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

**sushee** · November 21st, 2008, 09:52 PM

I was thinking about this in the shower, and I think I've nailed down what's been bothering me.

It's the term 'choice'. I touched on it before but will speak more plainly.

What it sounds like to me is that those who are going on about 'choice' are actually talking about wanting to choose a c/s. They talk about their birth choice like it should be beyond criticism (even if the criticism isn't at all directed at them), and over and over again feel the need to defend themselves.

Yet what about those women who actually wish to choose a VB? Who wish to choose a hospital that will less likely to introduce interventions? Who wish to be informed of their birth choices? What about their right to choose? By saying you don't need it when a woman is saying she wants that information, you're effectively inhibiting HER birth choices.

If anyone here is truly advocating choice, why it is you then object to women having access to information that will assist them in making that very choice??

Because I see the opposite of what you're fearing happening with the introduction of measures to make hospitals accountable - women will have a true, informed choice, be it to have a c/s or to have a vb.

So you can't have it both ways. You can't talk about wanting choice, but then say other women shouldn't have access to information that will assist them in making their birth choice.

**Ca Plane Pour Moi** · November 21st, 2008, 10:07 PM

I foresee one BIG problem.

The hospital "uses up" the amount of sections they are "allowed" by management for the month by day 2 (or maybe 1 - surgeons like chopping you up, admin like nice statistics).

A woman attends on day 3 and is going to die without a section. This rarely happens, the surgeons know, so they didn't leave a space for her.

What to do? The woman die so they can have more sections allowed by the top brass? Or be told off and fined because their section rate is now "too high"?

**sushee** · November 21st, 2008, 10:18 PM

If an ob purposely ignores a woman in obvious need of a emergency c/s woman simply because he/she is worried about the hospital statistics, I reckon he/she deserves to be sued for malpractice. Because at that point, when a woman actually needs a c/s, is when he's supposed to be doing his job, and not performing unnecessary c/s on women who didn't actually want them, but was coerced into one.

To me, if this makes a Dr think twice about pressuring a woman to have a c/s when there is every possibility that she wouldn't need one at all, I think that's a hell of a positive outcome. If obs go back to peforming c/s on women who need them to save her or her baby, I think that's another positive outcome.

I loved birthing in a birth centre. If, by some miracle, I ever fell pg again, I'd be booking myself into one so fast your head would spin. But if I couldn't get into one, I would choose a hospital birth over a homebirth. I don't want to birth at home, I don't want to have my teenagers in the next room watching tv, or wanting to have their friends over (this actually happened while I was in labour).

So I would want to attend a hospital that had low intevention rates, because I would want a vb. So would it be helpful to me if I could then find out which hospitals had low intervention rate? I think so.

**Ca Plane Pour Moi** · November 21st, 2008, 10:23 PM

Sushee, I'd love to find a hospital that had low intervention rates. Just one. Anywhere in the world. Because I don't believe they exist.

**sushee** · November 21st, 2008, 10:25 PM

Aw hun I don't blame you after what you've been through. Perhaps I should have said 'a hospital that had a comparatively lower intervention rate'.

**Ca Plane Pour Moi** · November 21st, 2008, 10:33 PM

. I would love rates to be published too, but I don't think it will affect anything. Rates in the UK are published (as has already been mentioned) and it doesn't stop scalpel-happy surgeons. But I know a hospital is paid more for a section than for a happy woman here. In Australia, they get more money from more women, yes? So the management will do all they can to attract women - which may include stupid limitations on C-sections. I'd give birth at the end of the month in that type of hospital!

I don't see why anyone who wants to know about the quality of care should be denied a hospital statistic. You can ask for infection rates, for morbidity statistics, for how long you have to wait for an appointment, for how much it will cost... why not how many operations are performed on what percentage of patients with a condition (such as pregnancy...

yes, now a medical condition as defined by a hospital!).

ETA - just looked at my own records on the computer. I saw my computer maty notes, from which stats will be pulled. Apparently I had a live birth. And no drugs administered whatsoever. Quite interesting reading. So someone doesn't put the details on the computer and bam, your targets are met. And I was only in under a midwife, no Obs. Best check these are my records and they've not confused me with... an imaginary patient because no bugger is allowed to not have drugs in here.

