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

[*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?

[Matryoshka]

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.

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?

Well then then wouldn't you want epidural rates, vaccuum rates, forceps rates etc publicised (dont know if they already are).

I was just trying to say that the only way to really secure an in control birth, low risk of "intervention", is birthing at home, b/c. And yes, money is an issue in other states (not here in WA - home birth is free.) But thats a separate issue, agree ALL choices should be publicly funded - c/s and homebirth.

[suse]

I voted no because I think that every woman should have the freedom to birth the way she wants to.

But having access to full and accurate information about hospital birthing practices enables a woman to birth the way she wants. Knowledge is power!!! Restricting access to such information it does not ensure freedom of choice, it denies it.

If a woman wants a vaginal birth but uses an Ob with an 80% epidural rate (without knowing that rate, but instead being told that he encourages vaginal birth), given that less than 1% of elective caesareans are due to maternal choice, what do you think her chances are of achieving a vaginal birth with this Ob? Statistically speaking, most of his other patients would have wanted a vaginal birth - why didn't they get one? This woman enters the relationship with her Ob with a false understanding of what her chances are of achieving her goal.

If a woman wanted a caesarean but chose a homebirth under the impression that this gave the best likelihood of achieving her goal, most people would think she was very unlikely to achieve it and that she had been given false information, given that the number of caesarean births arising from an attempted homebirth is significantly lower than those arising from an attempted vaginal birth in a hospital.

I think that it's important to consider that the issue has nothing to do with restricting choice, or about making a judgement about what is the best way to birth, but about transparency and accountability.

[maz]

In all honesty...who really gives a rats HOW you want to birth your child...c/s, vaginally for all I care out ya left ear!

The question was should c/s statistics be published to shame THE DOCTORS AND HOSITALS people!!! Not shame each other!

ETA - my g/f who had the doctor book the c/s for tuesday....well after I spoke to her and informed her of HER CHOICES.......she went to the hospital and demanded to see the ob...guess who got a stretch and sweap and is now being let to go naturally. Alarming what something as little as your voice can do isn't it

[suse]

for all I care out ya left ear!

Now that I want to see...

[kristy J]

well also too i think it would cost too much.

just having the persentage isn't enough i agree with a previous post. you would have to include the stats for all intervention types and also the persentage of how many were elective and how many were emergancy c/sects.

after thinking about it i think this is all that stupid pollies falt; maybe if she said hospitals have to give their patients all statistical information so they can make their own personal informed choice than this arguemant wouldn't happen.

[sushee]

Hmm I'm starting to feel like I'm hitting my head against a brick wall.

I don't see the problem with expecting to have statistics on c/s from hospitals. They have to provide stats on all other sorts of stuff, why not this? I don't see why it would be cost prohibitive. Part of their business should be about measuring their performance. They would already have this information, we're only asking to actually get to see it.

And for all those talking about choice, let me say that by saying these stats should not be available, you're effectively taking away MY choice to be informed, to chose my hospital based on their policies and the way their policies reflect on their outcomes.

And to say that if you don't want intervention, then don't choose to give birth in a hospital effectively says that hospital are good for nothing BUT intervention. Why shouldn't women be able to choose (that word again) to give birth in a hospital and yet expect to have a vaginal birth, and not be frightened into a c/s? Or is that too much to ask, that health services actually provide you with the best and safest options available to you?

[Schmickers]

after thinking about it i think this is all that stupid pollies falt; maybe if she said hospitals have to give their patients all statistical information so they can make their own personal informed choice than this arguemant wouldn't happen.

Indeed. It is unfortunate that the politician's (and the media's) sensationalist language detracts from the very important question - should statistics regarding rates of intervention be made publically available?

[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.

[paradise lost]

Birth plan? A birth plan is a great idea, but if you want your birth to be a big bowl of fruit you're probably not gonna have much luck getting it if you take your shopping list to the fish shop...

I agree wholeheartedly Kristy J, we need to know ALL intervention rates, i did actually put a list up of what we needed to know about 8 pages back...here it is again:

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

That's the sort of info a woman should have access to in order to assess the care she's likely to recieve at a given hospital or birth centre.

