Science Friday - C-Section Increase, Puerto Rican Hurricane Recovery, A Turtle Tiff. Oct 19, 2018, Part 1

Episode Date: October 19, 2018

The World Health Organization recommends that the C-section rate should be about 15% of births, for optimal outcomes for mothers and babies. But a series of studies published in The Lancet this week shows that rates worldwide are much higher. In the past 15 years, worldwide rates have nearly doubled. In the United States, one out of three children are born through the procedure. At the same time, the rate varies within countries—showing certain communities may have limited access lifesaving procedures. Even before Hurricane Maria roared across Puerto Rico, much of the food on the island was imported. Nearly a year after the storm, farmers still grapple with the storm's effects. Travis Thomas is a rookie scientist on the verge of publishing his first paper. He’s about to name two new species of alligator snapping turtle when he’s scooped by Raymond Hoser, an amateur herpetologist who goes by the name, “The Snakeman.” Hoser has named hundreds of animals using methods that some scientists call sloppy. The latest episode of Undiscovered uncovers how an outsider is able to use the scientific communities rules against it. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flato. A bit later in the hour, we're going to talk about the worldwide increase in C-sections. And if you have this story, you'd like to share with us about your C-section or your partner C-section. Why you had it? How did it go? What was it like? Please share it with us. Give us a call 844-724-8255, or you can tweet us at SciFri-Fone. 844-7-24-8-255 or tweet at SciFri. But first, last week's report from the intergovernmental panel on climate change gave us a sobering look at what a world worn by 2 degrees Celsius might look like. Then on the heels of that report, ExxonMobil announced that it was throwing financial support behind a U.S. carbon tax. It's a big step for one of the world's largest oil companies, which last year was sued by its own employees for misleading statements about the environmental and financial impact of fossil fuel. and has a history of denying the climate science is settled. Here with the story as well as other short subjects in science is Omer Erfan, he's staff writer for Vox. Omer, welcome back to Science Friday.

Thanks for having me again. So Exxon says it's going to back U.S. carbon tax on the surface. That sounds like a good thing, but what exactly are they proposing? They're proposing to back a lobbying effort launched by conservative former secretaries of state, George Schultz and James Baker. This is a group called the Climate Leadership Council, and it proposes starting with a $40 per ton price on carbon dioxide emissions, and that price would rise over time. Then they would use that money to go back to people like you and me, essentially, in the form of a dividend or a rebate, and the estimate is it would start at about $2,000 a year for a family of four. There is a catch, though, and Exxon wants rollbacks of other environmental regulations, and one big catch is that,

that they want immunity from climate change-related lawsuits that want damages for these companies. It's the same deal that the gun producers have. Yeah, pretty much. It's kind of analogous to what they got, and it's what other industries have also tried to get. Exxon has a complicated relationship with climate change. It's been ahead of the industry in acknowledging it's a problem. They've had researchers who helped author the IPCC report, and yet they're also being sued from misleading people about the impacts of fossil fuels, years ago, and in 2000, they took out ads in newspapers saying that the science was not settled. I mean, should we be taking this seriously, or is it just another, you know, make us look good sort of thing? That's always the question, isn't it?

I mean, the thing to remember about Exxon is that they are an investor-owned company, so they do have to answer to their shareholders, and they've been getting a lot of pressure in shareholder meetings to better address climate change. Also, climate change poses a business risk for them in terms of their facilities, and if they aren't out ahead on this, they might get slapped with a carbon policy that they don't like that doesn't actually work in their favor. And another way of carbon tax might actually benefit them is that it would target the dirtier fuels first, things like coal, which would clear some space for one of Exxon's other products, natural gas. And, of course, the catches, the things they want in exchange for getting the other environmental regulations rolled back and the immunity from lawsuits. I mean, those are all things that benefit the company. So this could be viewed as an act of self-interest overall. Yeah, we're going to have to look deeper into this in the weeks to come.

Let's move on to, speaking of a warming planet, there are a couple of new studies this week that show massive losses of wildlife that has scientists worried. Tell us about that. Yeah, there are a couple different studies that kind of have a grim outlook for what humanity is doing to nature. One of them looked at arthropods in Puerto Rico, which includes, you know, insect, and spiders, creatures like that. They're critical to ecosystems because they perform functions like pollinating plants, and they're also crucial food.

