20 June 2011

C-Sections Get An F

Mrs. Jenius is going to be a pediatrician...ostensibly to deal better with The Jenius.

Sigh.

So when it comes to health issues, especially those related to children, My mild attention to them is now enhanced. (As to why it was mild, it just was: I have many interests and millions of things I don't care about.) From this report comes another confirmation of a long-standing problem in Puerto Rico: 48% of Our births are by cesarean section, the highest rate in the world.

According to the The Unnecesarean blog (great name), the ideal number (percentage) of C-Sections is 15%, a reflection of the ratio of difficult deliveries, where the operation is needed, to normal ones, where vaginal delivery is possible.  That Puerto Rico has over 3 times that percentage has been a problem for at least four decades, but especially so since the 1990s, when the "health deform" (yes, I wrote "deform"; you get the joke) basically turned treating patients into something akin to a sausage factory.

As noted in the original article--from local fish-wrapper Primera Hora--the two trends that moved C-sections into unconscionable frequency were the baseless notion that vaginal deliveries were unsafe after a C-section and the need to tend to "dozens" of births a month, forcing doctors to "cut the babies out" rather than wait for Nature to deliver. That second trend is also behind the common tendency of inducing labor, to speed it up, so that a majority of babies are born on Mondays, Tuesdays and Wednesdays, between 8 AM and 5 PM. Office hours for Nature's greatest gift.

Notice that neither "trend"--no vaginal deliveries and mass production--is reasonable: the first is based on bad science and thus bad health practices and the second is based on bad politics becoming bad economies of scale, thus leading to bad health practices. In other words, this is not an inherent problem My Island has--like lacking even one reasonably intelligent politician--but a created one, by lazy doctors, stupid politicians (redundant) and ill-informed patients.

Now a system that forces doctors to choose between having a life outside of the hospital or providing quality health care is idiotic; it's what We got and doctors have to choose in their best interests. No problem there. But the blame for the "no vaginal deliveries after C-sections" claptrap falls squarely on the medical community. 

Their argument that "C-sections are safer"--usually linked with "insurance costs"--is self-interest of the worst kind: self-serving and deceitful. Mothers know that giving birth is not at all easy, but a C-section is the deliberate slicing open of a woman's body, through muscle and fascia, to remove a baby who--according to the statistics-- 2/3 of the time would have been born safely anyway. Yes, there's physical damage in a natural delivery, but ask women who have had both birth methods which one left them weaker and less capable of tending to themselves and their baby.

The human body is incredible, and what women go through to bring Life to the world is an astounding process, one men cannot duplicate. Even though Nature has pushed human childbirth to an extreme (again, ask a mother), the process is--pardon the pun--natural. Millions of women give birth every day; it doesn't diminish an iota from the wonder of it all. To think that cutting a body to get to another is a frequent "improvement" over Nature is hubris and idiocy of the highest order.  That a so-called "health reform" makes a C-section a coin flip decision is moronic, like calling "heads" on whether a heart attack patient should be treated or left untreated. 

Think about that...

Puerto Rico must also face its own blinders, the idea that "they" are the experts and "We" do what "they" say. Doctors and other professionals hate when their clients come in with incomplete information and act as if they have all of it. Neither party benefits from that. But the best professionals love it when their clients come in with some knowledge and the curiosity to learn more, by asking relevant questions and listening critically to the answers.

If your doctor hates to explain and won't listen to your concerns, change doctors. And as patients, We have to learn to take charge of Our responsibilities, to ask good questions, to confirm opinions with outside and secondary sources and to understand that if We don't do it, the system doesn't care and most professionals barely take the time to care. If We find a good one, then by all means, stick with him or her.

Motherhood is a beautiful part of Life. That too many of Our babies are coming into the world through needless slashing is criminal. Our health care system is failing Us in this very crucial aspect, and however difficult it may be to fight the system, Our future children--and their mothers--absolutely deserve that We strive for their greatest welfare, rather than settling to merely serve the system.


The Jenius Has Spoken.


[Update: 26 June 2011: From the Daily Mail, the idea that women choose C-sections for "image", a "too posh to push" option.]

[Update: 8 July 2011: According to local Health Department statistics, Our birth-related numbers suck when compared to U.S. of part of A. averages, which suck when compared to other industrialized nations. Some of Our lowlights:

--18% of Our births are from teenage moms; the average is closer to 8%.
--57% of the births are from single mothers; the average is closer to 24%.
--In 2007, 49% were C-section births; the average should be 15%, as noted above.
--19.4% are premature babies; other industrialized nations average less than 5%.
--12.5% are underweight babies; other industrialized nations average less than 3%.
--Our infant mortality rate is 9.1 per 1,000 births; the U.S. of part of A. averages 6.9; the top 10 industrialized nations average 1.8.

Affordable health care? Ha. We're more concerned with gossip..."up there" and "down here." We can't be bothered to vote right where it counts, and in any case, malformed and dead babies don't vote for "American Idol," "Nace una estrella" or any of the literal motherfuckers who keep trashing Our health system.]

3 comments:

Raúl Colón said...

Gil,

It is great that you are bringing these topics online so we can share. I honestly stay away from reading the local press as much as I can.

Those numbers are really scary!

Marcel said...

Its an interesting topic but to me, it doesn't seem like you address the most important question.

Are cesareans really safer? What is the percentage of people that have problems with cesareans vs natural births?

Also, about your comment that most babies are born on Mon-Wed between 8AM and 5PM. Does this statistic include cesareans? If it does, then it's not particularly interesting. Clearly most people that will have cesareans will have them between 8 and 5 and with 48% of births by cesarean, it doesn't take many natural births to push the majority into that timeframe.

Gil C. Schmidt said...

Raúl, thanks for the support.

Marcel, a quick check for some answers: C-sections are considered "safer" by doctors, but not by the women who go through them. I don't have the exact stats, but I was told that there are more follow-up procedures requested for C-sections births than natural births. As for "office hour" births, some hospitals report that over 90% of their C-sections and induced births happen Mon-Wed, 8-5. Nurses HATE those shifts and often complain about understaffing and mistakes happening more frequently.

I understand that some women may prefer choosing a birth time ("Murphy Brown," anyone?), but the downside of major surgery, that places risks extending far into the women's future, needs to be evaluated better. We can not put up with what one woman told Me, about preferring C-sections: "But the baby is born looking perfect!" No elongated head compression, I know, but this woman, related to Me, has suffered from abdominal and back problems since that C-section. Many others don't, but We're risking 3 times more of them than We should.

Thanks, Marcel. You asked very pertinent questions, a rare contribution these days.