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

[BellyBelly]

Well the polly is a democrat, she's just trying to keep the bastards honest

[paradise lost]

The "shame" referred to is NOT directed at the women though, it's directed at the hospital. I agree completely that emergency c-sections and in some cases "elective" ones (where the choices are limited and the risks clearly lie more with VBAC than with c-section FOR THAT WOMAN, for example where a woman was badly injured during her first birth and has severe scarring) are of COURSE necessary.

But how would you feel if you got your labour notes and the foetal distress you had your c-section for was actually massively exaggerated or even invented by your Ob and you didn't really need the section? Sadly this DOES IN FACT happen. I know at least 4 women who have their labour notes which show early decelerations with fast recovery (which are normal heart tones for late labour) which they were sectioned for and one woman whose baby had a period of about 15 minutes of ditressed-type heart tones almost 3 hours before her baby was delivered by section - immediately following the distress they gave her an epidural and prepped her for surgery which she then waited 3 hours for. Her surgical notes show the baby's head was at +2 when he was removed through her abdomen - they had to use forceps to get him OUT of the birth canal - she could have delivered him safely and vaginally and she is gutted. That's what the "shame" is for, to target hospitals who use fear or blurring of medical facts to pursuade healthy women to have unnecessary and unwanted surgical births. Undoubtedly c-sections are better for Obs - they can be planned in advance, are a very controlled way of delivering babies and can be done in a prescribed amount of time for most women. Unfortunately the ideal candidate for a problem-free c-section is the healthy woman not in labour who is ALSO the ideal candidate for a safe low-intervention vaginal birth.

The shame is NOT FOR THE WOMEN it is for those cases where the doctors or other staff have used fear, exaggeration or deception to coerce a woman into accepting a section, or where they have failed to educate a woman fully on her options and the risks of them (both vaginal and surgical birth).

Bx

[norquesta]

I fully agree that statistics regarding maternity care and outcomes be published.

Birth Options Association Australia (BOAA) has a page that can link you to some stats, but state to state varies in what they record, they are difficult to read and only cover some public hospitals.

What I would like to see is a system like BirthChoiceUK - Title Page

I made a choice not to birth in my local hospital because of the extremely high intervention rates. As a Level 1 hospital, all women/babies considered at risk would be sent to other hospitals. The rates of intervention should have been lower not higher then other hospitals.

I found out this information from the government, I had requested the information three times from the local hospital, only to be told three completely different answers.

I have found that policies, guidelines and statistics need to provided in writing. Verbal responses have proved to be incorrect.

Accountability and transparency is vital in our health services. If people would like to know the outcomes of a health service, they should be given access. For the people not interested ? you can then make a choice not to read them.

I coordinate the monthly Birth Options Information Sessions in Canterbury and every single time people come up to me after the sessions expressing thanks at having been told the truth and wanting access to further information.

Knowledge allows choices to be made that are right for you and support you in the path you wish to take.

I for one want the information so I can make an informed choice.

If anyone has the skills to put together a system like the one on the birthchoice site please let the Birth Options team know.

Deb

[sandrino]

I am due with my first and want to have a vaginal birth, but if my obgyn recommended it I wouldn't hesitate to have a c-section. Why should women feel "ashamed" of having a c-section? Its just another thing to add to the pile to feel guilty about, much like stopping breast feeding if its not right.

No one should tell anyone else how to have a baby nor should they place guilt an assumptions on such.

I agree with you completely.

I have had two babies....Both caesarean....One emergency and one selective. I had my babies at Mitcham Private Hospital....Both times when I booked in there, I asked the caesarean rate in comparison to vaginal birth rate and they were most willing to tell me that data.

I vote yes, that it is a hospitals responsibilty to inform expecting moms what the rates are, not as a form of shaming the hospital, but as a form of informing expectant mothers of what experience the hospital has in caesareans....It allows mums to know this information, should the caesarean need arise...and that in turn will make the expectant mum and dad feel more comfortable that the hospital is most capable catering for both scenarios.

The higher the rate, the better to me....With vaginal births, the doctor and midwife are needed, but ones body does most of the work without very little help from the medics....Whereas with a caeserean, one fully relies on the doctoring capability.

Yes for statistics

NO to SHAMING - Noones flippin business what someone else is up to...I prefer to worry more about my own life than stick my beak into everyone elses.

[Macca79]

I am probably just repeating other posts here but I voted yes and I had an emergency c section with DS.

I wanted to be an informed parent and birthing mother. If stats are not published how can a mother/parents make a truly informed choice? At least if the data is available then you can look it up if you wish too. If you do not wish to know/don't really care then you don't have to look at it.

As for shamming, what does shamming ever do that is really of any use?

[richsaralex]

Absolutely they should be named and shamed! Why should these hospitals be allowed to encourage women to choose a c-section over normal (natural) labour? ALL hospitals should be held accountable for the c-section rates they perpetuate.
Ive also heard that some hospitals (possibly alot of hospitals) prefer c-sections because then at least they can 'schedule' their doctors etc and have the babies arrive at a time that 'suits' them! (how can they think think that circumventing nature like that is a positive thing???)

