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

[Pretty Butterfly]

I'm sorry, maybe preggy brain, but I dont get it???

I know some Ob's try to scare you into a c/section, they tried with me, as Little Girl was frank breach. BUT I know it is still actually safer to birth a perfect frank breach, with a trained middie or Ob, than have a c/section.

I thought the oringinal poster was saying that MUMS are choosing to birth vaginallly, even though they are high risk, and shouldn't be. That she thinks more c/sections should be done??

Maybe I missunderstood....

[Liz]

Yeah, look at all our vbac'ers here on BB. Fighting tooth and nail against the drs that are telling them it's too risky. There are situations where people are put in a high risk category automatically, so there are people going 'against dr's advice' by attempting VB as opposed to going straight for c/s. I wouldn't say these women are stupid and putting their babies at unnecessary risk though. They are usually very researched and informed when making that decision, and usually make that decision because the real risk is actually still less than a c/s.

OK.. that made sense in my head.. not sure it came out clearly.. sorry.

[Pretty Butterfly]

Yeah, look at all our vbac'ers here on BB. Fighting tooth and nail against the drs that are telling them it's too risky. There are situations where people are put in a high risk category automatically, so there are people going 'against dr's advice' by attempting VB as opposed to going straight for c/s. I wouldn't say these women are stupid and putting their babies at unnecessary risk though. .

Thats what I think!!!

I dont think birthing in these situations "to be a problem", or 'too risky", which I what I assumed the original poster meant???

Am I getting it out right?? I know what I mean!!!

[Liz]

Yeah. I haven't heard of anyone attempting VB if the risk is higher than that of a c/s (not on purpose anyway!). But a lot of women are being told they are high risk, but really it's still less than c/s. Perhaps it's these women being mistakenly counted in that category of 'high risk' vaginal births.

[BellyBelly]

I think the amazing Marsden Wagner (of the Business of Being Born, he's a reknown doctor and worked for the WHO) says it all here:

Women will only agree to caesarean section if they are convinced it is safe for them and their baby. One of the first efforts of obstetricians promoting caesarean section has been to take the scientific evidence on risks of caesarean section and torture the data until it confesses to what they want it to say.

One example: Obstetric hype in popular and professional magazines says research shows 60% of women who have vaginal birth have urinary and faecal incontinence. But a careful reading of the research papers they refer to reveals something very different. The hype lumps all women with vaginal birth together instead of doing what the researchers did – dividing them into risk groups. When analysis of risk was done, they found that women at high risk for urinary and faecal incontinence have had large numbers of births; have had babies weighing over ten pounds at birth; and most importantly, have been the victims of unnecessary, aggressive obstetric interventions during their labour and birth.

What are these aggressive, invasive obstetric interventions that have been proven scientifically to cause permanent damage to the pelvic floor and urinary tract and also lead to more otherwise unnecessary caesarean section? One example is the use of powerful and dangerous drugs to start or accelerate labour, a practice that has doubled during the past 10 years. These drugs make labour abnormal with violent contractions that can damage the uterus and pelvic floor. The only reason women agree to such induction is because they are not told the truth about the drugs, for example that Pitocin (oxytocin), a drug used for decades to induce labour, doubles the chance the woman will have urinary incontinence in the future. By withholding such facts doctors seduce to induce.

Induction with drugs is not the only aggressive, invasive intervention that is frequently used in vaginal birth and is associated with damage to the urinary system, pelvic floor and rectal areas. Episiotomy has been scientifically shown to result in more pelvic floor damage than a natural tear. When an effort was made in the 1980s to reduce caesarean section in the United States, the rate of using forceps or vacuum extractor to pull the baby out went up—some doctors just can’t stop doing invasive interventions. And there is good data that using forceps or vacuum to pull the baby out has more risk of pelvic floor damage than any other form of birth.

Obstetricians have turned birth into a surgical procedure and done damage to women’s bodies and now suggest the solution is to promote yet even more radical and aggressive surgery; caesarean section. The solution is less unnecessary invasive surgical procedures during birth, not more.

[Re: the Midwifery Today E-News article, Issue 3:23]: The two obstetricians tried to say that vaginal birth can damage a woman, but they never pointed out the ways in which caesarean section can do harm not only to the woman but to the baby as well. The following excerpt from my article “Choosing Caesarean Section” in The Lancet of November 11, 2000, reviews some of the dangers associated with caesarean section, the alternative to vaginal birth that some doctors are trying to promote:
‘In addition to the increased risk the woman will die with an elective caesarean section, there are other risks for the woman including the usual morbidity associated with any major abdominal surgical procedure—anaesthesia accidents, damage to blood vessels, accidental extension of the uterine incision, damage to the urinary bladder and other abdominal organs.1 Some of these risks are common: 20% of women develop fever after caesarean section, most due to iatrogenic infections requiring diagnostic fever evaluation for both woman and baby.1

