Expectant moms can now hope to labor longer. This week, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued new guidelines that recommend women push for at least two hours before considering a caesarean section. Healthy pregnant patients, epidural-receivers, and first-time moms are encouraged to push even longer before going under the knife.
"Labor takes a little longer than we may have thought," said Dr. Aaron Caughey, an ACOG researcher who co-authored the guidelines. "Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean delivery."
The recommendations come as caesarean deliveries are on the rise. According to the Centers for Disease Control, one-in-three babies arrive via c-section. This is five times the rate of c-sections in 1969. Caesarean births are riskier, and can pose severe threats to the health of the mother and the child. Women can experience hemorrhaging, infections, blood clots, and other life-threatening symptoms.
...doctors and hospitals earn more from c-section deliveries. Tellingly, obstetricians perform fewer c-sections on fellow physicians.
"Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we're trying to avoid,” said Caughey. “By preventing the first cesarean delivery, we should be able to reduce the nation's overall cesarean delivery rate."
The new c-section guidelines will benefit women by forcing obstetricians to offer the best care for their patients. In 2013, a Listening to Mothers survey discovered that many pregnant women are uninformed about the benefits of vaginal births. Some doctors offer misinformation about vaginal delivery. Others present c-sections as the best option, especially for women who have had them in the past. Both of these routes rob mothers of the opportunity to determine what’s best for their bodies and their child. The Listening to Mothers survey found many women who’d had c-sections wanted to deliver their next child vaginally — but were told that it wasn’t an option.
What these women aren’t told is how caesarean sections benefit hospitals and doctors. Child Birth Connection, a program offered by the National Partnership for Women & Families, warns women against c-sections because they line the pockets of doctors and hospitals. From The Child Birth Connections:
Many health professionals are feeling squeezed by tightened payments for services and increasing practice expenses. The flat global fee method of paying for childbirth does not provide any extra pay for providers who patiently support a longer vaginal birth. Some payment schedules pay more for cesarean than vaginal birth. Even when payment is similar for both, a planned cesarean section is an especially efficient way for professionals to organize their hospital work, office work and personal life. Average hospital payments are much greater for cesarean than vaginal birth, and may offer hospitals greater scope for profit.
Economists Erin Johnson and M. Marit Rehavi reached a similar conclusion. In a paper published by the National Bureau of Economic Research, Johnson and Rehavi found that doctors and hospitals earn more from c-section deliveries. Tellingly, obstetricians perform fewer c-sections on fellow physicians.
"If the obstetrician is deviating from the best treatment because of their own financial incentive, the patient [who is a] doctor would be able to push back against the obstetrician," Johnson told National Public Radio.
"But that might not be the case for non-doctors because they simply do not have the medical knowledge to know whether or not this C-section is the appropriate [method of delivery] for them." The economists also noted that fewer c-sections are performed in hospitals where all doctors are paid a stagnant salary that doesn’t include bonuses for shorter deliveries.
Women suffer when doctors place their own financial needs over the health of their patients.
Writer Dara Mathis is one of these women. In an article for xoJane, she recounted how she was made to get an unwanted epidural and eventual caesarean section.
The surgeon came in, a brusquely efficient woman named Dr. Rogers, who was ready to get this thing going, chattering about how she didn’t care if the nurses switched shifts. Then I met Dr. Anesthesiologist #2. Her actual name was Dr. Dong, which fits, because she was an absolute dick to me. She crouched five millimeters away from my nose as if I were five.
“You care about your baby, right? This is about your baby now.”
Right, because I really didn't care about my baby before. I don’t know why I didn’t slap her. I clenched my fists and just nodded. Whatever. Hook up the IV to the anesthesia and go away. More numbness.
The bustling increased with more faceless nurses unplugging IVs, monitors, bed cords, and wheeling me out of the room. I wasn’t talking anymore; my eyes worked overtime as they slammed my bed through the OR doors. When they transferred me from the bed to the operating table, they tied my arms down with Velcro straps on either side of me.
One of the nurses addressed me as “Crybaby” while I was lying there.
Expectant mothers deserve effective and supportive obstetricians concerned with their child’s health, rather than their own profit. Here's hoping the new caesarean section guidelines will insure that birthing preferences are respected and mothers are able to experience the fullness of labor.