Plus its not just the danger to the mother, but also the effect it has on the baby (physical and psychological!)

Also, allowing mothers to 'choose' to have a c-section simply because its easier & less painful is ridiculous! You're choosing having a CHILD and labour is part of that... right? (though I am in no way saying that having a c-section out of medical necessity is wrong - I dont want to start an argument here! )

[brooksybaby1]

After reading these posts, I would have to say that a lot of women are narrow minded and ignorant when it comes to the reasoning to have a c-section. I do understand that some women do choose to have a c-section for convenience however the majority of the reasoning is for the safety of either the mother or the baby. I have recently had an elective c-section as I was having twins. I made this decision for the safety of my second twin. If I had a single birth, I would have chosen a natural birth but also had an open mind. All these threads do, is make women feel guilty for choosing a c-section and I think that you should all be ashamed of yourselves especially when you haven't been in that situation.

[studentmum]

YES YES YES YES YES YES...

All stats should be published nationwide in major newspapers and made freely available on the internet for all hospitals PRIVATE and PUBLIC...

What I think should be made known:

CS rates
VBAC rates
VBAMultipleC rates
Vaginal birth rates
Natural birth rates
Instrumental birth rates
Number of births attended by MW's only
Number of births attended by OB's

Anything I've forgotten???

The only way to empower women and give back the right to birth (as women want to) is to ensure total transparency in the health care system, that way for those that it matters to, right decisions can be made about where to go for the best possible care.

When behind closed doors even those labelled "the best" have the tendency to let the shine wear off. Regardless of what your experience is (cs, vb, vbac, all or other!) we are all entitiled to great care and until accountability is highlighted to and noticed by all the care will remain inconsistent and often below acceptable standards.

Sarah

[maz]

After reading these posts, I would have to say that a lot of women are narrow minded and ignorant when it comes to the reasoning to have a c-section. I do understand that some women do choose to have a c-section for convenience however the majority of the reasoning is for the safety of either the mother or the baby. I have recently had an elective c-section as I was having twins. I made this decision for the safety of my second twin. If I had a single birth, I would have chosen a natural birth but also had an open mind. All these threads do, is make women feel guilty for choosing a c-section and I think that you should all be ashamed of yourselves especially when you haven't been in that situation.

I have been guilty for thinking the worst about non c/s mum's who go on when they have no idea bout c/s's, but god...think from their point...they are only going on what they are feeling and luckily they have never had to go through a c/s.

The stastic's are NOT naming mothers or saying they are bad parents for having c/s.....the statistics are there to help us mummiys to be, to guide us into the birthing choices we make for our children. They are naming the dame hospitals people!!!! Not if jo blow had a vaginal birth and lucy Lue had a c/s.

Id be very interested to know if the hospitals would also show statistics of how many c/s mothers have had PND after birth compared to vaginaly birthed babies

[paradise lost]

My intention is only to clarify that THE SHAME IS NOT THE WOMAN'S!!!!

Brooksy's baby i had a homebirth and am (for ME) against even going into hospital for a birth, let alone having surgery, BUT if i had twins and the first one was breech i would have a section. If both or at least the first was head-down i would try for a vaginal but i would do so from an informed POV with many many female relatives who have birthed their twins vaginally - if you are informed and are having the section you feel is the safest option for your babies what shame is there? It is NOT the same as you having a singleton pregnancy and being told FOR NO GOOD REASON you must have a section you don't want for "safety".

It's hard, how to protect the choices of all and the feelings of all?

Is there anything wrong with having a c-section? OF COURSE NOT!

Is there anything wrong with forcing or coercing someone to have an unwanted and unnecessary c-section.....?

If a woman wants a natural birth should she not be able to find out the intervention rates of her local or chosen hospital? And if a woman wants a c-section should she not be allowed the same? I have a good friend who was raped repeatedly from the age of 3 by her grandfather. She has had 3 elective c-sections due to the associated psychological trauma with pain in or near her vagina. She knows the risks and made her choice and though FOR ME vaginal birth was very healing in relation to my past abuse, i know for her it was unthinkable and i completely support her. In her position would you not rather KNOW if you were going to an obstetric centre where women-requested c-sections were NEVER granted without serious medical reasons? The idea of her arriving in labour (she has laboured before all of her births, as she feels it's the best of both for her babies) to a hospital where she will be forced to go through what will amount, to her, to be a repeat of the horrific abuse in her past, is truly awful.

ALL WOMEN deserve to have access to ALL statistics for ALL hospitals so they can make their birth choices with a fullness of learning. Knowledge is power. If you KNOW you want a section, for WHATEVER reason, you need to know where you will have the best surgeons and most supportive team, if you know you DON'T want to have a section except in dire medical need, you need to know where you are most likely to be able to achieve your vaginal birth without intervention.

