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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to

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    Jun 26

    New study "Study Finds Disparities in Maternal Care Among U.S. Hospitals"

    Archived User

    In they category of  "Patient choice Cesarean sections" does anyone know if  they're calling c/sections that get done after a women has been in labor feeling tortured, starved, and flat on her back tethered to machinery for 24 then diagnosed with "failure to progress"  begging for it to end and they say they want a c/section is that categorized in the new study and "Patient choice".

    I know I was begging!

    If they have the audacity to classify what i went through and other women go thought as "Patient Choice to have a c/section" I think my brain is going to explode from knowing this is how I was categorized.

    Henci or anyone can you tell me after you read this brand new that came out today if  they l;umped that typical scenario into be classified "Patient choice".

    Henci Goer

    I hear your anger, and it is justified. An ongoing problem with the HealthGrades reports is the cavalier assumption that cesarean surgeries for which there is no medical indication all represent "patient choice" surgeries. The only data we have from asking women themselves comes from Listening to Mothers II, a survey carried out by Childbirth Connection of a nationally representative sample of 1600 women giving birth in 2005. In that population, 1 woman of the 252 who would have been eligible for an elective cesarean said she had a "patient request" surgery. That amounts to 0.4% of the eligible population or 4 per 1000. On the other hand, 9% of the women surveyed or 90 per 1000 reported feeling pressured by their obstetrician to agree to cesarean surgery. I have another study in which 13% of cesarean surgeries performed during labor or 130 per 1000 were by self-report "obstetrician choice" elective surgeries. Another 3% or 30 per 1000 were a joint decision between the laboring woman and the ob, but considering the unequal power relationship, those could reasonably be called "obstetrician choice" cesareans as well, bringing the total to 160 per 1000 or 40 times the number of patient request surgeries.

    Kalish RB, McCullough L, Gupta M, et al. Intrapartum elective cesarean delivery: a previously unrecognized clinical entity. Obstet Gynecol 2004;103(6):1137-41.

    So which do you think is the bigger problem: elective surgery at patient request or obstetrician request?

    -- Henci


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