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

[Smoke Jaguar]

all i care is that both my baby and myself come out alive and healthy.

Yep, well, I care about more than just myself (cos I'm going to prepare for a homebirth next time, so doesn't even personally apply to me, but I do like to stretch myself for the benefit of other people; I'm a bit of a lobbyist!) and because I care about safety of mother and baby, I'd like stats released for all hospitals performing CS's. Especially because CS's are NOT the safer option just because an OB says so, and because I know that the mortality rate for CS mother/infant dyads is higher than vaginal births. This alone says to me that it's BECAUSE safety of mother and baby is paramount that CS rates need to be transparent so that mothers can make informed choices.
I'm not down with the spin about 'shaming', but identification of high rates, and (I agree) the breakdown on interventions etc, is important.
Bringing it back to the personal, it's because I am aware of our escalating rates of interventions (not just the CS rate, but inductions, internal exams, epi's etc) that I will avoid all hospitals, and even birth centres attached to them (I loved my FBC experience, BTW). Not all women know what I and many on BB know, where it takes a bit of rooting around to find these stats, so to have them readily available will hopefully start opening the eyes of many other women and get them asking questions the OB's don't want them asking
By identifying the hospitals with higher CS rates, these hospitals will have to take a long hard look at their policies if they care about reducing their rates.
I also think that part of the problem is that OB's these days aren't trained or experienced in dealing with birthing 'complications' such as breeches and twins so all they know is surgery. It's a corner we've painted them into (as a society, not as individuals or even as a demographic) - they're not being trained in it, they don't get to see normal, undisturbed birth and they become proficient at surgery. So, who the hell is going to reverse this trend if the ones who DO know how to treat these things are retiring or long retired? OB's nowadays are a tending to be a liability in normal birth because of this, and this is why I believe OB's do not belong in normal birthing situations. A breakdown of stats indicates that OB's themselves are turning normal birth into emerg CS's, as well as misinformation, not enough information and the established vernacular about birth being dreadful, painful, geez, even death-defying!
In normal birthing situations, you're risking more by going to hospital than by staying at home. Women who have information about intervention rates may be able to make better choices about where they birth. I certainly don't want to be a maternity ward's excuse to rack up Medicare rebates for justifying the purchase of the latest whiz bang, super-expensive piece of obstetric equipment. And what a waste of money on PHI when the premiums pay for such equipment that I don't want anywhere near me, anyway.
This is just to illustrate how knowing figures and breakdowns has shaped my birthing choices.
Yes, there are other things going on in the world that also require our attention, and I'd rather work towards positive birthing so that I can add the great, constructive energy it has brought me so far to the world.
Risking PND, inability to establish breastfeeding, incontinence/uterine damage/prolapse etc, are all things that affect people's health and quality of life. It's pretty important to avoid things that compromise quality of life, if you can help it. Making people's lives better changes the world, and surely, a better start to life is better for mother and baby (not just mother, not just baby- they are one unit!), where they can make that informed choice, and plan to mitigate the effects of CS and other interventions if they then must be chosen, all things considered and made transparent

[Flower]

I voted yes! I would like to know. I will be home birthing with my next. My home has a 0% CS rate I like the sound of that!

[Charlie08]

I had an elective caesar. It was my choice and the end result was a healthy happy little boy. The title "name and shame" implies what was my choice is something to be ashamed of?! And I am certainly not ashamed.
I think its no-ones business what women choose to do. It frustrates me that women who have had caesars are made to feel like its the wrong thing to do. And like it has been said in past posts we dont know why people choose or even have to have caesars. What people want is their bubs to born happy and healthy. Does it really matter how they entered the world.
As far as the mortality rate being higher in caesars, do we know why? is it maybe because bubs was in a high risk category anyway and emergency was carried out to try and save them? therefore making the caesar mortality rate higher doesnt really prove much.

[paradise lost]

What people want is their bubs to born happy and healthy does it really matter how they entered the world.

Charlie i know a woman who had a c-section because her ob said her baby was far too big to fit through her pelvis. He was 5lbs 12oz at birth and spent almost a week in NICU, during surgery she lost more than half of her blood volume and then her uterus. It matters to her.

