Bruce Flamm: Some Say C-sections Are More Cost-Effective

“Some people in the medical community actually think it will be cheaper to increase the C-section rate. It sounds crazy, because the surgery stay is longer, but when you figure in the cost of going through labor and the 1-to-1 of nurses and patients, the difference is not quite as obvious.”


-Dr. Bruce L. Flamm, an obstetrician with Kaiser Permanente in Riverside, CA and a spokesman for the American College of Obstetricians and Gynecologists (ACOG)

From Birth by appointment in The Washington Times on April 15, 2009



More from this article:

“Medical-legal issues have contributed to the rise in the number,” Dr. Flamm says. “Obviously, if labor goes wrong, the doctor is open to a lawsuit. With a planned C-section, at least the perception of risk is eliminated.”

The PERCEPTION of risk.  Not the actual risk to the woman and baby.  The ACTUAL risks of scheduling a c-section come second to the PERCEIVED lessening of risks with a planned cesarean.  So really the PR task at had is to keep up the PERCEPTION that c-sections are safer or equal to vaginal birth.  Like this:

In fact, if one looks at C-section complications, a large portion of those occur during emergency procedures because the mother or baby already has experienced complications, Dr. Flamm says. Compare risks of a vaginal birth with the risks of a planned C-section, though, and they are pretty equal, he says.

Risks to whom?  If one uses the rudimentary measure of “live mother, live baby,” then they can expect that in most cases, both will live.  What about the increased morbidity to mother and baby, plus the risks to the mother and baby in each subsequent pregnancy?  Clarification of what “pretty equal” means and whether it’s based on best evidence would be helpful.


Flamm is a VBAC proponent and his book Birth After Cesarean is linked on Childbirth Connection’s Resources for VBAC page.


Flamm has written about evidence-based medicine in the past, according to the Secular Coalition for America:

Dr. Flamm has been a lifelong advocate of science over superstition and critical thinking over mysticism. He is an amateur astronomer and also has an interest in early electronic calculators, about which he has co-authored a book. Dr. Flamm has written several articles about the importance of evidence-based medicine and the dangers of faith healing.


What do you think? Which risks of planned c-sections are “pretty equal” to those of vaginal birth?  Which risks are not?  Cite evidence if you have it handy, please.



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