- - - - - - - - - - - - - - - - - - - page 2 of 2
_______________THE CRUELEST CUTBACK? BY FIONA MORGAN (01/27/99)
	I liked Fiona Morgan's article on the debate about C-sections. My colleagues and I have read and discussed the New England Journal article, which was seen by my obstetrical friends as right on the money. Obstetricians are being torn in many directions in this debate; managed care companies are pushing them to minimize their section rates, be it by monetary methods (i.e., decreasing the amount of money they reimburse the obstetrician for surgical deliveries) or by the constant threat of dropping the obstetrician from the managed care plans if certain "performance criteria" are not met; malpractice lawyers are always on the prowl in case a perfect child is not born. Through it all, these doctors are simply trying to deliver the best care they can to each individual patient without worrying about reducing their section rates to an apparently arbitrary 15 percent. That said, as a Harvard-trained obstetrical anesthesiologist, I would have to point out to you that your statement in the article that epidurals are responsible for the higher rate of C-sections since the '70s is most probably false. While this is the most hotly debated area of obstetrical anesthesiology, the most recent data strongly suggest that epidural analgesia for labor is not associated with an increase in surgical deliveries. To include this misinformation in your article does a disservice to the many women who are considering epidural analgesia for labor analgesia. Epidurals provide superb pain relief during labor with minimal side-effects. For millions of women it makes the birth of their child a painless and wonderful experience. -- Eric Fishman, M.D. EDITOR'S NOTE: The error has been corrected. - - - - - - - - - - There are other costs to a VBAC as well. Our baby was subjected to a uterine rupture birth, received severe brain damage as a result and the total cost to insurance approached $200,000 over her three-month life. What if the money that was otherwise spent on postnatal medical care after catastrophic uterine rupture were instead spent on improving the safety of VBACs? Research has shown that rapid diagnosis of uterine rupture and prompt intervention can prevent long-term damage. Either development and deployment of improved monitoring equipment, or additional monitoring staff, can improve diagnosis time. Redundant operating rooms and surgical staff can improve intervention time. It just costs money. -- Ken Turkowski SALON | Feb. 8, 1999

R E C E N T L Y+| MAIL ROOM DISPATCH ...

Do you want to respond to a letter to the editor? Join the ongoing discussion in the Welcome area of Table Talk If you would like to submit a letter to the editor for publication, please e-mail us at letters@salonmagazine.com. Letters sent by fax or "snail mail" are less likely to be accepted. Do not send attachments. Please include your full name and a phone number where you can be reached during business hours, so we can confirm your identity. This information will not be used for any reason other than verification and will not appear on the site. Letters may be edited for clarity and conciseness. Brief letters are more likely to be published. Place the name of the article you are responding to in the subject heading of your e-mail. If you do not wish your letter to be published, please say so in the subject line. For more information on Salon's letters policy, click here.