Lea79 · November 21st, 2008, 11:05 PM

I voted no. I agree with other posts who have said you have absolutely no idea why these c/s have been performed. Having a strong support person is more important than looking at c/s rates of a hospital. Ensure you try every possible way before c/s needs to be done. A hospital who has supportive midwives are also very important to avoid a c/s delivery too. C/S are fantastic resources to have, when mums or bubs run into serious trouble we count our blessings that there is such an operation as C/S but we also know the risks of them too. Having a vaginal delivery is most optimal but I believe when people look at C/S as the enemy and then when it needs to occur the woman can feel like she let herself and her baby down and it contributes toward PND. All I'm trying to say is dont put so much pressure on yourselves. In a perfect world everybody would have vaginal deliveries with no vaginal or internal tears but the reality is occasionally a C/S is required. In the end, does it really matter if you dont know the C/S rate of a hospital? The statistics just dont tell the truth. Having strong support people and a midwife who is too is far more important.

**sushee** · November 21st, 2008, 11:13 PM

In the end, does it really matter if you dont know the C/S rate of a hospital?

Actually Lea, it absolutely does matter to me, and obviously to a lot of women who have posted on here who have said they want access to those stats. And it also obviously matters to all the women who voted 'yes' in the poll.

Lea79 · November 21st, 2008, 11:25 PM

Sushee I said this because the statistical info isn't enough, they will never release confidential information on details why the C/S was performed which makes the information useless as its so inaccurate. If someone is going private look at the individual Obs C/S rate as it isn't always the hospital but the Ob. In the public sector its totally different but like I said have good support people around you and you cant go wrong

**sushee** · November 21st, 2008, 11:35 PM

I don't necessarily agree with that assessment, Lea. I think stats are often successfully used to identify trends, performance and anomalies, amongst other things.

In fact we use stats all the time, in govt and sales and mining and all sorts of other industries. There is value in stats. Sure it may not tell the entire, unfettered story, but it will give you a pretty damned good idea, and if nothing else, it can give you a platform by which to start to form a decision about your birth.

I for one, like stats and would like to see every hospital's stats on their c/s rates. if I want to see the hospital stats, why shouldn't I be able to? What's the big secret?

Lea79 · November 21st, 2008, 11:49 PM

Thats true, I agree with you there. I'm just saying you dont get the complete picture without details of the birth but it might reassure your confidence in that hospital. I dont mean to sound like I dont agree with you seeing it, as long as it helps and not hinder. I think everybody should birth in a birth centre or at home and avoid having to worry about all of this.

**sushee** · November 21st, 2008, 11:54 PM

The thing about information is that if you don't want to have it, you don't have to seek it out. But if I, or anyone else, wants it, I think it should be available. So in that respect, I'm glad we agree, matey.

**Charlie08** · November 22nd, 2008, 12:46 AM

i agree statistics should be available. when i went to antinatal class at my hospital they told us all what the caesar rate was for the hospital the month prior. however i totally disagree with the title "name and shame" and like any statistics that are put forward i believe a break down of the information is vital. Like it has been said before, we dont know why people have caesars. so it doesnt really prove much anyway. i think we are just so lucky that we live in a free country and we can choose our birth. what ever is right for us as individuals is what should happen.

**Neenee Jellybeanie** · November 22nd, 2008, 01:34 AM

I'm up to page 4 but I have to comment lol.

The whole "naming and SHAMING" phrasing; I agree that it's counter-productive, but I think the reason why it's been titled such is because the statistics for C/S are so much higher than what the W.H.O recommends. That's where the "shame" lies - the fact that we can pretty safely assume that many if not most of the C/S being performed are unnecessary, which in turn puts both mother and baby at risk.

I'm going to come back to this as I read through the topic.

First of many edits;

A lot of people are saying "its no ones business/all that matters is safety". The reason why this information should be freely available IS safety; in normal pregnancies, vaginal birth is safer than C/S births. There are circumstances that require C/S and no one is saying that they shouldn't be performed in those instances, but the fact remains that unncessary C/S are being performed in Australia which compromises the safety of mothers and babies. No personal information would be made available so it's not an invasion of privacy by any stretch of the imagination.

edit:

I think people are taking this issue too personally. It's not a criticism of anyone who's had a c-section and no one is trying to say it is. Birth is a very personal, emotional experience so it makes sense that we would respond emotionally to it, but this isn't about emotion its about freedom of information.

A lot of people are saying that the statistics won't have a context. That's easily avoidable. As has already been said, there could (and should) be a complete statistical break down of what interventions were performed under what circumstances. Women aren't idiots, we can sift through the information given to us and make a judgement based on reason. The notion of not giving statistics in case some people misinterpret them seems pretty moot, lets give ourselves a bit more credit here!