There are also risks women carry to subsequent pregnancies due to scarring of the uterus including decreased fertility, increased miscarriage, increased ectopic pregnancy, increased placenta abruptio, increased placenta previa.1,2, 3 Recently in the United States the widespread use of the unapproved drug misoprostol (Cytotec) for labour induction has created a new risk of caesarean section in subsequent pregnancies. Women attempting VBAC (Vaginal Birth After Ceasarean) who are given misoprostol have a rate of uterine rupture of 5.6% compared with a rupture rate of 0.2% for women attempting VBAC not given misoprostol, a 28-fold increase in risk of uterine rupture.4 For women choosing caesarean section, all of these risks exist in all of their subsequent pregnancies even if the original caesarean section was not an emergency. The increased risks of ectopic pregnancy, abruptio placenta, placenta previa and ruptured uterus are all life threatening to both woman and baby.

For whatever reasons women choose caesarean section, very few are clearly informed about foetal risks. In an emergency caesarean section where the baby has developed a problem during the labour, the risks to the baby of doing the caesarean section will likely be outweighed by the risks to the baby of not doing it. In an elective caesarean section where the baby is not in trouble, the risks to the baby from doing a caesarean section still exist, meaning the woman who chooses caesarean section puts her baby in unnecessary danger. That some women are choosing caesarean section strongly suggests women are not told these scientific facts.

The first danger to the baby during caesarean section is the 1.9% chance the surgeon’s knife will accidentally lacerate the foetus (6.0% when there is a non-vertex foetal position). (5) Obstetricians may be less aware of this risk — in one study only one of the 17 documented foetal lacerations was recorded by the obstetrician doing the surgery.5 A much more serious risk to babies born by caesarean section is respiratory distress. Many reports in the scientific literature document the caesarean section procedure per se is a potent risk factor for respiratory distress syndrome (RDS) in preterm infants and for other forms of respiratory distress in mature infants.1 RDS is a major cause of neonatal mortality. The risk of newborn RDS is greatly reduced if the woman is allowed to go into labour prior to the caesarean section.

Another serious risk to the baby born by caesarean section is iatrogenic prematurity (the baby is premature because the caesarean section was performed too early).

Even with repeated ultrasound scans, the standard deviation for estimating gestational age is large, creating errors in judging when to do an elective caesarean section. Doing the elective caesarean section after the woman goes into spontaneous labour would markedly reduce this risk as well. A vast literature documents the increased mortality and morbidity, including neurological disability, associated with premature birth.’

So beware. Surgeons try to sell surgery. Never forget that obstetricians are, after all, surgeons. Women must be extremely cautious in the face of this hard sell and get the facts from those who do not have a vested interest in surgery.

About Dr Marsden Wagner
Marsden Wagner, born in San Francisco, his education at UCLA included an M.D., clinical specialty training in pediatrics, then in perinatology (neonatology and obstetrics) followed by two years post-graduate study with an advanced scientific degree in perinatal science. Following several years of full time clinical practice and some years as a full time faculty member at UCLA, he was a Director of Maternal and Child Health for the California State Health Department. After six years as Director of the University of Copenhagen-UCLA Health Research Center, he was for 15 years Director of Womens and Childrens Health for the World Health Organization. He is now an independent consultant.
With extensive experience in maternity care in industrialized countries, including midwifery and the appropriate use of technology during pregnancy and birth, he has consulted and lectured in over 50 countries and given testimony before the US Congress, British Parliament, French National Assembly, Italian Parliament, Russian Parliament and others. His publications, in 11 different languages, include 131 scientific papers, 20 book chapters and 14 books.

For more about Dr. Wagner:
1. Wagner M, 1994. Pursuing the Birth Machine: The Search for Appropriate Birth Technology, Sydney, Australia: ACE Graphics.
2. Enkin M, Keirse M, Renfrew M, Neilson J, 1995. A Guide to Effective Care in Pregnancy and Childbirth, 2nd ed, Oxford University Press.
3. Goer, H, 1999. The Thinking Woman’s Guide to a Better Birth. Putnam, New York: Penguin.
4. Plaut M, Schwartz M, Lubarsky S, 1999. “Uterine rupture associated with the use of misoprostol in the gravid patient with a previous caesarean section,” Am J Obstet Gyn 180:1535-42.
5. Smith J, Hernandez C, Wax J, 1997. “Fetal laceration injury at cesarean delivery,” Obstet & Gynecol 90:344-6.
First published in byronchild/Kindred, issue 1, March 02

Being Seduced to Induce: What Women Should Know About Their OBs
By Marsden Wagner M.D.

[Beatrix]

I wouldn't say these women are stupid and putting their babies at unnecessary risk though.

I didnt see anywhere the OP said they were stupid?