As she now knows, her obs section rate is about 75% and he had had 3 other babies the month hers was born also in NICU due to being small at birth (all of them sections, all for "large baby"). If she had had access to the statistics for this hopsital and this Ob she would have certainly made different choices. SHe's in the US

Bx

[kristy J]

ANYHOO...as for this topic i still don't think that we really need to know how many c/sects come from each hospital. we don't know peoples backgrounds. and its also a personal choice. whats good for one doesn't suit everyone. if you are not sure ask your OB and make sure the OB / hospital you choose is the right one for you.
I assume people choose the hospital or OB because they like it / them not on statistics. i chose My ob and went to the hospital he works at. (well kinda, but thats another story)

[paradise lost]

I definitely used statistics and medical research in choosing my birth. How are you supposed to MAKE your "personal choice" without any knowledge on the stats? How would it have been if your Ob had suddenly told you at 38 weeks that he couldn't sanction the c-section and you have to birth your twins vaginally, and then said all along he was only going to section for medical need? This is how it is for many women who want to birth vaginally - they go to appointments and are under the impression they will be able to try for a vaginal birth, only to be told in the last weeks of pregnancy a bunch of "reasons" why it has to be a section - if they had access to the stats they wouldn't have to rely on what anyone SAYS, they could see the factual outcomes at their chosen hospital. How on earth is the right to greater clarity in decision making a bad thing?

Bx

[Katnap076]

I'm sure someone will have said this in a previous post, but if a woman had a choice to go to a birthing place which has a lower level of intervention they would.
would you go to a hospital which had a high level of infection, high death rates, poor outcomes for surgery or just poor standards of care if you know about it? I would think that people would opt to go for a centre with higher standards.
there is sooo much politics involved in this , but why would it be bad to see the standards of each hospital and how they perform, maybe with the numbers of how many vaginal by-passes are done in each hospital the out come should also be given. i.e. how well mother and baby have faired and how many post operation complications have happened.??

[paradise lost]

That's a great point katnap! In fact i know of several women in Perth (scotland) who chose not to have and Ob and went midwife only purely because the number of MRSA cases in newborns at the nearest obstetric cnetre was terrifying - WELL above the national average. My friend had to have an emergency section there due to her bubs turning partially-breech (bum, one foot and one hand presenting) during labour and she was VERY concerned. The centre have since pulled their socks up, because the NHS's openness means everyone is fully accountable.

Bx

[~Raven~]

We need to know so we can make informed choices. If you had 2 hospitals next door to eachother would your choice be swayed by having this information at hand?

What needs to happen is for these c/s rates to be categorized and not lumped into one.

There are several different circumstances that c/sect occur and nobody is saying that the mother is the one that should be shamed.

The ones that should be shamed are the medicos/hospitals that create a culture of pushing anxious parents to be into unnecessary interventions that ultimately end up with a distressed baby that needs to be born via c/sect.

[Smoke Jaguar]

make sure the OB / hospital you choose is the right one for you

How do you then make sure if you don't have these figures? Eenie meenie minie moe?
I'll second Bec and reiterate that it's the HOSPITALS that are supposedly being 'shamed', not the people having them (no-one's ever going to suggest this on BB without being censored for being rude and unreasonable!). I didn't think it was that subtle a difference, yet posters are still confusing this.

[BellyBelly]

Yes
41% (547 votes)
No
44% (591 votes)
Only in extreme cases
14% (191 votes)
Total votes
Total of 1329 votes

[Smoke Jaguar]

I guess I'm always going to be taken aback when someone says "I'm just going to trust my OB/I'll do whatever the doctors say"... When people have interventions, I'd much rather they not be ostriches about it and actually know what's happening to them. From other people's experiences in my immediate sphere, this really helps with healing and debriefing when interventions have to be made and lets mummies get on with creating more positive energy for their bubbas.

[BellyBelly]

Thats a good point. So many women wonder what the hell happened at their birth, feel disappointed and more women are getting post traumatic stress disorder and PND after birth... we need to start taking more responsibility for ourselves and our decisions, we research so many other things when we are making a purchase, why isn't birth as important?

There is a BB poll, where I asked how you choose your Ob, the #1 response was word of mouth. I notice that alot, people will ask around who they had and pick them. Along with the "My ob was brilliant, he saved my baby when it was an emergency!" -- well what created the emergency in the first place? Alot of babies are born in 'emergencies' these days. We know that simply having a doula at your birth reduces c/s by 50% based on many studies around the world, they all match up, that's gotta be saying something, thats massive - and its NOT a reduction from having medical care... hmmmmm....

