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Asking the Right Questions about the Necessity of a Cesarean Birth

By Michael R. Udwin/Thursday, July 11, 2013

Michael R. Udwin imageThe HealthLeaders Media article "C-Section Rate Reductions Panned" rightly applauds the drop in cesarean births prior to 39 weeks yet is unable to completely explain why such deliveries have continued to rise after 39 weeks. As suggested in the article, concern about large babies and the over-use of induction may be contributing to this phenomenon. Like so many other challenges facing the healthcare community, the key to changing outcomes rests in asking the right questions. Yes, this does sound like a cliché. But surprisingly, it is not happening often enough.

Those with access to healthcare data are in a unique position to pose and answer the right questions. Such queries could explore the indications for the surgery? How many cases started as inductions? And are these inductions “necessary?”

It is instructive and perhaps not coincidental that early elective deliveries declined as hospital rates were publicly published. This suggests that providers are indeed sensitive to patient perceptions and concerns. With this in mind, it is up to both doctor and expectant parent to not just pose the above questions but also adjust behavior based on the answers.

It is a common refrain in hospitals, “mothers come to have a healthy baby, not to have a natural delivery.” This is indeed true, but it does not preclude ideally doing both whenever possible.

Michael R. Udwin, MD, FACOG
National Medical Director
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