So they're at the bottom of the food pyramid, so to speak. But the forest ecosystems have been changing faster than the rest of the planet. You know, the planet has warmed one degree since pre-industrial times. Forests have warmed on average by two degrees. And that's had a pretty consequential effect. And so in the first study, the research is they did sort of a population census of arthropods in Puerto Rico. And with one method using nets, they found an eightfold decline. And then using their sticky traps, which is another method of counting insects, they found an upward of 60-fold decrease in these invertebrates.

Now, this doesn't spell extinction per se, but it does show that there's been a drastic, drastic decline. And scientists have called this, you know, one of the most disturbing articles they've ever read. The other big study that also came out looked at mammals, specifically mammals that have gone extinct due to human activity. since humans have started walking the earth, we've seen more than 300 mammal species disappear. But what's unique about this study is they tried to quantify how unique these animals were, not just the numbers, but like how irreplaceable they are. So as mammals share a common ancestor, they branched out on the tree of life. And it turns out humans have been severing entire limbs off of the tree. And in aggregate, we've cost nature about 2.5 billion years worth of genetic, phylogenetic diversity.

as they call it. Can you give me an example of one of those branches that was cipher? Sure. Ed Yong, writing in the Atlantic, he gave the example of the pygmy sloth, which is a threatened species. It branched off from its common ancestor about 9,000 years ago, which makes it a very young species, and so kind of a small twig on the tree. But then there are animals like the Ardvark, which is the last survivor in its group, and it branched off 75 million years ago.

So that means that if we were to lose those animals, that's a... thing that would take, you know, millions of years to regenerate in terms of diversity. Yeah, I get it. Let's move on. There's an ongoing outbreak of Ebola in the Democratic Republic of the Congo. We reported on that back in August when it first began, so give us an update in what the status is now. Well, the outbreak is still outgoing. There have been 223 cases and 144 deaths, according to the World Health Organization's latest report. They met this week to determine whether or not this counts as a global health emergency. This is a declaration that would mobilize, you know, more international resources, but it also has sort of tradeoffs because companies will respond to that by imposing travel restrictions and

quarantines, which can make it harder to get supplies in. So health officials have to be kind of careful about making these kinds of declarations, and they declined to make it a global health emergency. They made it a regional emergency. And what's scary and just kind of unnerving about this outbreak is that it's occurring in an active war zone. Oh, that makes it tougher to get in there and do something about it. Yeah, that's right. Is there any reason for hope then? Yeah, this is actually one of the first live trials of a vaccine.

We now have an effective Ebola vaccine, but of course the ongoing conflict in the North Kivu region of the Democratic Republic of the Congo makes it harder to get health workers in. The health workers have been attacked in the past, and then they've had to be escorted by armed personnel, which in turn breeds distrust among the locals. And there's a limitation to how many resources that are going in. And so rather than using a blanket vaccination strategy, they're doing what's called ring vaccinations where they track infected individuals and then try to vaccinate everybody around them, the caretakers and family members to help sort of contain the virus in a more efficient way. Great stuff, Omer. Thanks for taking time to be with us today. Likewise, thanks for having me. Amir Irfan is a staff reporter for Vox.

Now it's time to check in on the state of science. This is KERNO. W.WNO. St. Louis Public Radio News. Iowa Public Radio News. Local stories of national significance. One year after Hurricane Maria, Puerto Rico is struggling to rebuild itself in nearly every way, including its small farming sector.

Reporter Bobby Bascom traveled to Puerto Rico nine months after the hurricane struck to see how farmers were recovering. After the storm made working the land, all but impossible. And she joins us with that story now. Bobby Bascom is a managing producer and reporter with Living on Earth. Welcome to Science Friday. Hi, thank you. You're welcome. So what is the local farming community like in Puerto Rico?

How did Hurricane Maria affect it? Well, you know, before the hurricane, roughly 85% of the food in Puerto Rico had to be imported, and that, of course, made it really expensive, about 20% more expensive than here in the U.S. And after the storm, that number shut up to about 95% imported food. and the crops that they do grow, the things that were most heavily damaged were things that made a good target for wind, you know, so trees, things like coffee, mango, oranges, that sort of thing. Crops that could hide underground, so potatoes and carrots, they did fairly well. But then you had the collapse of the infrastructure there. So there were months and months without running water or electricity.