Good for the women who want a VBAC..

nothing wrong with it, and def not against it.


back on topic...

But again there are many many different reasons behind a c sect and we do not know these.. each and every labour has different circumstances so naming and shaming hosptials with high c sect percentages does no good without the info behind it to back them up.
what some women think is a legitimate reason to have a c sect other could be dead set against..

[onthefly]

I see absolutely no reason why statistics shouldn't be freely available.
The name & shame label is perhaps counterproductive, since it sets people's backs up, but really, what have these hospitals got to hide that they don't want to release stats? If they've done nothing wrong and are acting correctly in their patients' best interests then what's the problem?

[Liz]

hmm.. I never quoted the OP? Just saying that these women aren't stupid.. they're probably the most informed of the lot of us for these 'riskier' births.

All public hospitals are required to disclose their c/s rate.

Thanks Tobily for answering my question.. thought it might have got lost back there

Well, if the information is already available, then I guess I'm not really for the whole naming and shaming if the shaming is it's sole purpose. I kinda jumped in thinking it was just about making the information available.

[Beach Mama]

what some women think is a legitimate reason to have a c sect other could be dead set against..

Well said hun. I think most women weigh up the risks and the information they are given, and try to make the best decision for them and their baby. In some cases, yes they are misinformed and choose to have c/s for reasons that are not valid (like the too posh to push brigade on 60 mins saying they didn't want their veejays stretched) but even then, they believe they are making their decision based on what they think is fact. They obviously havent researched extensively enough but that is the choice they have made for reasons they believe are valid.
As far as "risk"goes.... I was booked in for a c/s at 9 days because of "risk"I was able to push it out to 14 days because I was determined, had done my research etc.... Other women would have taken the 10 days at face value and agreed, just as I did with the magical 10 days over and getting induced with Isabelle. I still believe the info should be there for those who want to make an educated choice about what they think is best for them and their baby. I also think that what I see is "risk"is different to the next person- I know many people at my mothers group can't believe I went to 14 days considering I was "high risk"and I know others who probably though I should have gone longer, but my "risk"assessment ended at 14 days. Ugh not sure what I am getting at but hopefully you all get the point.

[Bathsheba]

As I believe in Freedom of Information and Transparency in public services I will be voting Yes.

Some people have posted opinions based soley on their experience without seeing the big picture... I see this as a bit futile, no one is suggesting womens' choice will be compromised... only the ease at which women can inform themselves. This is a discussion about a policy that will affect everyone, not just an individual.

ETA:

Yes
38% (475 votes)
No
46% (571 votes)
Only in extreme cases
14% (184 votes)
Total votes
Total of 1230 votes

[Ellibam]

its only the public hospitals that Have to share their statistics... private hospitals dont and this is ultimatley what sandra knack is trying to change.
so that eveory one can see which hospital has the higher rates of c/s and intervention.
then from that point look at why these hospitals are having such high rates.
i dont think they would ever name and "shame" an ob......

also most of the stats dont go in to to much detail either a vag birth is still a vag birth doesnt matter that you had an every thing from gels to synto with gas to epidural or episiotomy to suction.
the only time its not a vag birth is when bubs comes out the sunroof!
which isnt a good way to do the statistics as we all know because there are so many variables.

[fionak]

I ended up having an emergency caesar a few months ago at one of Melbourne's private hospitals. In our pre-natal classes, the nurse running the sessions went through all the hospital statistics in detail. VBAC vs Emergency Caeasar vs Elective Caesar. They also broke down the number of births that were forceps or vaccum delivery which we all found really interesting. I don't really understand why other hospitals are so secretive about this information. I feel that when parents are selecting hospitals, they should be able to have access to this information. Having said this though, I don't agree with the notion of "naming and shaming". As many people on this thread have said, we have no way of knowing the particular circumstances surrounding each birth.

[Denaya]

ETA I actually think people are getting too hung up on the word 'shaming'.

Sushee i think the word "shame" is the problem too, people aren't reading past it, it's a red flag.

Narrow minded people are seeing 'shame' and rather then think just go of on a tanjet!

Not at all. It's just making a point of the state of our tabloid-like news reporting. Shouldn't have said it was shaming full stop. It's not narrow minded to take offense to that.

People are still able to read past it and respond to the actual concept.

The question of whether or not c/s is necessary or needed or painful wasn't on question for the original topic, so people shouldn't feel bad for not responding to the digressed conversation in the meantime (and yet still have read the thread ).

[sushee]

Can we then all agree that using the word 'shaming' does not properly depict the issue at hand, and agree that it's about making hospital more accountable, and move on?

Because I agree that the word was used in a tabloid-like context, so let's not allow it derail the conversation. Because from some of the posts I've read, some people haven't been able to get past that word. I'm happy to talk about the media though and their poor choice of words in a seperate thread.