This thread, in the freshness of my just-woke-up mood. Is hilarious. The original post asks should figures for how a hospital performs in terms of birth outcomes be available to women. The thread is again and again defensiveness over mode of birth and parental guilt - someone up above even tried to intorduce the whole bottle/breast debate in! WTF girls? It's seriously like:

woman one: should we be allowed to know safety stats for cars in crashes before we buy them?
women two-fifty-three: NO! I wanted to drive like that anyway! And i should be allowed have whatever colour car i like! And if you don't want to wear a seat belt then get a push bike because i was HAPPY with my crash!

And so on. I know people are passionate about birth - i am that lady on the bus giving a blow-by-blow of DD's arrival to a perfect stranger, but really, this isn't ABOUT your choices. No one cares how your baby arrived, no one cares how you feed it. You can indeed pull it out your ear and feed it on gin for all i care, BUT if a DOCTOR told you that ear-birth and gin were the best and safest way to do it, i want to know about that, so i can educate MYSELF on how i want to do it. Who knows, i might choose ear-and-gin myself, but it will be a CHOICE and not just the default because i had no idea, walking through the doors of st. earache-and-nappy-rashes hospital for women, that that's what i was letting myself in for!

Bx

[maz]

Now what Id like to know...if its 'extra work' and 'extra expenses' ...how can it be???

Dont these guys use computers and have 'codes' that tick boxes. Are all our files in hospitals on computer. I know when I booked in for my c/s that it was all done on the computer and the admin asked if it was elective or medical elective c/s. what's the big friggen deal if they have to hit one more friggen key on the keyboard.

I have no doubt in my mind that the boards of hospitals have enough statistics about their c/s rate's compared to vaginal births to take to their monthly meetings. How else would they be able to work out their expenses and medicare repayments?????

I think a birth plan is a good idea...is a friggen start in the right direction of being in control of birthing the way you want...and its a hell alot better then going in all doey eyed. I had no birth plan with my first 2 and fell flat on my arse...yet thanks to BB and the advice I recieved here..I had one and it made my 3rd emergency c/s a hell of alot better. So lets not condem and make it sound so negetive when infact its actually positive!

[Ellibam]

hoobley its a game of chinese whispers!!!
quite a few of us get it but a few that just pop in cos it seems to be the "in thing" arent reading any of this right.
my mum is a m/w of 30+ yrs and she sits down every month and has to do the hospitals statistics.
my IM m/w has to put in her statistics to( and she goes in to te detail we want even though her tranfer rate is about 4% and c/s rate is 3 women in 7yrs doing four births a month)
so why cant private hospitals here in adelaide give out there stats??
(the public ones it is available to anyone who looks)

[Snacks]

Well then then wouldn't you want epidural rates, vaccuum rates, forceps rates etc publicised (dont know if they already are).

Well, sure. That'd be interesting reading too The fact is, that many unnecessary ceasareans wouldn't occur if dr's didn't intervene with the above in the first place. So yes, I'd want to know those things, but the c/s rate would give me a fair idea without knowing those things, KWIM?

I was just trying to say that the only way to really secure an in control birth, low risk of "intervention", is birthing at home, b/c.

I hear you, but do you not think that is something to remedy? We CAN achieve a low-intervention birth in hospital if we are educated, aware and well supported. In order to educate ourselves we need to get our hands on information. The information should be freely available.

[Pretty Butterfly]

What happens to a woman who is sent back to a regional community after a traumatic birth (having had to travel hundreds of km's to birth), where there is NO maternal health care reasonably available to that woman (and there are many women in this situation).

Would it not be better for that woman to birth via c/s if she wants? And wouldn't there be a higher incidence of this type of c/s in those areas?

?

I dont see how sending her back after a "traumatic" birth is worse than sending her home after a C/section, if she has no care afterwards????

And I cant see how if you had to travel 100kms away, a c/section would be better if there is no medical need? A vaginal birth where your up immediatly and can leave asap, or major surgery? I would of thought it a no-brainer....

[Ellibam]

my mum works in a country hospital that has women comeing from upto 300kms away to birth because no other option is available and there c/s rate is about 23% for first time mums. (yes it is split between first time or having previous pgs)so much lower then the private hospitals that are mentioned having such high %s

[canberramomma]

I dont see how sending her back after a "traumatic" birth is worse than sending her home after a C/section, if she has no care afterwards????

And I cant see how if you had to travel 100kms away, a c/section would be better if there is no medical need? A vaginal birth where your up immediatly and can leave asap, or major surgery? I would of thought it a no-brainer....

Well, you have just illustrated m point exactly. It is of absolutely no benefit for women and children to publish these figures per region as every region, as with every birth, has many different variations!