I went up to a farm in the mountains where the roads were literally impassable for two months. So people had to have supplies airlifted in by helicopter. One of the people that I met there was a small-scale farmer named Domingo Romano. 90% of our farm was destroyed, but it was really like 100%, because with the hurricane, no one could come here to harvest. Wow, so where do we stand now after that? Well, now, I mean, they're trying to recover, but infamously, FEMA and the government were slow to respond, And so really volunteers sort of stepped in to fill in the gap.

When I was there, there was a group of volunteers from an organization called El Departmento del Camino. That's the food department. And they organized volunteers to, they send a group of volunteers anywhere from, you know, half a dozen to 20 people will just descend on a farm for a week. And they'll tent out, you know, they'll camp out in tents. And they'll do anything the farmers need done. They'll fix fences, plant crops, weed, fix the roof. and it's that sort of physical support that helps get a farm back up and running, but the emotional support, I think, too, is really crucial to people.

You know, I did a five-part series on recovery on the island after the hurricane, and I saw this over and over again. You know, the government didn't respond, so people just, you know, neighbors and volunteers, you know, turn to each other for help, and I think you're going to see more of that in the future. Why aren't there more local farmers in Puerto Rico that might help? a large local food source of this type of disaster were it to happen again? Yeah, good question. I mean, it's a tropical island, plenty of sunshine and rain.

It didn't make any sense to me to begin with either, but you could really trace it back to U.S. policies, specifically Operation Bootstrap was initiated in the 1940s, and it was a series of tax incentives and access to U.S. markets and things like that that discouraged domestic agriculture in favor of tourism and industrial agriculture. So growing things like coffee and sugar cane that can be exported for profit, you know, and that's fine and dandy, but people can eat sugar cane and coffee for dinner. You do see some small farmers markets and things like that. So they do exist, but it's really a niche market right now.

Yeah, you like that's a little bit of a law change. Could change all of that. It could. If they had a mind to. If they had a mind to, exactly. But I think that people do understand, you know, that they need more of that. You know, for months after the storm, people were skipping meals and eating out of a tin can just to get by. So they're certainly acutely aware of how vulnerable the food system is there.

And I think I'm eager to do something. Bobby, thank you for taking time to be with us today. Bobby Bascom, managing producer and reporter with Living on Earth. We're going to take a break and then look at the rising rate of C-sections worldwide and here at home. What are the causes and they jump in the procedure? Did you have one? Why did you have it? What was your experience like? You can share it with us on our phone number 844-8255. We'll be right back after this break. This is Science Friday. I'm Ira Flato. For anyone having a baby, the decision to have a C-section is not unusual. But what is unusual is the number of C-sections happening all over the world. Listen to this. The worldwide rate has nearly doubled from 12 to 21. percent in the past 15 years. And in the United States, one out of three births is by C-section

now. A series of studies in the journal The Lancet looked at this trend to see what is behind this uptick, what are the effects on mothers and babies, and what interventions can be done to decrease that number? And that's what we're going to be talking about, C-section rates globally, also what's happening here in the U.S. And my question for you listeners is, did you or your partner to get a C-section? What's the first? factored into that decision. What was your experience like? You can phone it in or you can tweet us. Our phone number, 844-724-8255. You can tweet us at SciFri. Let me introduce my guest. Holly Kennedy is an author on that Lancet series. He's also a professor of midwife,

Wiffery at the Yale School of Nursing. Thank you for joining us today, Holly Kennedy. Thank you. Tell us, the Lancet series looked at 169 countries, And overall, there is a rising C-section rates. Can you give us some of the numbers of different regions? It must have varied around the world. Well, it does. And what we found was that over 60% of countries overuse C-sections and 25% underuse the procedure.

So there's quite a disparity. And there are multiple reasons. Part of it has to do with the sort of sociocultural acceptance. of surgery as a normative thing to do. Part of it has to do with insurance and access. And a large part of it has to do with women not being able to get a vaginal birth after they've had their first cesarean. So it's complicated. We've seen the rise in particularly in North America, Western Europe, Latin America, and the Caribbean.

For example, in Latin America, it's gone from 32% to 44%. And there's a bit of a paradox when what we would call too much too soon and too little too late. So in the countries that overuse cesarean, they are probably intervening too much in low-risk women that really don't need the procedure. And in countries such as in Africa that don't have enough access probably are underusing it. The World Health Organization suggests that 15% is about right. So when you think about one in three women in the United States having a cesarean, we're way over. Well, let's talk about over. There's a statistic, for example, in Brazil, 90% of the women that go into a private hospital are getting C-sections.

