Thursday, January 8, 2009

Mom's fault, as usual, or, yet another installment of crummy science reporting

Get a load of how the media played today’s story on new evidence of the risks of early C-section. Here’s the LA Times lead: “Thousands of women put their babies at needless risk of respiratory problems, hypoglycemia and other medical ailments by scheduling cesarean deliveries too early.” It’s women who put babies at needless risk. Not doctors or hospital policies. As usual, it’s mom’s fault.

Why would silly moms do this? NPR concluded its spot on the same research by noting that women may be scheduling C-sections early to insure that their “personal physicians” (idiotic term) were available to deliver their babies. To protect their babies, women may just have to let go of that choice, intoned the reporter.

The research looked at “elective” C-sections, that is C-sections for which there is no medical reason. Why would anyone have such a thing? The Times opined that it was women who are “too posh to push.” Again, those irresponsible moms.

Nowhere in the stories was there any mention of whether medical practice and policy might have anything to do with this problem. Nowhere in the stories was there any attention paid to the strange fact that doctors perform such a thing as a C-section for which there is no medical reason, or the disturbing fact that researchers could find 13,000 elective C-sections to study.

In further scolding of women, the LA Times mentioned that the American College of Obstetrics and Gynecology has counseled that women wait until 39 weeks before having an elective C-section. But missing from the stories was the information that ACOG and the American Medical Association have ruled elective C-sections to be ethically neutral, despite the health risks C-sections pose to women and babies (especially repeat C-sections) or that when researchers have looked for women who chose C-sections for the heck of it, they haven’t found any.

The Listening to Mothers survey, the biggest and best look at the subject, managed to find one woman among the 1600 surveyed who chose a C-section of her own volition. A full quarter of those who’d had C-sections described themselves as “pressured” by medical caregivers to have the operations—information that doesn’t appear in medical records that term the C-section “elective.” And, thanks to another directive from ACOG, fewer and fewer hospitals will allow women to even attempt vaginal birth after C-section. Women’s childbirth choices certainly play a role in this issue, but their choices aren’t made in a vacuum.

Nor did the stories mention the inherent risks of C-section, regardless of when they’re scheduled. The LA Times story did contain a hint in that direction: “The initiation of labor is a baby's way of signaling that it is ready to live outside the womb,’ [Dr. John Thorp, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill and coauthor of the study] said. When doctors schedule elective C-sections, ‘we're saying we're smarter than that signal,’ he said. ‘There are some babies who aren't ready to make that transition and are forced to do so.’ ”

1 comment:

K said...

This article appeared in one news source entitled: C-sections better for baby after 39 wks. My first reaction was horrific because I thought they were comparing c-sections to vaginal births.

I agree with you that much important information on risk was left out and that doctors can always refuse to operate on a patient. After all, they take an oath that goes like this: First do no harm!