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

[scooby]

I vote a a great big NO.

I also have to agree that the stigma attached to CS doesn't need any further promotion either. I am currently 30 weeks pregnant and have been diagnosed with vasa praevia, a condition that, unless things change in the next 4 weeks, will require a planned CS. When I tell people I am having a CS I am either grilled about why, given a disapproving look and a tsk tsk or lectured about having an 'elective CS'. Now I feel I have to give a full explanation of my condition every time someone asks in order to avoid the harrasment.

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I definately agree Sonjiji the CS stigma doesnt need promotion like this and putting CS and shame in the same sentence is an issue in this article. I didnt come looking for this thread i was sent an email to make a vote and/or comment, i dont believe im being narrow minded because the word "shame" upsets me. i have exactly the same issue (and dont want to explain about anal tears and fecal incontinence to every stranger i meet) and articles like this just make it harder.
Can i just state again that i would vote yes as i do believe we have a right to the info so WE can make an informed choice

[suse]

Personally I don't really understand why this is even an issue. Hospitals are required to be accountable for their performance on a wide range of criteria, and publishing statistics is part of that accountability. Why should it be any different in relation to birth? It is not only about enabling informed choices about the type of care one will receive, but about ensuring that a healthcare facility performs to optimum standards.

Purely from a healthcare administration perspective, performing unnecessary caesareans is a highly inefficient way to operate a facility. Operating costs are high, recovery times are longer and require a higher level of nursing care, there is a greater likelihood that the infant will require NICU or SCN care; all these things tie up hospital resources and incur significantly greater costs than a vaginal birth. So I have always found the concept of 'convenience' to be somewhat of a bizarre one. It may allow a certain degree of convenience to begin with (which in any case is negligible; unless the elective caesarean rate was 100%, a hospital or obstetrician still must allow for a certain level of unpredictability), but results in a much greater level of care at the tail end of the process.

Even private hospitals are accountable to the government as well as to their shareholders, so why maintain a model that is so deeply flawed in terms of operational inefficiency and that is not in line with best practice principles or indicative of an optimum outcome? One would not perform open heart surgery if it were not needed (or to prevent the possibility of needing open heart surgery), why is birth so different? BTW, that is a rhetorical question, I know why birth is different, but that's for another thread . But the point is that the 'convenience' argument doesn't actually make any sense.

This is not to discount the other reasons for requiring hospitals to publish stats (and to be accountable for their performance), which have been pretty well covered in the thread so far, but just to add another point in favour of publishing stats. Aside from allowing consumers an informed choice, from a governmental and operational perspective, a call for greater transparency and accountability in this area of health is critical.

[Snacks]

One would not perform open heart surgery if it were not needed (or to prevent the possibility of needing open heart surgery), why is birth so different? BTW, that is a rhetorical question, I know why birth is different, but that's for another thread .

This is a great point suze, and one that I've struggled to express before. No doubt people would be livid if there were drs out there performing unnecessary radical surgeries without going over the risks properly with their patients. And yet, when it comes to birth we allow it. It has become normalised. And what's more, there are many who say, 'Why should you be upset about the way your body was violated by an unnecessary and painful medical procedure - you should just be happy that you and your baby are alive'.

[*Belle*]

Thanks for the information Midi27 it is very helpful.

At my parenting class before my first birth I was given the stats of rates of c/s both emergency and elective at my private hospital. Pity they dont seem to do the same thing in the public sector.

I'm confused too, because why dont people prepare a birth plan and give it to their OB, midwife, birth attendant, support people etc, so if they cannot speak on their behalf due to pain or tiredness they can speak on their behalf about their request and have them listened to. Furthermore, it should be mandatory and mentioned at the pregnant womens first visit to the hospital or shared care or OB to have a birth plan whether you do public or private hospital births. And personally thank god for Belly Belly who I found on the Web when pregnant with my first child so I was able to prepare myself with all the information and birthplan etc.

[sushee]

I went to both public (first 3 births) and private (last birth). The last, as I said, was private and I was not provided stats that I requested. Just thought I'd clarify.

[Tobily]

I'm confused too, because why dont people prepare a birth plan and give it to their OB, midwife, birth attendant, support people etc, so if they cannot speak on their behalf due to pain or tiredness they can speak on their behalf about their request and have them listened to. Furthermore, it should be mandatory and mentioned at the pregnant womens first visit to the hospital or shared care or OB to have a birth plan whether you do public or private hospital births. And personally thank god for Belly Belly who I found on the Web when pregnant with my first child so I was able to prepare myself with all the information and birthplan etc.

