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Thread: Ttc 2013
July 6th, 2013 01:20 PM #1641
July 6th, 2013 02:35 PM #1643
Congrats from me too, lovely news! And great to have some good news on a thread like this
Still waiting on AF here.Mother to miss Mila Arden. Expecting her brother Cato Bennett in March 2014
July 6th, 2013 02:47 PM #1645
I should know, not just from theoretical knowledge, but I'm also a pregnant woman staring down the same unfortunate barrel (my placenta is 0.7cm away currently, and it's been bleeding daily for weeks). I really, really don't want a c-section, but at least I'm not harboring paranoid suspicions that greedy hospital execs have made up this protocol to rake in the cash. C-sections don't just charge more, they COST more. You stay in the hospital longer, there are many more personnel involved, you have a mandatory OR charge (OR time in the US costs variably between $2000 and $3000/hr-- just to be in the room, not to do anything!), etc. Running and maintaining the machines, using all of the equipment, using more medications, etc all COSTS the hospital more, and they charge you accordingly. There are definitely cash cows for hospitals, don't get me wrong (elective joint replacement, anyone? gamma knife surgery?) but maternity/obstetrics care, including c-sections, is usually at best a break-even operation.
And I agree with you 100% on universal health care. On the spectrum of commodity -> human right, I am firmly in the "human right" camp, and would love to see this country catch up in its thinking (even if it will most likely damage the free market incentives currently driving a lot of the research & development that makes this country unique).XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)
July 6th, 2013 03:20 PM #1647
Infant mortality is, by far, the wrong statistic to look at if you're interested in making cross-national comparisons of maternity/obstetric care. Infant mortality includes all deaths in the first year of life, whereas perinatal mortality includes only stillbirths from 24+ week's gestation up to live infant births in the first 7 days of life. Unfortunately, for reasons I find very difficult to appreciate, only the US and Canada count extremely premature infants who are born with signs of life as "live births." Other countries exclude all infants born at <500g, even if they breathe and have a heartbeat.
They probably don't want to encourage the epidural because it increases the risk of cesarean (despite what they teach the doctors in the US currently).
Believe me, you don't want a C section unless you absolutely need one. A cesarean section involves serious short term and long term risks to mother, child, and any future children that mother may have. I'm talking to women on a placenta previa forum who have to have hysterectomies and partial bladder removal due to placenta accreta/percreta caused by unnecessary cesareans. I would gladly forgo a bunch of needless blood tests, ultrasounds, and pain medication if it meant I could also avoid a c section.
Doctors here are so afraid of getting sued that they often won't let women try for a natural birth if there is even the slightest risk that something could go wrong - like in my case. I asked my midwife what would happen if my baby was breech and she said it would be a C section because no one knows how to deliver a breech baby anymore. There are tons of youtube videos that show how to do it and it really doesn't look that complicated to me, but since there are a few more risks to the baby if the doctor yanks on the baby doctors are afraid of getting sued.
Delivering a breech baby vaginally is actually quite difficult, and it's not done because it carries a 3% mortality rate (and every single one of those deaths-- which don't include permanent neurological disability-- is preventable by c-section). Do you understand the risk of a breech presentation regarding compression of the umbilical cord? Do you understand why it's not a "variation of normal" but a potentially life-threatening situation? No matter if baby is head-up or head-down, the head itself is still (nearly always) the biggest part, and the most difficult to deliver. It take just as long to deliver the head if the body is already out as if the body were still in, but the difference is that the head is squeezing the umbilical cord up against the cervix and completely pinching off blood & oxygen to the baby. If you can't deliver the head in 5min, neurological disability results. If you can't deliver the head in 15-20, death. You want to read horror stories? Read breech delivery stories before the advent of surgical birth (or in settings where it's unavailable). Attendants/midwives hack open the cervix to pull the baby out, provoking serious hemorrhage and lifelong cervical dysfunction. Or they just let the baby die to save the mother.
And I'm sure you know how ludicrous it is to watch a video on Youtube and feel you've mastered the technique. Watch a video on cardiopulmonary bypass or piloting a fighter plane... it doesn't quite compare to having to do it.
They also like to cut corners to save money on C sections here like using staples, which have an increased risk of wound separation but take only seconds to close the incision. They have this super glue stuff called Dermabond that has a tendency to pop open during recovery if it's not applied properly, but it takes only seconds to close the incision compared to half an hour with double layer stitches so it's the preferred method in many hospitals. If one of those dermbond or staples women decides to try for a VBAC a lot of times the doctor will say they're not comfortable with it because they didn't get double layer stitches and there is an increased risk of uterine rupture.
The uterus is sutured closed each and every time. It is not glued, glue is used for the epidermis only. It's sutured in a double-stregth "baseball stitch" technique with permanent 2-0 suture. The uterine scar itself is the only thing of relevance when it comes to discussing future uterine rupture risk in TOLACs, etc.
Next to be closed is the fascia-- the abdominal wall. This is sutured with 2-0 Maxon in a 'figure-of-eight' pattern. It is the major strength layer of any operative repair. Once the fascia is closed, the rest is gravy/cosmetic, including the skin incision.
Third to be closed is the dermis and connective tissue. This is typically sutured with a dissolving stitch, usually 3-0 Polysorb, in a buried fashion.
Finally, the skin is closed. Once the dermis has been closed the skin is more or less approximated and even if nothing further is done, it will heal in a linear scar. The "plastic surgery closure" favored by surgeons is a running subcuticular stitch with a 4-0 or 5-0 monofilment suture, clear in color. Other types of surgeons use Dermabond. The epidermis itself is NOT a strength layer of the repair and very little stress is placed on the most superficial layer of the incision (not to mention the fact that epithelialization usually occurs within 48h), so glue works just fine if you prefer it.
General surgeons and OBs often use staples instead of the latter two (the dermal and epidermal sutures). Stapling takes approximately 20-30s whereas suturing takes 10-15min. Since OR time is $2000/hr ($3000/hr in New York), cost-conscious doctors will staple you to avoid charging you/your insurance the extra $500. If you would like a plastic surgical closure you should feel free to request it.
I've talked to a lot of women who had cesareans at the hospital I go to who say a student did the epidural or surgery or incision closure and they screwed it up because they are just learning how to do it and an OB didn't watch the procedure.
Medical students do not place epidurals, and medical students do not perform operations. *Resident physicians* (doctors already graduated from medical school, with an MD, with a medical license, etc, but in specialty training) DO. They never do anything without adequate supervision [else the attending physician is held liable, could be fired, and could be subject to professional disciplinary action including losing their license]. If you are certain you would not like to encounter any trainees in the course of your stay, simply seek care at a small community hospital without any residency programs. However, multiple studies have validated the fact that the best care is delivered at academic teaching hospitals and that the presence of trainees makes all aspects of medical care more safe. This is true in every industrialized country, not just the US (after all, every doctor in every country in the world has to be educated and trained).XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)
July 6th, 2013 03:25 PM #1649
I really want women to know that if they're avoiding pain relief because a) they believe the drugs pass on to the baby and affect the baby or b) they believe epidural analgesia in particular "stalls out" labor and increases the risk of c-section, both of those claims are completely false and have been repeatedly studied and repeatedly disproven.
If they have other, personal reasons, such a spiritual or religious beliefs, fine. Unlike many other decisions in childbirth, pain relief affects the mother alone, not the baby. I fully believe in individual autonomy and completely support and if a mother simply wants to feel the pain of childbirth by all means, feel the pain of childbirth.XY: Antoine Raphael (3.1.2012)
XX: Cassia Viviane Noor (11.30.2013)