Are they requesting that before they go in? What is the mechanism? What happens there? Well, I can't speak specifically to, you know, the interaction, but you're right, women who are wealthier, who have insurance, are much more likely. The majority of them will have a C-section. And it's an accepted normative part of the culture in Brazil. There are big differences within countries. In China, the rate ranges from, what, 4% to 62% depending on the province? Exactly. And again, that has to do with access and wealth education. Interestingly enough, women that have greater education are more likely to have a cesarean, which is a bit of a paradox in itself, because a cesarean is not a low risk of surgery. It's major surgery and things there are small but serious risk. both with the immediate surgery and then later in terms of the scar and stillbirth and preterm birth,

later with subsequent pregnancies. And it's one small part of the piece of the puzzle in the United States for our increasing maternal mortality rate. You mentioned that in some places there's too much and some places not enough. What are those not enough places like and why? The not enough places are places that don't have access in particularly in Africa and countries that have lower resources. So they just don't have the facilities to do a cesarean sometimes when a woman really needs it. And I think it's important to stay at the outside. There are women and babies that it is a life-saving procedure, but it's not one that should be done for the majority of women. I want to focus on a little bit about what's happening here in the U.S.

and why C-sections are increasing here. Tony Goleyn is the vice chair of quality in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center in Boston. Welcome to Science Friday, Dr. Gole. Thank you for having me. Let's talk about this. There's also this idea of planned C-sections, right? Do you have to approach this?

Have you seen this in your experience? It's quite interesting. I think there's a natural suspicion that this is a major contributor to the C-section epidemic in the United States at this point. And while it's true that families, women can request to have a delivery via cesarian, it turns out that that's not really the most significant driver. In our experience at Beth Israel Deaconess, for example, which is a tertiary care institution, an academic hospital. in the middle of Boston, it really only contributes to about 1% of our deliveries per year. So while some of this could be attributed to patient opinions or patient desires or their perceptions of what's safer, the truth is that I think that we as health care providers need to realize that we are probably the major, major contributors to the rise in cesarean delivery rate here in the U.S. When you say health care providers, you're talking about the doctors who actually actually are performing it?

Yeah. So certainly the doctors, the obstetricians, they are the ones who make the recommendation for a cesarian at the end of the day. That's who's responsible. It's a complex environment to practice obstetrics, so there are other things that put pressure possibly on obstetricians. We have incomplete, somewhat inaccurate data about health of fetuses during labor that might contribute to our decision-making.

The progress during labor in terms of the cervical dilation is subjective, so that can contribute to some inaccuracy. There's other things that happen on our unit that might put pressure on us, other emergencies that might be happening on a labor and delivery unit that might put some pressure on us to make quicker decisions to move toward delivery. But at the end, it's really our decision as obstetricians to make that recommendation. And generally speaking, when we make a recommendation like that, patients and families do. say yes. And they ask questions, but they generally do say yes. Holly, what's your reaction to this? Oh, I would completely

agree with her. The culture of the unit where a woman is giving birth is very instrumental. There are a number of strategies we can do to promote a first time mother having a vaginal birth. But you have to have the

staffing, you have to have the commitment to do the kind of care that's going to help her and her physiology to best achieve a vaginal birth. Let's go to the phones. Let's go to Northern Kentucky. Hi, Lauren. Welcome to Science Friday.

Hi, Ira, thank you for having me. You're welcome. Go ahead. So I actually had an emergency C-section at 31 weeks, and I was super thankful for that being available to me. But when I got pregnant for a second time, I really wasn't given the option of having a vaginal. birth after a C-section, I kind of had to do all of that education investigation on my own.

So I had to look at CDC websites. I had to look at rates and what were the risks for me and my baby and for future pregnancies. And it really was up to me. It wasn't like my provider, they said, do you want to have a repeat? And at the time, I was like, oh, sure, I'll have a repeat C-section. But I wasn't given the risks and benefits. of both to be able to make a truly educated decision. And so I think that I was able to,

I actually had a planned C-section, a repeat, and then I changed my mind at 36 weeks, and my provider was really awesome with that, and I was able to have a V-back, but I feel like there wasn't a lot of information given to me by my provider. I really had to search it out. Okay. And a lot of the information was very emotional,

and it was really hard to find. the facts. Lauren, let me get a great, great call. Let me get a reaction. Tony, you know, truth be told, I'm a C-section, maybe. And I'm one of three. Back in the day, everybody had to have one C-section after another. And Lauren was sort of saying, you know, I didn't know that maybe I didn't have to have that.

