Monday, January 29, 2007

Birth machines

From the Associated Press:

Japan's health minister described women as "birth-giving machines" in a speech on the country's falling birthrate, drawing criticism despite an immediate apology.

Japan's health minister described women as "birth-giving machines" in a speech on the country's falling birthrate, drawing criticism despite an immediate apology.
"The number of women between the ages of 15 and 50 is fixed. The number of birth-giving machines [and] devices is fixed, so all we can ask is that they do their best per head," said Health, Labor and Welfare Minister Hakuo Yanagisawa, as quoted in the Asahi and Mainichi newspapers. Yanagisawa reportedly apologized even as he made the remarks Saturday and later told the Kyodo News agency the language he used was "too uncivil."

But Democratic Party leader Yukio Hatoyama was unmoved by Yanagisawa's expression of regret. "It was extremely rude to women," Hatoyama said Sunday.

Japan's population of 127 million contracted for the first time on record in 2005, mostly because of a drop in the birthrate, raising the prospect of labor shortages and difficulties in paying pensions for large numbers of seniors.

Sunday, January 28, 2007

Cesarean rates and NYC

This is an opinion piece I wrote for the New York Times today

Cut and Run

LAST month, Betsy Gotbaum, New York City’s public advocate, issued a report noting that Caesarean section rates at some of the major hospitals in the city were nearly 40 percent, about 10 percentage points higher than the national average. The rates are probably even greater, given that the data — the most recent available — was from 2004 and the surgery’s popularity has only grown since then.

What gives? Have New York women been more susceptible to the Britney Spearsification of childbirth? That is: book an operating room reservation for delivery and then get a tummy tuck. Childbirth activists believe that the too-posh-to-push phenomenon, while tiny, may be part of the problem, especially in trend-conscious New York. But they say doctors are more to blame because they fear malpractice claims and want to control birth and their schedules as much as anyone, so they encourage women to have Caesareans that may not be necessary.

Obstetricians claim the rates are so high because professional women are becoming pregnant later in life, often with technological help, which makes labor and delivery riskier.

However, these truths don’t hold with all women. While New York-Presbyterian Hospital/Columbia had the highest Caesarean rate, at 39.6 percent, the hospital with the lowest, at 18.3 percent, was North Central Bronx Hospital, according to Ms. Gotbaum.

Which brings us to another angle to consider.

In 1908, Franklin Newell, a doctor affiliated with Harvard Medical School, said that moneyed urban women suffered more when having a baby, and he wanted to prevent them from having “nervous breakdowns” by offering Caesareans. This was a radical concept at the time. Caesareans were truly dangerous then. Antibiotics had not yet been invented. Anesthesia was in its infancy. But Newell still thought the surgery would be best for the mother.

“It seems to me that this overdevelopment of the nervous organization is responsible for the increased morbidity of pregnancy in the overcivilized class,” Newell said. “The advocacy of an elective Caesarean section for patients who have no pelvic obstruction will undoubtedly come as a shock to many members of the profession.”

Indeed it was. At the time, Caesarean rates were about 1 percent. (The World Health Organization today states that Caesarean rates in industrialized nations should be between 10 percent and 15 percent, beyond which, the risks and costs of the operation outweigh the benefits to mother and baby.)

But back to Newell. I believe he was on to something. New York women, stereotypically some of the most empowered and health conscious in the country, should not have any trouble giving birth, even if they are 38 years old and pregnant for the first time. Strength, both mental and physical, is all it usually takes to give birth (along with a lot of encouragement).

Yet if “overcivilized” is synonymous with “educated,” which could equal “having too much information,” which could make anyone neurotic, then it could also be said that city women are overcivilized. Thinking too much about everything that could go wrong during birth, instead of focusing on how it is a natural physiological process, is a recipe for surgery.

All a New York obstetrician has to do is introduce the concept of danger or inconvenience, and the expectant mother gets the vapors. Even some midwives, the guardians of natural birth, have admitted to me that they can tell by looking at a pregnant woman’s résumé whether she will be more prone to a Caesarean. Uptight? Check. M.B.A.? Check. Drives a Volvo? Check. If the city’s Caesarean trend keeps up, they can just skip to one simple question: From the Upper East Side? Check.

Although it is difficult to determine which belief came first, that upper-class women could not or would not handle childbirth or that doctors thought such delicate flowers could not or would not tolerate it, both, sadly, seem to be increasingly true today.

Although New York-Presbyterian Hospital/Columbia serves a diverse population, it also has many high-risk and affluent patients, as well as private-practice doctors who may be financially motivated to perform the surgery. (Nationwide, uncomplicated Caesareans cost almost two times as much as uncomplicated vaginal deliveries in the hospital.)

By contrast, North Central Bronx, a public hospital that serves a diverse population and doesn’t have the financial incentive to perform Caesareans, has the lowest procedure rate.

Or perhaps, doctors there aren’t inquiring about mothers’ résumés.

Tuesday, January 23, 2007

From today's wire

Teens births in Mass. decline while Caesarean sections rise

BOSTON (AP) -- The teen birth rate hit an all-time low in Massachusetts
while the number of Caesarean sections continued to climb, reaching a new
high, according to new birth data released by the state Department of
Public Health on Tuesday. The teen birth rate was 46 percent below the national rate, or 21.7 births per 1,000 for women ages 15-19 years old.

The Caesarean, or C-section, delivery rate was the highest ever reported
in Massachusetts. One out of every three births were C-sections or 32
percent of all births. The C-section rate is 7 percent higher than the U.S.

The numbers are from 2005, the most recent year for which statistics are

The study also found:

-- The overall number of births in Massachusetts declined by 2 percent
in 2005;

-- The infant mortality rate among black, non-Hispanic women was twice
as high as among white non-Hispanic women (9.4 deaths vs. 4.3 deaths per
1,000 live births;

-- The teen birth rate for Hispanic women was almost six times higher
than for white non-Hispanics (73.2 percent compared to 12.9 percent per
1,000 women ages 15 to 19).

-- The percentage of multiple births remained high. In 1990, 1 out of 38
births was a multiple. In 2005, 1 out of every 22 births was a multiple.

Monday, January 22, 2007

Last year around this time women were asking their OBs to be induced so as not to miss the Super Bowl. Now the trend has extended to the playoffs.

Not quite Nirvana

This is why not ALL fathers should be witness to their child's birth: