Word: caesarean
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Dates: during 1980-1989
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Doctors at BWH call the Caesarean section rate issue quite separate from other gynecologic complaints. Any discussion of delivery techniques inevitably becomes tied to the national debate on the subject. BWH's Dr. Ryan, for instance, has worked on a National Institute of Health task force on the topic and sent a memo to his staff in July 1981 expressing concern that BWH's section rate was too high. He recommended a long-term review independent of specific complaints Last spring, while the review was still pending and shortly after the Joint Committee filed its grievance. Ryan took what...
...John Davies, Ryan's temporary replacement, notes that "no one knows what a proper rate of Caesarean sections would be. "He adds. "There isn't any date to support the statement" that the BWH rate is too high...
Other doctors argue that BWH's Caesarean rate is high because, as a teaching hospital, it serves as a referral center for high-risk and complicated cases. And they add that concern for the safety for both mother and baby sometimes conflicts with patient preference for "natural" childbirth and maximum choice for the mother, who may not want to be operated on or drugged...
Exhaustion is only one of many roads to a caesarean. In fact, it often seemed to Harrison that all roads led there. If the mother has not delivered within two hours after her cervix has dilated fully, protocol generally calls for a caesarean or forceps-assisted delivery. If highly sensitive monitors detect "fetal distress," a section is of ten done. If the mother has received so much local anesthetic that she cannot push, she may be cut. Three out of the first four deliveries at "Doctors" in which Harrison assisted were caesareans, though the hospital records show a 19% rate...
...Israel Hospital. Though Friedman expresses respect for Harrison's med skills, he feels that her book describes an obstetrics that is passé. "We've become enlightened," he says. "We do not intervene willy-nilly." He cites a declining episiotomy rate, efforts to control the number of caesareans and a willingness to "allow labor to evolve." This view is affirmed by Dr. Warren Pearse, executive director of the American College of Obstetricians and Gynecologists. The national caesarean rate, says Pearse, is about 17%, and, he predicts, with efforts now under way, "it drop back to the neighborhood...