Access to V-back or vaginal birth after Cesarian is going to be, is one of the critical interventions that we all as a health care community are going to have to embrace and need to embrace in terms of lowering the overall caesarian delivery rate. It's really a matter of exactly what the caller said, which is grabbing hold of accurate information. We see that as our obligation, as obstetricians and midwives, to really spell out what the risks are. I think we tend to sometimes overemphasize the risk of V-back.

The risk of V-back can be something quite categorizing. catastrophic, but it's rare. And the benefit of a V-back is that for births that happen thereafter, it's highly more likely. So, for example, if someone's going to have a third or a fourth baby, it's highly more likely that that person would have a vaginal delivery if she's once had a V-back. And that really is something that contributes to the overall lifelong health of a woman, because the risk of a cesarean delivery is not only related to the hour or so or even the days or so that follow a first cesarean delivery, but it traces back and forward to the years that follow, sometimes in some cases decades that follow. Women who have had cesarean deliveries are just more likely to have repeat cesarean deliveries,

as your caller almost did, increasing the risk of life-threatening complications. The other thing that's very interesting about V-BAC is that in units, in hospital units, labor and delivery units, where V-back is embraced, where vaginal birth is something that's valued, it turns out that the primary cesarean delivery rate, which has no direct relationship to V-back, because these are women who are having their first baby, and by definition, V-BACs are not your first baby, those units who have higher V-back rates of even trying to have V-BACs and supporting women and having V-BACs have low. primary cesarean delivery rates. It really speaks to this idea of the culture of a unit and really valuing the safety of a vaginal delivery. Lots of, lots of callers 8447-8255. Let me get to some of the tweets because we have never had so many tweets before. Let me choose out some interesting ones. Colleen writes, I had three cesareans, all my three kids. The first was an emergency one, but my concern now are that my children did not receive the bacteria from the birth canal. I'm seeing possibly weak microbiomes affecting their digestive health.

Holly, Tony, what do you think about that? You know, as Tony was talking about the culture of the unit in Veeback, I think the additional things that are really important for families to know when they're trying to make a decision is the value of a spontaneous labor. The neurophysiology that prepares the baby to be born actually contributes to health later in life based on population-based studies. And the travel of the baby through the birth canal does seed the baby with microbiome. So she's right that that does contribute to long-term health. I mean, it's been worked on.

We've looked at different things to do to sort of do that with the baby after a C-section, but if you can do it just naturally, that is better. The other thing is that babies born by C-section tend to have more respiratory distress, and particularly if they don't have spontaneous labor. So there's something about that spontaneous labor that can, contributes to the neurophysiology and the health of the baby. I'm Ira Flato. This is Science Friday from WNYC Studios. So many questions. Let's go back to the phones to Wendy in Portland, Oregon. Hi, Wendy.

Hi. Thanks for taking my call. Go ahead. So I'm actually an obstetrician gynecologist, but I'm working just in a hospital. So I'm an obstetrical hospitalist. And one of the things that I do is just stay in the hospital to, you know, manage labor patients. So I think one of the ways the country is responding is that my type of job is becoming more and more popular so that there are just physicians that are managing labor and hopefully are allowing feedbacks and allowing patients to labor as long as possibly safe. I'm from Portland, Oregon, and we have the second highest rate of attempted out of hospital birth, and we have really the best data from our birth certificates looking at

transports back into the hospital. And I guess my concern is that when I hear, you know, the, when I hear people talking of the, you know, very important things that result from having labor, I have seen some attempts at labor that really should have never been there and have really resulted in some catastrophic outcomes for both mom and baby. So I love vaginal deliveries. I think they're great. But I think there are some moms and some babies that need C-sections, and we need to support that as well and really provide it when it's necessary.

Tony Golan, reaction? Thanks for that call. I couldn't agree more. Cisarian delivery is a life-saving procedure, and there are certainly many women who should not undergo a vaginal delivery. There's a number of different conditions that make that unsafe. The important thing, I think, to keep in mind is also that regarding the example of home birth in United States and sort of that being an extension of the health care system and promoting vaginal birth,

While home birth in many countries is a safe option and is a way to promote vaginal birth, we haven't quite figured that out in the United States. It is important in a health care system that promotes home birth to be able to make a really clear connection between home and hospital. And when certain thresholds are reached, then a patient needs to be moved from home to hospital. That's the part that we haven't quite figured out here yet. And until we figure that out, I think it's going to be challenging to really embrace that as an option to promote vaginal birth. We can try to mimic that as best as we can in the hospital setting and certainly have patients stay at home for as long as is reasonable.

