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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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:
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.
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