Neel Shah

 

We need to be able to not solely cut costs for the sake of cutting costs

but make better arguments for the value of investing in our moms. Neel Shah, M.D.

 

I don’t mean to be the bearer of bad news, but the reality is that in the current obstetric model you have a 1 in 3 chance of having major abdominal surgery to have your baby. Put it that way and a cesarean section doesn’t just seem like “no big deal, everyone’s having them.” Nor does it when you add to it the real risks this procedure carries over a vaginal birth.

But chances are, your OB doesn’t even know he or she is doing too many cesareans. As my guest today on Natural MD Radio, Neel Shah, MD, says, “obstetricians like me may be hardwired to operate.”

At this time 5 of the 10 most common medical interventions performed in the US are related to childbirth, and cesarean sections are the most widely performed surgery in the US. The cesarean section delivery rate has increased 500 percent since 1970. But the risk of having a baby hasn’t gone up at all.

So if having a baby hasn’t become 500 percent riskier in the past 40 years, what’s really going on that has led to this escalation in cesarean sections over the past four decades?

Join me, midwife and MD, Aviva Romm, here on Natural MD Radio for a conversation with an unusual guest – an obstetrician at a major Boston teaching hospital – and learn why he’s on a mission to reduce the rate of unnecessary cesareans, why he thinks sometimes home birth may the safest place to have a baby, and why we both think moms need to know the truth for their own best health and the health of our babies.

There is absolutely no mom shaming or blaming about cesarean. We just think moms need to know the truth.

With respect and caring,

Aviva

Show Notes:

  • When Dr. Shah realized there were too many cesarean sections being performed
  • What institutional pressures are contributing to c-section rates
  • Why we need to reframe our perspective on when a woman needs a cesarean section
  • Why the evidence and research isn’t always applied
  • How to identify labor normality
  • How to talk to the different people involved in the decisions about c-sections
  • The effect of the information economy
  • What women can do in the moment to sort through the cesarean decision
  • The importance of seamless home to hospital care for home birth moms and babies in the US

Links Mentioned:

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5 Comments

  1. I’m a Registered Nurse with NCC certification in Inpatient OB who works in a NY hospital that did over 9000 deliveries in 2016, and I am in 100% agreement with this interview. We do not value normal birth, and do not allocate sufficient resources (money) to Labor and Delivery. We have too few rooms, are understaffed, and undersupplied. Being charge nurse is a nightmare; you have to do everything you can to give your nurses break (otherwise management gets on your back because they have to be paid overtime), and can end up watching 3 patients while running the unit. Safe? I don’t think so. We are responsible for tasks like billing, cleaning and stringing instruments, and endless charting of care plans. We are under pressure to clear rooms after deliveries, not births, but deliveries, to make place for the next patient, who’s been waiting in Triage for hours. And the emphasis is on the interesting case: the percreta who might need a bladder ressection, or the preecalmptic with blood pressures that are through the roof. We worry about the para 10 TOLAC (woman who has given birth 10 times and is having a trial of labor after a c/section) who is a potential uterine rupture and PPH. Providers and nurses disagree about “bumping the Pit” (increasing Pitocin) on Category II tracings all the time. What’s forgotten is that these are WOMEN AND BABIES, not just cases.

    I also have seen homebirth midwives take risks that are too great. Inexperienced ones right out of school who were not trained in homebirth need to learn those skills. And I would love to see the bridges built to make homebirth the safe option that it is in England.

    Aviva, if you ever have a job opening for a burnt out L&D nurse, I’d apply in a heartbeat.

    Devorah Shulman, BSN, RNC-OB

    • For Devorah Shulman,

      I think an important distinction needs to be made in terms of homebirth midwives as your post unfortunately, lumps them into the same category and they are not the same.
      Lay Midwives are not registered nurses, do not have a national certification under the North American Registry of Midwives, or other recognized license by the state. While some states allow for them to practice home births, their educational preparation is traditionally limited to an apprenticeship under another Lay Midwife. They train almost exclusively in homebirth situations.

      Certified Professional Midwives complete an accredited program of study and are eligible to be certified by the North American Registry of Midwives. They are also not registered nurses, but their educational preparation is consistent and they have a standardized program of study. They train exclusively between birth centers and home births.

      Certified Nurse-Midwives are Advanced Practice Registered Nurses. They are all registered nurses and have a minimum of a Master’s or Doctor of Nursing Practice educational preparation. In addition to maintaining their RN license with the state, they are nationally certified by the American Midwifery Certification Board. They predominantly deliver in hospitals, birth centers, and home birth environments. They are primary care providers that can see a woman from adolescence to her senior years and manage gynecological, prenatal, and pregnancy needs. They are experts in the normal, physiological birth process and are educated and trained to collaborate, consult, or refer with a physician when needed. They have prescriptive authority in every state and can bill insurance for services including Medicare and Medicaid.

      So when you say, ” I also have seen homebirth midwives take risks that are too great. Inexperienced ones right out of school who were not trained in homebirth need to learn those skills.” ====you need to define which type of midwife you are referring to because they are not the same.

  2. I love hearing Dr. Shah’s thoughtful and well articulated, nuanced view. And I love what he is saying: we need to invest in moms and babies, this is important to humanity. And moms are fundamentally resilient! Wow. Thank you. As a mom who underwent C-section and then sepsis complications, it is so good to hear someone acknowledge that these outcomes are important and we deserve more than the old “healthy baby” adage. Of course we all want a healthy baby, and as Aviva says, we would chew off our own arm and give it to the baby if it was necessary! But, then you are left with only one arm to care for that healthy baby… So to speak. Mom’s health and experience affects baby, and it is important.

  3. This was being debated 44 years ago, when I had my first child by via cesarean birth. At that time it was “once…..always.” So my 2nd was a cesarean birth as well. When will everyone get it together?

  4. Aviva ,I had the pleasure of hearing Neel Shah speak yesterday at the Partners in Perinatal health conference here in Boston. Much of what he said was similar to the conversation that you and he had which I just listened to . Thank you for the link. Neel received a standing ovation after he finished and I think we are all so grateful to him for his courage in speaking out about os much of what is happening to Moms and babies in the system. The comparison of course to end of life is completely on target. Like you I am looking forward to hearing more from him and hopefully he will inspire more doctors to come forward and discuss the excesses and biases of the very problematic medical system that exists in this country at this point in time.
    People at the conference yesterday who knew of your work commented that we share the same name.

    Aviva Bock

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