Belle while a birth plan is good tool it is not, and should never be used as, a substitute for making choices (about caregivers and birth places) that are congruent with how you want to birth.

I get very nervous when I hear birth plans being talked about like they're a sort of "insurance policy" or first line of defence against the things you don't want. In fact, they are a last defence. Your very first defence is making smart choices to minimise the likelihood of your having to deal with these things blindsiding you in the birthing room. And you cannot make those choices in an informed way without having some idea of what your odds are of having those interventions with the obstetrician or hospital you are using.

And it is often not a matter of just having these things on your birth plan and they are automatically respected either. There is a massive power differential at play in hospitals and women and their partners are not on their own turf. This means they are usually less confident in their decision making, less assertive with "authority" etc...lots of issues for many people here.

At my parenting class before my first birth I was given the stats of rates of c/s both emergency and elective at my private hospital. Pity they dont seem to do the same thing in the public sector.

Belle this actually fairly unusual. The public sector is more transparent because they are run by the government and by extension tax payers. So the Health Department requires that public hospitals disclose their stats. There is no such onus on private hospitals.

[*Belle*]

Belle while a birth plan is good tool it is not, and should never be used as, a substitute for making choices (about caregivers and birth places) that are congruent with how you want to birth.

I get very nervous when I hear birth plans being talked about like they're a sort of "insurance policy" or first line of defence against the things you don't want. In fact, they are a last defence. Your very first defence is making smart choices to minimise the likelihood of your having to deal with these things blindsiding you in the birthing room. And you cannot make those choices in an informed way without having some idea of what your odds are of having those interventions with the obstetrician or hospital you are using.

And it is often not a matter of just having these things on your birth plan and they are automatically respected either. There is a massive power differential at play in hospitals and women and their partners are not on their own turf. This means they are usually less confident in their decision making, less assertive with "authority" etc...lots of issues for many people here.



Belle this actually fairly unusual. The public sector is more transparent because they are run by the government and by extension tax payers. So the Health Department requires that public hospitals disclose their stats. There is no such onus on private hospitals.

Tobily I was merely trying to point out that the more you look into preparing yourself for the birth the better of you are, for example selecting a hospital based on recommendation and research, preparing a birth plan and at the first visit to the hospital or carer to include the stats of c/s which is being discussed in here. Everyone who has prepared a birthplan may view the use of it differently. Choice was not the issue I was getting at at all. As I said my first post was personal about my choice and after reading the whole thread I am entitled to move my decision to saying the information should be made available as people in here have made valid posts as to why. My last few posts in this thread I have been trying to put that point across about more information as I think its good to help others so pregnant women can be made aware of the information they want so they can think about where to have the birth and their carers, afterall when you are pregnant you do think about these things. Im lucky that North Shore Private hospital is prepared to offer that information at their parenting classes.

[Matryoshka]

The title of the article is judgemental, there's no shame in a c/s, nor do i feel shame in high rates of c/s.

I vote no, because i think if you are after a vaginal birth, then choose to birth at home or in a birth centre, then there's the least likely opportunatey of an unnecessary c/s.

[Snacks]

Yes, but for what purpose?

For the very purpose of 'getting the birth you want'. If I want an intervention-free birth, I will not go to a hospital where the c/s rate is abnormally high.

i think if you are after a vaginal birth, then choose to birth at home or in a birth centre, then there's the least likely opportunatey of an unnecessary c/s

That's not fair! I can't afford to birth at home (can't afford the pvt midwife who's services wouldn't be covered under my health fund), and the closest birth centre to me is a good drive away and very popular. Why don't I have the right to choose to birth in a hospital AND have a low or intervention-free birth?
This is kind of academic because I am fortunate enough to have had and currently have low risk pregnancies, so I can go through the public system and see midwives. This is my way of minimising intervention. However, were I to need the services of an OB because of a higher risk pg, then I would want to choose a place where my desire for low intervention would be respected. Surely I have that right?

[Pretty Butterfly]

I vote no, because i think if you are after a vaginal birth, then choose to birth at home or in a birth centre, then there's the least likely opportunatey of an unnecessary c/s.

So because I've had 5 great, natural drug free vaginal births, I should have to pay for a private midwife or drive hours away to a birth centre?????

Just so some silly Ob doesn't push me for a unnecessary c/section????

Wouldn't it be better for ALL women if we stood up and looked into why and where this is happening??

I should have EVERY right to know if the hossy I walk into is knife happy, and if the Ob is too..... if you dont wanna know, then dont.

It really is very simple. I cant believe in this day and age ANY woman would say no to any information on childbirth... astounding. .
But they shouldn't stop the rest of us from getting it.