Nearly three in 10 U.S. mothers are giving birth by Cesarean section and more seem to be choosing a surgical birth even when there’s no clear medical need. No one knows exactly how many C-sections are purely elective. Some estimates suggest there could be tens of thousands annually, and critics say many of those women were pressured into surgery or didn’t know the risks. There are good reasons to avoid C-sections, if possible. First, they increase, though very slightly, the risk to the mother. Second, they leave a uterine scar, which can cause problems in future pregnancies. But third, they cost more money than vaginal deliveries.
Sometimes, however, a c-section is the only way to ensure your baby is delivered safely. I’m sure you believe that your obstetrician wouldn’t let the cost differential sway her from doing what’s best for you and you are probably right. What you aren’t being told, however, is that your obstetrician’s hospital and managed care organizations care very much about the cost and they are leaning on your obstetrician not to do C-sections.
How? They keep track and calculate a C-section rate for every obstetrician. If she’s at 30%, when the “guideline” is 25%, she may get a call from her section chief. And she may get calls from the various managed care entities she contracts with. They threaten to label her an “over-utilizer.” They need say nothing more. It’s understood that these are “friendly” warnings before the powers that be start playing hardball. Times have truly changed when one of the things doctors fear most is to labeled an “over-utilizer.”
There can hardly be a more vulnerable position for a woman to be in. She’s in labor and in pain. There are indications of trouble. She has no idea (unless she herself is an obstetrician) what the various “things” mean nor what should be done. She has to trust her obstetrician to properly balance the risks between waiting and intervening -a quintessential exercise of judgment, to be sure, but the woman has a right for that judgment to exercised solely for the benefit of herself and her fetus, not for the obstetrician’s statistics.
