my thoughts exactly!
I voted yes. Why go to a hospital that could potentially perform an unnecessary or preventable c/s. Don't want people being too quick with the knife thank you!
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my thoughts exactly!I voted yes. Why go to a hospital that could potentially perform an unnecessary or preventable c/s. Don't want people being too quick with the knife thank you!
BellyBelly Life Subscriber
Was just thinking - the way they word these things always affects how people vote I reckon. "naming & shaming"... i dunno.. why not just say "release each hospital's statistics to inform women".
I don't think the hospitals need to be 'shamed' as such.. but I think the info should be available.
I haven't read or voted - i'm in the UK, c-section rates are published as a matter of course here. We have a national health service. When public money is used these things HAVE to be transparent.
And yes, the section rate at my local hospital (nearly half of all 1st time mums) DID put me more in favour of homebirth. The rate of epidural uptake did too - 80%, 91% of all first timers... I just could see it was unlikely i'd get the sort of birth i wanted there. If i'd wanted a section i'd have gone there. Surely knowing the figures gives women more choice. If you want a section you wouldn't have a homebirth, so if you want a natural undrugged experience why would you go to a place which specialises more in the medical model of care?
Women should be able to access these figures so that WHATEVER kind of birth they want, they can know they're going to a place where they're most likely to get it. The whole "naming and shaming" aspect is a bit childish really. Part of the reason (NOT the whole reason) the hospital near me had such a high section rate is because it's an obstetric centre for complicated births and a teaching hospital. It's catchment area is gigantic and ALL the complicated cases are passed to it. If a hospital takes more high risk pregnancies it will of course have more sections, though i got a statistician friend to adjust for that and it still came out above the national average (which is WELL above what the WHO advise) which spurred me into asking for a homebirth. I was served by the midwives from that hospital and i was very happy with my experience. In fact i just found out i can elect for that team again at my new address and i'm doing a little happy dance
Bx
♥ BellyBelly's Creator ♥
Yes because the WHO says that with all things considered, from every angle, c/s rates should be no higher than 15%. So you can tell how a hospital is performing in line with the WHO and how many unnecesareans are being done.
The ironic thing is, if you look at the stats, private hospitals actually have higher rates of intervention than tertiary hosptials. Look up the Victorian Peri-Natal Data Collection Unit. I have some stats on BB already. I guess to make an informed vote you need to know the facts.
Kelly xx
Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
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Well said.I voted yes.We have a right to know these things.
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I have a query regarding someone's post about paperwork & labour/delivery.......
After having my 2nd I was given a copy of what Im guessing are casenotes from the midwife. It has all the details on it ie times, pain relief, cervical checks, bubs presentation, contraction rates etc etc Would that be a summary of the paperwork she was filling out when I was in labour? I was surprised to be given it but my OB handed it over knowing a) we move alot and b) Id probably end up having another baby.
No one likes to hear they may have a) made a bad choice based on wrong information supplied by your Dr, or b) blindly trusted a Dr who DIDNT have their best interests at heart. I would hate to have come to terms with a birth I never intended on and then suddenly via statistics discover that it was uneccesary in the first place. Same goes for accessing your own medical records. Would open up a whole can of lawsuits on OBs and hospitals for malpractice (and I consider unneccesary procedures performed on misinformed women malpractice).
Take for instance a person I know. She's in her early 20s, had an emergency csection for her first baby as she was 10 days overdue and he was over 9lbs. She laboured for 3 days/2 failed inductions, never got past 4cm and eventually he had to come out. Thats fine with her. I met her when he was 6wks old and told her that she didnt need to worry about a csection next time just because she had one first time round. She was SHOCKED about this because her hospital told her otherwise. So she was due with her second baby 11mths after #1 and they told her no VBAC/induction because of time-frame, risk of rupture blah blah. Fair enough I guess BUT she ended up going into labour on her own early, got to the hospital in established labour at 5cm with no real issues and they scaremongered her into having a csection! Gave her the "Your baby will die, youll rupture, bleed to death, stop progressing" bull. Considering a) she was in no pain bar contractions and b) her first csection was failure to progress after 2 failed inductions BUT she established labour and dialated further than she had 1st time round ON HER OWN. Pure laziness on the hospitals part and Im betting their statistics reflect this. I was horrified to hear her story afterwards. Bloody disgusting. Now she is pregnant with #3 12mths after 2 c/s and she is planning a Vba2c. No reason to think she wont get it either but she knows she'll come up against heavy opposition from the Drs here even though any reason they could possibly come up with as to why she shouldnt VBAC would be pure scaremongering again.
That is a prime example why statistics SHOULD be available on everything related to birthing, not just c/s rates.
Last edited by Trillian; November 24th, 2008 at 12:45 PM. : Removing inflaming comments
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Most hospitals in NSW, not sure about other states fill in a computer database with all the details that provide the stats. We then give each women a copy of this on discharge so she has it for her own record. If the hospital has the data the woman also has the right to it.
Re writing info during labour, we document timing of contractions, length & strength, maternal pulse, fetal heart & during the pushing stage we record the fetal heart at least five minutely.
It is a shame that not all hospitals request the right of the woman to birth how she wants provided it is safe. I'm glad that I work in a hospital that tries to cater for women's needs and wants, esp with VBAC & midwifery care. I feel for women who don't have choice purely because they live in a rural area with only one option for where they birth or who provides their care.
