dc/32.png) [@redtail23](https://boards.straightdope.com/u/redtail23)\ **Post date:** [August 25, 2011, 3:07pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/131 "2011-08-25T15:07:28Z")
> [@Anaamika](#): > > 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. :)) ---
**Author:** ![tumbleddown](https://avatars.discourse-cdn.com/v4/letter/t/e9bcb4/32.png) [@tumbleddown](https://boards.straightdope.com/u/tumbleddown)\ **Post date:** [August 25, 2011, 7:09pm UTC](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198/132 "2011-08-25T19:09:09Z")
> [@irishgirl](#): > > 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. > [@rachelellogram](#): > > 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? > [@redtail23](#): > > 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. [Previous page](https://boards.straightdope.com/t/portland-hospitals-banning-elective-c-sections-and-early-inductions/593198.md?page=6)