So, it turns out there are more out-of-wedlock births in the U.S. than ever. And, interestingly, the births are not to teenagers — the good news is that out-of-wedlock births among teenagers is actually on the way down. More and more people in their 20s are simply deciding not to get married.
I would also like to lament the huge increase in C-sections. I am not begrudging mothers who get a necessary C-section (thank goodness that’s possible today). I am, however, lamenting doctors who push women to get C-sections when they are not necessary. That happened with my wife, and she had to really push back with a doctor who was trying to convince her to get an unnecessary C-section.
See the AP story here.
I’m glad to see the out-of-wedlock births dropping among teenagers; this is good news. I wonder if the drop is due to increased abstinence, or if they are using contraceptives?
On a side note, my wife had to deliver both of our children C-section. She was in labor for over 24 hours before the doctor determined that our first child would not come on his own.
I’ve heard that c-section numbers are high. But it is heartbreaking to hear just one story like my friend’s sister who went to the hospital full term with a healthy fetus, the baby was not coming out even with forceps, and the doctor waited too long to do a c-section. The baby died.
Doctors are imperfect. When is the time to go to plan B and do a c-section? I don’t know, and apparently neither do doctors. Some doctors jump too early, some tragically decide too late.
We are very blessed that our babies and mothers rarely die in the birth process or its aftermath.
Remember that some of those c-sections are neither medically necessary nor forced on women by doctors: they are the result of the woman exercising patient choice. I’ve done this twice and plan on doing it again. I’m too busy to hash through the debate here again so I’ll refrain (if you really want to tell me how evil I am, look up my post on T & S called “An Unnatural Birth Advocate” and do it there), but I just wanted to mention it as an important piece of the rising C-section rate puzzle.
My sister who lives in Manhatten is the only one of the women in her office in her same position with no children or pregnant. However, none of the women in her office have ever been married either. They keep making jokes that she better be careful and check and see if she is pregnant, since currently two of them are. She assures them this is impossible–they don’t get it. She is 31 after all, and they know she is not gay and has had boyfriends.
I’m very troubled by the number of children born out of wedlock. This is a very serious problem that leads to some of the major problems we are seeing today in our society, which will worsen with the future generations. I’m glad to see the birth among teenagers going down, though. That is a good sign.
Could the rise in C-sections have something to do with the rise in malpractice lawsuits against OB/GYNs? The risk of complications during a natural birth is high, and could be causing doctors to opt for C-sections quicker than they would have otherwise.
Julie, I hope your “evil” comment is not aimed at me: I have absolutely no problem with women who decide to have c-sections, and indeed I said that in the original post. I do have a problem with doctors who coerce patients into an unnecessary operation for their own convenience. South Miami Hospital, where my son was born, coerces women into c-sections in almost 60 percent of births. Note that governments are trying to get the c-section rate down to 15 percent.
Take a look at some of the articles here:
http://www.readersdigest.ca/mag/2001/06/caesareans.html
http://www.msnbc.msn.com/id/12011436/site/newsweek/
Mike is correct that some of it has to do with malpractice suits. People in Miami believe it is simply a matter of money: doctors charge more for c-sections, so they push women into something that is not necessarily safe so the doctors can make more money.
No, Geoff, not aimed at you at all–just a general preemption for the flak I usually get when I tell people about my choice. I am in complete agreement with you that women should not be coerced into a kind of birth that they don’t want–I would just add ‘natural’ to the list of things they shouldn’t be coerced into. I would add that I don’t think doctors coerce just for money but also for personal convenience (i.e., timing)–or the combination: more money for less time.
Here’s an interesting recent look from a historical point of view of the changing attitudes toward cesarian births:
http://www.newyorker.com/fact/content/articles/061009fa_fact?page=1
I am not an obstetrician, but I have to interject that there is no question that most caesarean sections done are unnecessary.
There is also no question that they are done in response to the skyrocketing number of lawsuits against the obstetric community. This has been incontestably shown in studies which show the clear association both geographically and temporally between increasing lawsuits and the subsequent increase in caesarean sections.
Specifically, in the late eighties and early nineties there was a spate of lawsuits regarding cerebral palsy following vaginal delivery. Many of the hearings turned on the question of, “Doctor, why didn’t you just do a C-section?”
Yes, there are other factors. It is true that the majority of natural deliveries occur between midnight and dawn — an inconvenient time for doctors. It is also true that a caesarean section is more profitable for a hospital than a vaginal delivery.
However, in my humble opinion the real problem is that our society has allowed the medical malpractice community to set the standard for a safe and effective childbirth. The irony of course is that a caesarean section is in fact less safe for maternal health than vaginal delivery. If you don’t like this standard, you know who to blame.
Again, I’m not an obstetrician so I don’t claim to have a full mastery of their literature. But for anyone interested in further reading:
Local malpractice environments cause large variations in cesarean rates.
Med Health. 2006 Aug 21;60(31):1, 6.
Change in cesarean section rate as a reflection of the present malpractice crisis.
Conn Med. 2005 Mar;69(3):139-41.
Malpractice experience and the incidence of cesarean delivery: a physician-level longitudinal analysis.
Inquiry. 2004 Summer;41(2):170-88.
Choice of cesarean section and perception of legal pressure.
