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My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth. But because of their ins

My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth. But because of their insurance coverage, if a mother or baby dies during natural childbirth the doctor is at greater risk for malpractice. So, they will rush mother's into C-section at any excuse (it saves them hours of work too not having to sit through a long labor). Unfortunately, money and efficiency have taken priority over natural processes.

Xixi 8y ago
But are the injury and mortality rates higher because C-sections are riskier, or because high risk childbirth are done through C-section? You need to control for the prior, otherwise the statistic is not very useful.
- everdev 8y ago
  From what I understand C-sections are much riskier for the mother than we might think. It's significant surgery which can always lead to complications or infection. The other factor is delivering a child naturally that gets stuck and didn't get enough oxygen but lives is probably the most expensive outcome for doctors because that child can live with severe physical or mental handicaps and need support the rest of their lives.
  - Xixi 8y ago
    The problem is not that C-sections are riskier than "we" might think, and certainly not that I might think because I'm extraordinarily unlikely to be in a situation to decide whether to do one or not. The important question is whether they are riskier than the alternative (natural child delivery) in the specific instances where a C-section is practiced. It's entirely plausible that C-sections are done too casually and doing them less often would result in better outcomes. It's also plausible that they are not. The cynical in me finds very plausible that the answer to that question varies widely doctor to doctor.
rayiner 8y ago
> My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth. That is of course true, because C sections are primarily used in high-risk pregnancies and in emergencies. But what you actually care about is the counter-factual: if a given set of deliveries were "natural" rather than a C section, would mortality go up or down? It's hard to develop studies to answer that counter-factual. But there is good evidence that C-section rates are negatively correlated with mortality (i.e. they lower deaths) up to about 20% of deliveries, and have no positive or negative effect beyond that: http://www.skepticalob.com/2017/10/more-wailing-and-gnashing-of-teeth-over-the-c-section-rate.html http://www.skepticalob.com/2017/10/more-wailing-and-gnashing.... Indeed, there is new evidence that "natural" births are in the long term bad for mothers, dramatically increasing the risk of things like incontinence later in life: http://www.skepticalob.com/2018/03/what-if-c-sections-are-better-and-safer-than-vaginal-birth.html http://www.skepticalob.com/2018/03/what-if-c-sections-are-be.... As a practical matter, these negative effects will impact far more women than differences (if any) in morality rates.
- tptacek 8y ago
  A nit: is it really true that C sections are primarily for high-risk pregnancies? C sections are at an all-time high. Both my kids were delivered by C section after attempts to induce labor, but those inductions were based simply on calendar due dates assigned early in the pregnancy. People schedule C sections in advance. More importantly: anyone who has had a C section before is likely to deliver all future children via C section; it's not a requirement, but a normal birth after C section is a special arrangement. Finally: C section itself is a traumatic surgery with long-lasting health effects for the mother. It's routine, but still a big deal.
  - dragonwriter 8y ago
    > A nit: is it really true that C sections are primarily for high-risk pregnancies? C-sections are very disproportionately used for those, though perhaps not primarily; in relation to the risk statistics upthread, is the same basic impact. You cant just compare adverse outcome rates for C-section and vaginal birth without taking into account factors associated with adverse outcomes which also make C-section a more likely event.
conanbatt 8y ago
Its not money and efficiency, its the law! Money and efficiency goals would satisfy your criteria by lowering death and extracting more money from the payer. Its precisely a law trying to change money and efficiency that produces this result!
LorenPechtel 8y ago
C-sections are done when something isn't going right, or when there is some medical issue against natural childbirth. You can't compare the risks with natural childbirth because you're looking at two different populations. Your argument is like saying doctors make people sick because someone in a doctor's office is more likely to be sick than someone on the street.

Xixi 8y ago

But are the injury and mortality rates higher because C-sections are riskier, or because high risk childbirth are done through C-section? You need to control for the prior, otherwise the statistic is not very useful.

everdev 8y ago
From what I understand C-sections are much riskier for the mother than we might think. It's significant surgery which can always lead to complications or infection. The other factor is delivering a child naturally that gets stuck and didn't get enough oxygen but lives is probably the most expensive outcome for doctors because that child can live with severe physical or mental handicaps and need support the rest of their lives.
- Xixi 8y ago
  The problem is not that C-sections are riskier than "we" might think, and certainly not that I might think because I'm extraordinarily unlikely to be in a situation to decide whether to do one or not. The important question is whether they are riskier than the alternative (natural child delivery) in the specific instances where a C-section is practiced. It's entirely plausible that C-sections are done too casually and doing them less often would result in better outcomes. It's also plausible that they are not. The cynical in me finds very plausible that the answer to that question varies widely doctor to doctor.

rayiner 8y ago

> My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth. That is of course true, because C sections are primarily used in high-risk pregnancies and in emergencies. But what you actually care about is the counter-factual: if a given set of deliveries were "natural" rather than a C section, would mortality go up or down? It's hard to develop studies to answer that counter-factual. But there is good evidence that C-section rates are negatively correlated with mortality (i.e. they lower deaths) up to about 20% of deliveries, and have no positive or negative effect beyond that: http://www.skepticalob.com/2017/10/more-wailing-and-gnashing-of-teeth-over-the-c-section-rate.html http://www.skepticalob.com/2017/10/more-wailing-and-gnashing.... Indeed, there is new evidence that "natural" births are in the long term bad for mothers, dramatically increasing the risk of things like incontinence later in life: http://www.skepticalob.com/2018/03/what-if-c-sections-are-better-and-safer-than-vaginal-birth.html http://www.skepticalob.com/2018/03/what-if-c-sections-are-be.... As a practical matter, these negative effects will impact far more women than differences (if any) in morality rates.

tptacek 8y ago
A nit: is it really true that C sections are primarily for high-risk pregnancies? C sections are at an all-time high. Both my kids were delivered by C section after attempts to induce labor, but those inductions were based simply on calendar due dates assigned early in the pregnancy. People schedule C sections in advance. More importantly: anyone who has had a C section before is likely to deliver all future children via C section; it's not a requirement, but a normal birth after C section is a special arrangement. Finally: C section itself is a traumatic surgery with long-lasting health effects for the mother. It's routine, but still a big deal.
- dragonwriter 8y ago
  > A nit: is it really true that C sections are primarily for high-risk pregnancies? C-sections are very disproportionately used for those, though perhaps not primarily; in relation to the risk statistics upthread, is the same basic impact. You cant just compare adverse outcome rates for C-section and vaginal birth without taking into account factors associated with adverse outcomes which also make C-section a more likely event.

conanbatt 8y ago

Its not money and efficiency, its the law! Money and efficiency goals would satisfy your criteria by lowering death and extracting more money from the payer. Its precisely a law trying to change money and efficiency that produces this result!

LorenPechtel 8y ago

C-sections are done when something isn't going right, or when there is some medical issue against natural childbirth. You can't compare the risks with natural childbirth because you're looking at two different populations. Your argument is like saying doctors make people sick because someone in a doctor's office is more likely to be sick than someone on the street.