Whether a woman births vaginally or surgically doesn't she have the RIGHT to good, safe, transparent obstetric care? Doesn't EVERY WOMAN have the right to an informed choice? It is not better to force a woman to birth vaginally than surgically. Every woman has the right to birth her baby in safety and peace in the way she feels most confident about, and every woman deserves to be fully informed in her choice.

I am not against c-sections, i was BORN by elective c-section in the days when VBAC's were impossible to obtain. I am against coercion, scaremongering, secrecy and policies that are for the good of ANYONE but the mother and the baby. I want to know in the supermarket the ingredients and cost of what i'm buying - why would i want less in my obstetric care? I wouldn't take my car to an F1-team mechanic to get fixed and i wouldn't employ a zoo vet to vaccinate my dog. I want the right person for the job. That means if i want a vaginal homebirth i don't want an Ob, and if i want an elective section a midwife isn't going to be much use. I want to be able to choose a professional who will do the job i want doing. The job is irrelevant, the choice is EVERYTHING.

Bx

[paradise lost]

In terms of figures i'd want to know:

C-sections termed emergency
C-sections termed elective
C-sections termed elective with pre-existing medical condition (that one would be an eye-opener! As Kelly says, it's less than 1% of electives who are maternal-request for no medical reason!)
Vaginal births
Drug-free births
Epidural uptake
Labour artificially initiated
Labour artificially augmented
Instrumental birth rate by mode (forceps/ventouse)
episiotomy rate
2nd-4th degree tearing rates
midwife to patient ratios
ob to patient ratios
anaesthatist to patient ratios
average and mean times from prescription to birth of emergency c-sections

Think that's all for me....

Bx

[Trillian]

Not wanting to sound like a broken record or anything, but this is the THIRD TIME I have had to come in here and post about keeping it on topic. I have removed several posts and this is honestly getting beyond a joke - if you feel that you cannot keep to the topic or cannot control your emotions, then please refrain from posting any further in this thread.

[sushee]

the majority of the reasoning is for the safety of either the mother or the baby

I'm sorry I have an issue with this statement. I think part of of why we have such high c/s rates now is because c/s is sold to women as being safer for mother and baby, when, if you look at the statistics, it's NOT.

So if mums honestly believe they're having a c/s because it's for her or her baby's safety, then even more we should be publishing the names of the hospitals that perpetuate this sort of myth.

Because if women had c/s when they actually needed it, and not when they're coerced into believing it's the better thing for them to do (because it's not necessarily the better thing in most cases), then someone should be held accountable for the hundred and thousands of unnecessary surgeries women have undergone, which they would not have undergone if they were told the truth, which is you and your baby are statistically safer if you have a vaginal birth.

So let's not muddy the waters with emotion. The fact is, there are FAR too many c/s being done on women who don't need then, and who ordinarily wouldn't have one if they were not scared into it. So IMO anything that makes hospitals more accountable to their clients and to society in general is a good thing.

[maz]

i think ive read more stastic's about the cow's going to abitors then then c/s rates at hospitals

[Macca79]

Would like to know what circumstances c sections are performed under.

[shalini]

I vote no. Naming a hospital because they perform high c sections is an indication of what again??? Majority of the mothers to be ....have knowledge of both options and do their research as a result...the option they choose is based on a number of factors....and it is between the patient and the Doctor.

[Schmickers]

She may as well name and shame women who have abortions too while she's at it.

MP's with nothing better to do bore me.

There are so many factors like people say. Sigh, and we financially support these people in our government. Meh.

I am unsure as to how you could make that comparison, but I think that it stems from a basic misunderstanding of the matter at hand. It is the hospitals being named, not the women having the CS. Yes - there is no reason why statistics on TOPs shouldn't be published, as well as statistics on CS, and on various other forms of surgery. Hoobley said it best, when she said that given that these hospitals operate on public money, it should be a given that what that money goes to be made public as well. They're our tax dollars.

As far as shaming is concerned, well, I guess that's up to each hospital to make it's case and justify it's level of CS, or whatever other surgery we happen to mention. But hospitals will only have to justify what they do once women (and their partners) are empowered to be able to ask that question. And the only way we will be able to ask, is if we have the statistics at hand.

I vote yes.

[sarahreeves]

I really don't see why we should shame hospitals who perform a high rate of c-sections. What is it going to achieve? If there is a concern regarding this high rate of c-sections then it would be more beneficial to make pregnant women more aware of the dangers so they can make more informed decisions about how they choose to deliver their baby.

Women should always be able to choose between a vaginal birth and a c-section. As far as i know we still live in a free country where we are able to make choices for ourselves and our families without fear of persecution.

There is always a debate about natural delivery versus c-sections. I think in the end it comes down to personal opinion. if you ask a different Doctor each day what their opinion is, you would get a different answer from each Doctor.

I don't see why it is such a big deal. I am a mother of five. I've had 3 natural births and 2 c-sections. The first was an emergency and the second was elective. I am pregnant again now and will be having another c-section as it is my right as an Australian to have a choice.