But home birth is not yet something in the United States that we have a really great system to support. All right. We're going to have to take a break. Lots more questions. We're going to spend another good 10 minutes on this. So we're going to talk with Holly Kennedy and also Tony Goleyn. Our number 844724-8255. Stay with us.

We'll be right back after this break. This is Science Friday. I'm Ira Flato. We've been talking this hour about the increase in the number of C-sections and what that means for women's health. My guests are Dr. Holly Kennedy, professor of midwifery at the Yale School of Nursing. Dr. Tony Golland, Vice Chair of Quality,

in the Department of Obstetrics and Gynaecology at the famous Beth Israel Deaconess Medical Center in Boston, and lots of folks on the line. Let's see, we only, gosh, we can't get to everybody. Let me ask you, Holly, you worked on research midwifery in the U.K. How does the approach there compared to what we do here in the U.S.? Well, it differs in several ways. And actually, when this Lancet series on C-section came out, the World Health Organization also issued a new guideline to help us look at decreasing caesarians.

And one of the things that they have recommended is what the U.K. does, which is to have a collaborative midwife obstetrician model of care, where the midwife does most of the primary care. And that's what happens in the U.K. All women have a midwife, and some women have an obstetrician, too, when it's really needed. And the Lancet also published a series on midwifery, a very extensive review of the evidence, and they found that midwifery was associated with improved outcomes, including decreasing C-sections. And so what I'd like to just mention is in the United States, a study came out this earlier this year, that mapped the integration of midwifery across each state to see how friendly the state was in a regulation and reimbursement independent practice to midwifery practice. And so if you look at New Mexico, which has the lowest C-section rate of just about 18%,

26% of births are attended by midwives in that state. Conversely, with New Jersey, has the highest rate of 33%, and only 7% of births are attended by midwives. And then they map that with outcomes. And if you look at Alabama, Alabama has some of the worst maternal and infant. outcomes in the country, and only 1% of births are attended by midwives. So that's not a causation. It is an association-type study, but it is pause for thought, and that is what we saw in the UK, is that when you have a model of care, when women have access to continuity of

care with their midwife, their midwife knows them, they feel respected, you have better outcomes. Tony Goleyn, you work to drive down, the rate down at your hospital at Yale, and after a decade, It went from 40 to 29% in a decade. What did you do there? Well, first we recognized that we had a problem, and I think that's step one in trying to solve it. And then we looked toward the evidence,

not just our own evidence, but the national evidence, about what was contributing to mostly, mostly in terms of the indications for caesarians and focused very narrowly on primary caesarian. First looked at the interpretation of how, we monitor fetuses while women are in labor. That kind of monitoring called fetal heart rate monitoring is very tricky.

It's quite inaccurate and it predicts quite well for us when babies are well, but does not do a good job at telling us when babies are unwell. And nonetheless, obstetricians based decisions on this test, I often say that in no other area in medicine would we make surgical decisions based on such a faulty test. Nonetheless, it's ubiquitous and people use fetal heart rate monitoring. So we focused on really trying to focus on describing the fetal heart rate tracings using science and objective criteria rather than subjective words.

We focused on our documentation, our communication. We also really tried to make sure that people were using scientific, modern definitions for progress in labor. Old definitions were assumed that women would move much faster in labor. labor, then newer, more modern data really proved to us. We wanted to make sure that people use modern definitions for what we thought was normal labor. As I mentioned earlier, we focused on improving access and enthusiasm for be-back, and then also some other operations issues for our unit to change the culture of our unit. I misspoke here with Beth Israel, and I said you're with Yale where Holly is from, so I apologize for that. I'm here in Boston. So does this all mean that the

The hospital you go to determines, more or less, if you'll have a C-section or not? Unfortunately, it does. And so one of the reasons why we know that we have room to improve on cesarean delivery rates is that if you look from one hospital to the next, even separated by one or two miles from one another, who take care of patients who have similar medical problems are of similar demographics, their cesarean delivery rates may vary by as much as 10%. This is unexplainable by any other reason other than the environment, the unit that you work in, the people that you work with, and the general enthusiasm for vaginal birth. We have a tweet that's relevant to this, and Sarah says, I have to wonder how much of the increase has to do with how much money insurance companies make on them versus a typical delivery. Did you study that in your report, Holly? Well, not specifically, except that the recommendation is that the financial strategies, women who have more money, who are wealthier, will have more C-section, which implies that they can get, you know, reimbursed for that. And one of the recommendations that the series made was to not pay more for C-Syarion to really level that playing field.