[Kitt3n]

-- well what created the emergency in the first place? Alot of babies are born in 'emergencies' these days. .

This is so true. I think society has put upon us a fear of birthing - so we hand ourselves over to the medical institutions to care for us, because we are not informed as to how to take care of ourselves..... and many of us do not seek this information, we simply go along to our monthly/fortnightly/weekly appointments and smile when the ob says "yep everything is fine".

I know 5 other people who are due at around the same time as me. Not one of them had any idea what a doula was, and all of them think i am some weird freak for planning a homebirth. None of them have done any investigations as to what happens to them, one didnt even know about the stages of labour! I mean c'mon!!!!!!!!

[brooksybaby1]

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.

I totally agree, the hospital has no say in whether you have a c-section or a natural birth. I made my choice with my obgy and told the hospital that's what was going to happen. I admit that it is not the nicest experience however, I got two healthy babies delivered safely....and that is all that should matter. So i feel that if you feel that you are not being informed or feel that you are being pressured into a c-section....find another dr!!!

[nicky33]

This is a good question.after having 2 boys naturally i found out at my 42 week check up at the hospital (yes 42 weeks) that i was breach with my daughter and had to have an emergency c section as i was going into labour.i had top wait 3 hours for a postion to come up for me to get into have the procedure.after having my daughter and coming out to the ward it made me realise just how many ladies had accually had the proceedure (alarming).i was devistated to find out i had to have a c section.after having 2 natural labours and now a c section personally i would note choose to have a c section.you might get away with the pain but it takes a long time for you to recover after having it done and i could not even get up to attend to my daughter for the first 2 days and according to the nurses they were amazed when i got up on the 3rd day and tried to attend to her.statistics dont need to be put out as you do not know how many are elective c section and how many are emergency.please ladies consider all your options.you may not get as much pain during the childbirth/labour process with the c section but you do pay a price in other ways.i wish i could have been able to attend to my daughter myself in the first couple of days not relying on everyone else and trying to breastfeed a newborn lying on your back is a definate task.

[Smoke Jaguar]

So i feel that if you feel that you are not being informed or feel that you are being pressured into a c-section....find another dr!!!

Which would be fine if you actually had other information readily available to alert you to the fact that you weren't being informed! People who are aware of things don't tend to get information fudged, because they can either tell that it's happening, or the other person won't even try.
The majority of women clearly don't have all the information that would help them make informed decisions. And the majority of voters in this present poll don't even want all the information! Which tells me that there's a lot of women who will 'just trust what the medicos say'. Like professionals never make mistakes or follow policy over customer/patient welfare...ha!

[paradise lost]

I totally agree, the hospital has no say in whether you have a c-section or a natural birth. I made my choice with my obgy and told the hospital that's what was going to happen.

I'm sorry, in your case that might be true but in many it's not. I have a cousin who is now a paediatrician and she told me when she was doing obs and gynae they were FREQUENTLY told to advise a section when it was getting lat either in the evening or the week... It's not a comfortable truth but it IS the truth, NOT ALL women who have sections needed or wanted them. I'm not talking about breeches or twins which without a willing and skilled careprovider ARE better delivered surgically, i'm talking about healthy women having normal labours who are subjected to unnecessary interventions. My cousin even told me at one hospital the Obs joked about the "tea-time push-along" - at 4pm they reviewed all labouring women to see who they could augment and get the babies out before 8pm shift-change. How many sections a day came about because of that? How many sections that women neither wanted nor would have NEEDED if they had been able to labour normally?

This is not ABOUT it being "right" or "wrong" to elect a c-section, this is about women having a REAL CHOICE in who they choose to go to for their births. If i want a natural birth i should be able to find a place to get that (fortunately i have already discovered i live in that place - my home!), just as if a woman wants or needs a c-section she should have access to the stats about where to get that.

I don't understand why people don't want the information out there. If YOU don't want to know you needn't look, but why can't i know? Why can't another woman making different choices have access to the information that would help her do that? What does it cost one woman if another wants to know how her hospital stacks up statistically?

Bx