Anna - I notice you live at Bushland Beach, did you deliver your 2nd bub at TTH? This is where I work and we give the mums as much as we can documentationwise so it can be utilised for follow up care and for their next bub if they move. We usually include perinatal data sheet, mums and bubs careplan for the entire time you are in hospital, antenatal care details and discharge summary. We dont usually include your partogram from what you have mentioned but thats great if you have that too. Its fantastic to hear you are using our new birth centre for this bub, who are your midwives? All 4 of them are excellent as you probably know by now. All the best!
Leanne
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In the Waiting room at the new Royal Women's Hospital (Melbourne), they had copies of their Quality of Care Report '07 available for visitors. This contained rates of vaginal & caesarean sections over past 7 years, a breakdown of birth type by mothers age, induction of labour rates, incidence of CS for multiple births ove past 7 years, perinatal deaths,post partum haemorrhage rates, peripartum hysterectomy rates and incidence of 3rd & 4th degree tears. Also a table of maternity service performance indicators and the percentages that RWH has achieved over past few years and compared with Victorian average.
There was a lot of other info, and i was interested and really pleased to have it available.
I think many centres do provide this info, and so often people don't take the time to research or read the info when it is available.
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The base numbers/percentages may not be meaningful at all without contextual information. For example, if you have a tertiary level hospital that routinely takes women with high risk pregnancies/situations etc that would not be admitted in smaller hospitals, then you would expect that hospital to have a higher CS rate - but the figure alone would not provide an explanation. The same hospital may also have a higher rate of midwife assisted births too but that would not necessarily stand out in the name & shame model either.
I note that the Victorian health department does publish its CS rates (remember reading them somewhere over the last few years)...could be that some of that information is already available in the public domain or to researchers already. But I don't believe that attempting to 'shame' the 'worst performing hospitals' is a helpful approach.
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I guess the stats need to be considered in context eg. elective vs emergency but ... I really can't understand why you'd want to have an OPERATION ... I'd much rather just have a BABY!!
I'm FOR any attempt at better educating prospective mothers and encouraging them to have faith in what their bodies are designed for.
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I'd like to add that an analysis of caesarean rates also needs to be done in the context of previous birthing experiences - ie a vaginal birth that is managed poorly can result in the mother requesting an elective caesarean for subsequent births (due to trauma or physical damage from things like a rushed induction, forceps delivery etc). In which case the hospital that carries out the CS may not actually be the "problem".
In my case, the hospital that traumatised me got to record that birth as a vaginal delivery - whereas the compassionate hospital that treated me well and gave me an empowered, healing birth got to record that as a caesarean delivery. The second hospital was definitely "better" than the first but that is not reflected in my own contribution to the stats.
I was just coming back to post something similar Marydean. My friend recently had an elective section and her first birth was like something from a horror film. They intervened in every way possible, kept her strapped to the bed, took ages giving pain relief then mucked up the dose, eventually giving her a foceps delivery for her "he's just too big" baby who turned out to be just over 6lbs, and caused a haematoma inside her vagina which ruptured 3 times in the following days, causing her to need 3 more surgeries and 15 units of transfused blood. The same hossie wouldn't let her even think of attempting VBAC.
To me the epidural rate speaks more than the section rate because a well-supported woman having an uncomplicated birth probably WON'T need one. The epidural rate of my hospital put me off because it made me think probably there was no good support. I have since learned they do not assign midwives for a whole shift to one woman and routinely kick dads out at 10pm unless mum is actually pushing. No wonder so many women end up having spinal anaesthesia - alone and labouring without consistent care in the night...
Routine postnatal debrief and follow-up with patient-scored performance reports would be more useful than section rates alone.
Bx
Registered User
Unfortunately the name 'elective' doesn't give a good picture either. I had an elective csection with my daughters but I didn't have a choice, it just wasn't concidered an emergency situation. My 2nd daughter was lying across my stomach so there was no way she was going to come out and after many attempts and different things and many weeks, at 41 weeks I had a csection.
Lianne
♥ BellyBelly's Creator ♥
The whole women's choice thing is not really relevant in the big scheme of things, so we have to wonder why the stats are so huge.
Full article here: Mothers Report Cesarean Views and Experiences: New National Listening to Mothers Survey Results | Alerts :: Childbirth ConnectionIs there any truth to the assertion that many women are choosing a primary cesarean with the understanding that there is no medical reason?
The first national data from women themselves clarify that demand from women for a planned initial (or "primary") cesarean with no medical reason is infinitesimal. Despite some professional and mass media discourse about "maternal request" or "patient demand" cesarean when there is no medical indication, just one woman (0.08%) among 1314 survey participants who might have initiated a planned primary cesarean without medical reason did so. Just that one woman (0.4%) out of 252 survey participants who actually had a primary cesarean initiated a planned cesarean without medical reason. Two other women with a primary cesarean said that it was scheduled ahead of time without medical reason and initiated by a health professional.
All others (98% of women with primary cesareans) believed that there was a medical reason for their cesarean. The most common reasons cited were concerns about fetal distress, position of baby, size of baby, and prolonged labor.
Kelly xx
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