J Perinat Med. 2000;28(2):111-7.
Herodotus: here are two links you might find interesting:
http://www.bermansexualhealth.com/content/index.php?option=com_content&task=view&id=38&Itemid=58
And I can’t find the original survey right now, but:
“In a 1997 British survey of female ob-gyns in England, 31 percent reported they would opt for an elective cesarean to prevent problems such as incontinence, perineal damage, and sexual dysfunction.”
I mention these two because if female MDs are choosing to do this to their very own bodies, we have to believe there is something more than bullied, uninformed women behind the trend.
@Julie
There are unquestionably indications for a caesarean section. I don’t think anyone would debate this. I suspect that I have as good an idea as any of the pros and cons of both from medical school and my wife’s experience (gravida 2 para 2), but I would not want to get into a deep comparison as it lies out of my area of expertise. I’m sure there’s an obstetrician lurking somewhere who could give us a real breakdown of the medical issues involved if we ask nicely.
I will however say this: Even in Britain where the study you cite was performed, the caesarean section rate is significantly lower than in the U.S. While the rate in the U.S. varies geographically (and according to the malpractice environment according to every study published on the subject), it can reach as high as 90% in some communities. This compares with 23% in the U.K.
In the U.S. we read the same literature as doctors in the U.K. We use the same techniques. The only major difference is the malpractice environment. Draw your own conclusions.
(By the way, if by “bullied women” you are referring to obstetricians I would disagree with this characterization. First of all there are still many men in the specialty despite a recent trend away from it. Secondly, malpractice influences all specialties of medicine including mine. There is nothing unique about the need to practice defensive medicine in obstetrics.)
No–I was referring to the mother as the (not necessarily) bullied woman.
While malpractice climate is obviously a major difference, another is birth culture, trends, playground gossip, and patient choice.
Julie, I agree with your last post and suspect that we are close to being in agreement generally on this issue. However, I enjoy debate. My wife who has followed the “bloggernacle†for ages allocates you to the “nice person†camp, so I’d feel bad if I offended you with my arguments. Don’t take me too seriously. With that preamble, consider the following:
In 2000 a federal health initiative called Healthy People 2000 estimated that caesarean sections are medically needed in 15% of pregnancies and set a national goal of reducing the rate to that level.
(Let’s ignore for the moment that this is probably a controversial figure in the obstetrics community with some doctors in agreement and others objecting.)
In spite of this initiative, the national average has increased and is currently around 30%.
Let’s assume for the sake of discussion that the other 15% are not medically necessary. These are done for other reasons such as the convenience of the doctor, the convenience of the patient, malpractice fears, monetary incentives, or other perceived benefits. Let’s now consider only the category of “convenience.â€
Is performing a caesarean section for a doctor’s or a mother’s convenience an appropriate use of health care dollars? The costs of a caesarean section are significantly higher than those associated with vaginal delivery and nationally we obviously have a huge problem finding adequate health care dollars; we are unable to pay for the basic medical needs of a large portion of our society. Should society shoulder the costs of convenience?
As a totally separate discussion, in my own specialty I recently ran into a study that surprised me. You are probably aware that over the last thirty years there has been a major emphasis on involving the patient in medical decisions rather than taking the “paternalistic†attitude that “doctor knows best.†This study surveyed thousands of patients seeking care in my specialty and asked them what sort of guidance they wanted from their doctor. What they found was that while patients wanted to be informed about risks, they really didn’t want to make their own medical decisions. They wanted the doctor to decide. I don’t know that this study can be generalized to obstetrics and I’m sure every mother has her own opinion about how much autonomy she wants regarding her delivery, but it certainly changes the way I think about my own specialty.
I had my first via c-section. Not really a choice, he was in trouble. But, I plan to do the rest the same way. Partially because a lot of doctors don’t allow VBAC (Vaginal Birth after Cessarian), but I actually liked it. Not the shot in the spine (That hurt!!) but I didn’t have a single contraction. I know, that part of birth. The recovery took longer, but – I don’t know how to explain it. I just liked it.
What JKS said. I think doctors have been partially forced to err on the side of caution due to the malpractice suits.
Nicolas has made Sarah promise she won’t have a C-section, because she is adamant (and I am grateful for it) that his mother won’t deliver their children at home.
The whole thing scares me to death.
I am not sure that malpractice is the only difference. The funding for health care is also radically different in the two locations. Does the British National Health Service pay for elective c-sections?
Julie, I’ve read various of your writings on this issue, but I haven’t yet seen that you explained whether health insurance pays for these pricey deliveries, or whether y’all pay out of pocket?
I know that in the US, some health insurance companies require women to attend VBAC classes, although actual medical decisions are left up to physicians.
Also, please keep in mind that not all those children of unwed mothers are doomed. Some of the moms might join the church. People do it every day:)
I did, and my child grew up to be a National Merit Scholar, Eagle Scout, full-time missionary, married in the temple, great dad, etc.
But the first few years in the church I heard nothing but how dooooooomed he was. I’m very grateful for President Hinckley’s comments in recent years about single mothers.
Re 18, I didn’t mean to put Julie on the spot personally, but rather make the general point that support for another woman’s birthing choice may be a different matter than being willing to pay for her (much more expensive) choice.