Persistent problem: The height of section C will affect the South

Julia Maeda always knew she really wanted her baby to be born. Therefore, it is recommended to be in the hospital, vaginally, without an epidural for pain relief.

This is her first pregnancy. As a nurse she worked with the sick at the time, not mothers and babies. “I didn’t know what I was going to get into,” said Maeda, now 32. “I wasn’t very prepared.”

Her state of Mississippi has the highest number of cesarean sections in the U.S. – nearly 4 in 10 pregnant women there feed their babies by C -section. Nearly two weeks ago in 2019, Maeda became one of them after her doctor visited her while she was working.

“You’re not in trouble, your baby isn’t in trouble – but we don’t want you to go that route, so we have to think about a C -section,” she reminded her doctor. “I was completely lost. I just gave up.

C -pieces are sometimes necessary and life -saving, but public health experts have long argued that many things done in the US are not. They argue that it was a big cut that was accompanied by a lot of trouble and a high price tag.

Overall, 31.8% of all births in the U.S. will have C-sections by 2020, a slight increase from 31.7% a year earlier, according to new data from the Centers for Disease Control and Prevention. But it neared its peak in 2009, when it was 32.9%. And the higher the prices in many states, the higher the South.

These high C -section numbers continued – and in some states, such as Alabama and Kentucky, they grew slightly – despite regular calls to reduce them. And while the disease has presented new challenges for pregnant women, research has shown that the U.S. C-section rate is not affected by covid. But obstetricians and other health professionals say height is a difficult problem.

Some states, such as California and New Jersey, have reduced their costs through a variety of programs, including sharing C-section data with doctors and hospitals. But the transition has been difficult in other areas, especially in South and Texas, where women’s health has not diminished during their pregnancies and maternal and fetal health problems have been among the most common. the highest in the US.

“We need to rethink our thinking about C -sections,” Drs. Veronica Gillispie-Bell, an OB-GYN, is the medical director of the Louisiana Perinatal Quality Collaborative, a group of 43 maternity hospitals dedicated to lowering Louisiana’s C-section count. “It’s a life -saving operation, but it’s not without problems.”

She said the C -cells, like other processes, make up the skin tissue, which also enters the abdomen, which can make it difficult to conceive in the future. C -sections usually lead to a longer rest period and recovery time and increase the duration of illness. Babies can face challenges. In smaller cases, it can be cut and cut during an incision.

Although C -sections are sometimes necessary, health officials say these cuts are widely used in many places. Black women are more likely to be born in the C region than any other ethnic group in the country. Often, hospitals and landmarks do not have enough space to pay for it.

“If you’re giving birth in Miami-Dade County, there’s a 75% higher chance of having a caesarean than in North Florida,” Drs. William Sappenfield, an OB-GYN and epidemiologist at the University of South Florida who studied the state’s highest C-segment count.

According to some doctors, their pay is guided by the mothers who request the procedure, not by the doctors. But Dr. Rebekah Gee, an OB-GYN and former secretary at the Louisiana Department of Health, said she saw a significant increase in C-section counts at 4 and 5 p.m. time when doctors want to go home.

She has led several initiatives to improve birth outcomes in Louisiana, including increasing Medicaid payments to hospitals for vaginal discharge and C -sections. In most areas, more the high cost of C-pieces before taking a woman, making the high C-pieces costs not only a concern for pregnant women but also for taxpayers.

Medicaid pays for 60% of all births in Louisiana, according to the KFF, and about half of all births in most Southern states, compared to 42% in the country. That’s why some states – including Louisiana, Tennessee, and Minnesota – are trying to fix high C -district costs by changing the amount of Medicaid they pay for. But pay regulation alone is not enough, Gee said.

“There’s one person in the middle of Louisiana who is doing more C -districts and first -round picks than anyone in the U.S.,” he said. “When you have a culture like that, it’s hard to change from it.”

Linda Schwimmer, president and director of the New Jersey Health Care Quality Institute, said many hospitals and doctors do not know their C-section numbers. Sharing this information with doctors and hospitals – and making it public – has disappointed some providers, he said, but has acted later. New Jersey’s C-section rate among the first, low-income mothers fell from 33.1% in 2013 to 26.7% six years later when the state began sharing this data. , among other works.

The New Jersey Health Care Quality Institute, along with other similar organizations around the country, is focusing on reducing a subset of the C -sections called “nulliparous, term, singleton, vertex “C-sections, or first-time, full-time cuts. mothers who give birth to one child with the head placed down on the abdomen.

NTSV C -cells are important because 90% of women have a C -section during early pregnancy. In the US, the figure for these C -segments is 25.9% in 2020 and 25.6% in 2019.

Dr. Elliott Main, a maternal-fetal specialist at Stanford University and medical director of the California Maternal Quality Care Collaborative, also wrote a paper, published in JAMA last year, explaining the the company’s performance lowered the NTSV C-Section score from California. 26.0% in 2014 to 22.8% in 2019. The figure has not changed at that time.

Allowing women to work for a longer period of time before using the cut is important, he said.

The abdomen must be larger than 10 centimeters before a woman can give birth. The threshold for “workmanship” was first when the shell was spread out about 4 centimeters. In recent years, however, the amount of hard work has changed to 5 to 6 centimeters.

“People get to the hospital right away,” said Toni Hill, president of the Mississippi Midwives Alliance. “If you report to the hospital at 2 or 3 inches, you can at 2 or 3 inches for weeks. I didn’t expect that to work.”

Often, she said, women in the early stages of the procedure are removed and removed through a C-section.

“It’s almost like, right now, C -pieces are served like lollipops,” said LA’Patricia Washington, a doula based in Jackson, Mississippi. Doulas, non -medical professionals are trained to assist parents before, during, and after childbirth.

Washington works with a non -profit organization, Jackson Safer Childbirth Experience, which pays doulas to help pregnant mothers across the country. Some state Medicaid programs, such as New Jersey’s, will re -pay for services in doulas because research shows they can reduce the cost of section C. California is trying to roll back the same benefit for its Medicaid members.

In 2020, when Julia Maeda became pregnant again, she paid out of pocket for a dollar to go to give birth. The experience of getting her son through a C-section last year was “emotionally and psychologically traumatic,” Maeda said.

She told her OB-GYN she wanted a VBAC, short for “post-cesarean birth.” But, he said, “he just shook his head and said, ‘That’s not a good idea.'”

He has a VBAC. Maeda praises her doula for working.

“Maybe he went and told the nurses this was important,” Maeda said. “They want to have your baby during business hours. And biology doesn’t work the same.”

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