Should c/s rates be published? Naming & shaming...

[AnyDream]

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.

[on tra_k]

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.

[AnyDream]

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.

[paradise lost]

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

[Indadhanu]

So you can tell how a hospital is performing in line with the WHO and how many unnecesareans are being done.

But how do you know that even if a high number of c/s a performed that the majority aren't necessary? I know theres a lot of grey fuzz in whats necessary or not but unless every statistic was detailed, well naming and 'shaming' is pretty much pointless... I mean, a smaller hospital with inadequate c/s facilities who refer emergencies to other hospitals will have a very low rate... but does that mean they're better or that they're ill-equpied to deal with those situations?

I voted NO, because without all the details of every situation the numbers are pointless and I think give woman a false sense of security. A woman could go to the hospital with a 1% c/s rate and be in the 1% and have an unnecessary c/s performed.

Besides, hospitals don't perform c/s, drs do. I'd still vote NO but it'd be more accurate to propose publicising individual dr c/s rates...

[Lianne]

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.

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]

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.

Is 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.

Full article here: Mothers Report Cesarean Views and Experiences: New National Listening to Mothers Survey Results | Alerts :: Childbirth Connection

[mako]

I really don't see the point in "shaming" the hospitals with high rates of c/s birth rates as there is so many different circumstances which impact the reason for women having c/s births.
I for 1 had my baby delivered by c/s last year and by no means did i really have a chioce even though it states on all my records that it was "elective". I had a scan on the Monday night and sent to the delivery suite to be monitored as my fluid levels had decreased significantly and my placenta had stopped functioning.I was sent home to pack my things and told to come back the very next day to have my baby.

As far as I'm concerned my c/s saved my babys' life as along with the above medical issues he also had the umbilical cord wrapped tight around his neck and was knotted. I was told the next day that he would not have survived a single contraction or much longer in the womb the way things were. He was born 3.5 weeks early and in reasonable health.
He is now a very healthy 1 year old thanks to my OB and her decision.

I don't want to scare people but just wanted to share my situation... I certainly would not hesitate having another c/s in the future.

[ranger 2]

I really disagree with Sandra Kanck when she opens her mouth it is usually only to change feet . I get really angry with what she comes out with because more often than not she has no idea what she is talking about.There is no need to "shame" hospitals with high rates of c/s as there are many different circumstances to why women have a c/s .
I had to have a c/s with Johanna if I didn't she probably wouldn't be here.

Jodi

[Tanya]

I really disagree with Sandra Kanck when she opens her mouth it is usually only to change feet . I get really angry with what she comes out with because more often than not she has no idea what she is talking about.There is no need to "shame" hospitals with high rates of c/s as there are many different circumstances to why women have a c/s .
I had to have a c/s with Johanna if I didn't she probably wouldn't be here.

Jodi

But why did your labour end in c/s? Was there intervention that some women would prefer not to have? That's the thing women need to be able to make these decisions and they should be informed of what is the norm at their chosen hospital/obs.