And in addition to liability reform, many in studies that I've conducted, obstetricians have said to me, you know, I won't get sued if I do a C-section, but I can get sued if I don't do one in time or perceived to be in time. Yeah, go ahead. The issue of reimbursement is interesting here in the U.S. where by and large physicians or obstetricians do not get, a vastly different amount of money for a vaginal delivery than a cesarean delivery. However, the hospital does. And that is something that I think isn't quite transparent for patients. And probably reimbursement itself doesn't influence a lot of obstetrician decision-making here in the U.S. The reimbursement is greater, but it really goes more toward the hospital side because of the length of stay.

Let's go to Sarah in Somerville Mass. Hi, Sarah. Hi, I've had two C-sections, and they were mandated by the doctor due to complications from Crohn's disease. And so I really appreciate this nuanced discussion, but I just wanted to give a perspective of how this is actually playing out among lay people and patients. And I think a lot of the talk about this has become very anti-woman. When I told people that I was having a planned C-section due to my chronic illness complications. I had male friends saying things like, well, are you sure you don't want to just labor for a little bit? Maybe you could just ask if you could labor for a little bit. And I really interpreted that kind of as questioning, you know, can I be a woman if I don't, you know, push the baby out vaginally? And that was really upsetting to me because my two beautiful daughters wouldn't be here

if the C-sections were not available to me. And, you know, I think, I just think it's really important for those that the academic and provider levels to understand that people are hearing these discussions, and I think taking them in sort of inappropriate and different directions. So I'd love to hear the response to that. I've got about a minute, Tony or Holly, which one? I would completely agree with you that one of the most important things in this conversation is for the provider and the woman to talk through what is important to her,

and so that she can make an investigation. informed decision about the best strategy for her. So it is, I would completely agree that it's important that you have that conversation and the risks and benefits of both vaginal birth and cesarean are fully, fully discussed. And Tony, what about this, the charge of sexism here? Point well taken. I think, you know, any extreme is going to be dangerous. I think it is important to realize that regardless of how a baby is born, the person who gives birth to the baby, becomes a parent after that happens. It's no less or no more, regardless of what the mode of delivery is. And cesarean delivery certainly makes you just as much as a mother as having a

vaginal delivery. Great way to end. Holly Cannon, Professor of Midwifery at Yale School of Nursing, Tony Golein, Vice Chair of Quality in Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center in Boston. Thank you both for taking time to be with us today. You're welcome. Our science documentary podcast Undiscovered is back with its second season, and this week the Undiscovered team investigates a cross-oceanic turtle feud. That's right, a turtle tiff over taxonomy. See what I did there? Here to tell the tale of the turtle is Ella Fetter, co-host of Undiscovered. And joining her this week is our sci-fi producer Alexa Lim, who helped report this episode.

Hi, both. Hey, I'm sorry. Thanks for having us back. So, what's this turtimore? turtle feud, Alex. I assume that the turtles aren't the ones that are feuding, right? I am happy to report that no turtles were harmed in the making of this episode. So yes. No, no turtle battle, but the scientist, it's a battle between scientists. And this story starts out with Travis Thomas. He's a PhD student at the University of Florida studying turtles. And he's studying a particular type of turtle called the alligator snapping turtle.

I don't know. Have you seen an alligator snapper as they're called? No, I have not. Okay, well, Elle and I went down to Florida to visit Travis, and we got to meet one of these turtles. And let me tell you, the best way to describe them is scary. And these alligator snappers look more like dinosaurs than turtles. They have these spiky shells and this beak that seems to stay open, ready to, like, maybe snap your tiny finger off. Or worse. Or worse.

And this is a clip from our meeting with Travis in one of those turtles. Whoa! Oh, my God. Did they always just open their mouth like that? Usually it's a defensive sort of mechanism. Don't panic if she just keep that firm grip. You get a picture? I find it.

Yeah, it wasn't my proudest moment. You didn't panic. I did panic a little. That was me. In my defense, this turtle was very burly and frightening-looking. Massive claws. We actually got a clip of the sound of the claws scratching the floor. Wow.

