As I put the finishing touches on my curriculum, set to be published with the month, I have been doing some additional research. While not terribly surprising to me, I still can't help but notice a stark contradiction in two specific areas of maternity care that I want to draw attention to.
The link below titled "Consumer Reports"will connect to to an article I found on the Washington State Healthcare Authority web page: http://www.hca.wa.gov/medicaid/ebm/Pages/oboutcomes.aspx, for your reference. In this article, they are discussing the dangers of:
- Elective early delivery (induction)
- Elective Induction with a low risk pregnancy
- C-Section with Low Risk first birth
- Automatic second Cesarean Section
- Late ultrasound (after 24 weeks)
- Continuous Fetal Monitoring
- Early epidurals
- Routine Rupture of Membranes
- Routine Episiotomies
- Sending your newborn to the nursery
On the the next contradiction.
If the Washington State Healthcare Authority has set a statewide goal of a cesarean rate of less than 20%, why do the "best", most technologically advanced, most expensive medical centers, with the highest acclaim in the area have a rate of almost double that? Are they unaware of the goal? Are they incapable? Are they trying to make money at the risk of over-treating patients? Are they trying to be too politically correct and giving in to women who want a cesarean because they are tired even after only 16 hours of labor (happened yesterday at Evergreen)?......at 16 hours we have not even reached average yet. Are they trying to keep their surgical skills sharp? Are they causing cesareans with the over use of the top ten listed above? Are they creatures of habit? Are they too industrialized? Are they telling themselves stories that rationalize the practices? Are they just trying to satisfy the shareholders expectations for profit? In my humble opinion...Yes to all, at some level.
What other conclusion could there be?
If you don't want a Cesarean, please make sure that you choose the Hospital that you go to (whether planned or on transport from a home birth or free standing birth center) VERY wisely. Be willing to travel for that additional 10% of a chance that you may deliver vaginally. The building and birthing suite may not be as pretty, but the saying "don't judge a book by it's cover" it very important in this situation. The values of those you trust with your care will matter as much as the circumstances that may come up during your labor. If you can't find a provider or a hospital with a cesarean rate of less that 30%, HIRE AN EXPERIENCED DOULA. Do not rely on the nursing staff to be your advocate if it involves contradicting the OB. They will advocate for you with your family and friends, but rarely will a nurse undermine her overseer.