Okay. And if that's not enough, I are, this is a photo. Oh, wow. It's bigger than you are. Yeah. That's not the one I picked up. It's a huge, scary-looking turtle. Right.

What was Travis, why was he studying these turtles? So this is where the feud part comes in in the turtle feud. Travis and a few other scientists for years, they were trying to show that alligator snapping turtles were not just one species like we thought before, but a few separate species that we'd lumped together. and just when they're ready to publish in 2013, when they're about to announce these new species, they find out they've been scooped,

that someone else has beat them to the punch. I'm Ira Plato. This is Science Friday from WNYC Studios. Just as we're getting to think of the part, I'd interrupt. Ella here with Ella and Alexa. Now, okay, see, being scooped, that sounds like a tough break.

It is a tough, and that in itself would not be a story. This is something that happens all the time. unfortunately to scientists and to journalists. But this was a little weirder. The paper that scooped them, it didn't have a method section or result section, the kind of thing you usually see in a science paper, which meant it didn't describe any new scientific evidence. And midway through this paper, it hits a pause on the whole turtle question

and turns its attention to local politics in Australia, which is not what you normally see in a taxonomy paper. So Travis takes a look at who wrote this very odd paper, and it's somebody that he's never heard of. His name is Raymond Hozer. Right. And Travis may not have heard of Raymond Hozer, but other herpetologists who are people who study reptiles and amphibians, they definitely know who Raymond Hozer is. Because he has a bit of a reputation. He calls himself the snake man.

That's a nickname he's given to himself, and he's actually trademarked it. So, you know, that is... Don't care of use it. Yeah. Yeah. And he's got a big personality. This is a clip from his YouTube channel. Snake man here with my favorite steak.

It is a death adder, of course. I pick a snake up in my hand. Sorry about that. And I kiss it. Watch. My other story is, if you're nice to your snakes, they probably won't bite. Let's try that way to get.

Yeah, so that's the snake man, Raymond Hozer. And he's published hundreds of papers naming over 1,000 types of animals, lizards, snakes, the occasional turtle. But a lot of scientists say he's turning out a lot of quantity, but not so much quality. So that he's flooding their field with these animal names based kind of on slippery, like sloppy science. So how is they able to name a species without good science backing it up, Ella? So this was surprising.

It turns out that in zoology, they have this big rule book for naming animals. But the main rule is you pretty much have to yell dibs. It doesn't matter if you've got any science to back up your new animal declaration. You just need to publish first. You can even self-publish if you want. And so that's kind of what this episode is about in part, is how scientists got into this mess. And it's also, of course, about what happens with Travis and Snake Man.

We went looking for the Snake Man. And, you know, the story got more complicated than we first thought it would be. That makes a good story. It's a real story. Oh, yeah. I went back and forth on, anyway. You'll find out. You're in season two of this.

Was this the scariest episode you've had, do you think? Was it the scarce? We do have some life and death. Yeah. The stakes were not quite as high as in some other episodes, but the reports where we were very nervous, feuding about turtles.

Wow. Serious business. All right, L. L. Fetter, co-host and produce the Undiscovered podcast, along with Annie Minoff. Alex Lim is a Science Friday producer. Thank you both for taking time to be with us today.

And if you want to listen to the latest episode and all the rest of them, they are on our website. Undiscoveredpodcast.org. Undiscoveredpodcast.org or wherever you get your podcast. Thank you, guys. Thanks. One last thing before we go.

Microsoft co-founder and billionaire philanthropist Paul Allen passed away this week. And in 2004, he told us how he decides to spend his wealth. Yeah, I guess it's pretty obvious that science and space exploration and technology in general are really in my blood. And I just try to find things that either need to be done, should be done, or where I can make a difference. in a significant way. And the things I've been able to participate in have been very, very exciting. Paul Allen, leaving us this week at the age of 65. Charles Berkwist is our director, our senior producer, Christopher and Taliatta.

Our producers are Alexa Lim, Christy Taylor, and Katie Haller. We had technical engineering help today from Sarah Fishman and we're welcoming Kevin Wolf on to the technical staff for our first time. And, of course, we are active all week on Facebook, Twitter, Instagram, all the social media. You have a smart speaker? Yeah, you can ask it now to play Science Friday whenever you want. So every day now is Science Friday, and you can email us. Our address is SciFri at ScienceFri.com.

And when you go to our website at ScienceFriy.com, we've got all kinds of great educational material up there, all kinds of videos and great stuff for teachers and their students. I'm Ira Flato in New York.