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

[maz]

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

Im going to have to ring my hospital as ask to see if they give me their c/s rate.

Ive heard midwives and OB's at the hospital say

dont give birth on tuesday or thursday...its c/s day

so if their saying this then surely there has to be some data SOMEWERE in their system to back it.

We have freedom of privacy and freedom of speech......so why not freedom of information of statistics that again HAVE NO NAMES ATTATCHED TO THEM

Have any of you EVER seen your doctor records let alone your hospital records?? Doctors tend to NOT give your your medical records but prefer to pass them on to the new doctor themselves....have you every wondered WHY? Its information about you


Hospitals and doctors need to be made accountable for their auctions...god we trust these people with our lives so why the hell cant we demand some statistics before we go giving them a ok to cut us open full stop!

[Tobily]

well also too i think it would cost too much.

This information is already gathered. They already know it.

You should see the amount of paperwork that is done after a birth. I was at a birth a couple of days ago where the mother was standing against the bed pushing, the midwife was sitting on a footstool behind her waiting to catch the baby and filling in the paperwork in between pushes! Anyone who has gotten a full copy of their labour notes can attest to the information they collect for the hospitals purposes.

Releasing this information would not involve any significant additional cost whatsoever.

[norquesta]

Warning - for people who do not want to know the statistics of hospital, please do not read this post.


Most level three hospitals have lower rates of intervention then Level 2 & 1 hospitals. But hospitals vary dramatically - this can not be explained away by saying certain women are going there, the local population or a specialist program are affecting the results.

We have a serious problem with our maternity health services.

Each hospital (private and public) has their own policies.

Each private Dr's or Midwife also have their own way of practice.

This is what is affecting the outcomes for mothers and babies.

We need easy access to statistics of all maternity services.

Let's prevent woman saying "but no-body told me'!

Here is some example for Maternity Performance 2006
http://www.health.vic.gov.au/materni...m-ind-0607.pdf

Caeserean Rate for: Standard Primiparae (1st time) low risk mother.
Frankston Hospital 30%
Mercy Werribee 27%
Stawell 43%
Ararat 5%
West Gippsland (Warrigal) 9%
Monash Medical Centre 13%

and these,
Term infants transferred or admitted to SCN or NICU for reasons other then birth defects,
Royal Women's Hospital 4%
Mildura Base Hospital 29%
The Northern 12%
Box Hill 11%
West Gippsland (Warrigal) 1%

and this is interesting,
Rate of third or fourth degree perineal tears in standard primiparae
Barwon Health (Geelong) 11%
Sandringham 1%
Casey 2%
Monash 3%
Warrnambool 10%
Royal Women's Hospital 6%

As a post note: I just rang the Stawell Hospital to find out what level hospital they were and found out ........... they are not open - they are on by pass to Ararat - as they are every second weekend. Just to remind everyone Stawell CS rate is 43%, Ararat 5%.

What is going on?????

[Tobily]

OK so this is particularly interesting from the report that norquesta has linked to above:

Data variations

A constant feature of the Maternity services performance indicator report over a number of years is the variation between hospitals. Understanding the root causes of the variation is a critical step in working towards improved outcomes.

Wide variations in key outcomes suggest that clinical practices differ significantly between hospitals which, in turn, raises the question of whether these variations can be attributed to disparity in the application of evidence-based practices. A strong argument can be made that improvements in consistency in practice, informed by research evidence, are likely to lead to fewer interventions and improved overall outcomes.

Some examples of wide variations in the 2006?07 report
relate to:

* rates of induction of labour in standard primiparae
range from 3.4 per cent to 42.9 per cent
* caesarean section rates in standard primiparae
range from 0 per cent to 50 per cent
* rates of planned VBAC range from 4.8 per cent
to 62.5 per cent
* rates of term infants requiring transfer or admission
to SCN or NICU for reasons other than birth defects
range from 0 per cent to 29.4 per cent

These figures are for LOW RISK, first time mothers. These disparities are HUGE - and are occuring amongst groups of women whose risk levels are low and theoretically the same. The difference between them is that they birthed at different hospitals.

Food for thought.

[richsaralex]

Now THAT is scary!

How do they justify a difference like that - 43% and 5% between two neighbouring hospitals? Its gotta come down to the doctors working there and the hospital policies, doesnt it? So cant they just regulate the hospital policies... but then how do you regulate the doctors??!!

[BellyBelly]

Warning - for people who do not want to know the statistics of hospital, please do not read this post.

ROFL!!!!!!!!!

[Bathsheba]

Good to see this thread getting back onto the real topic: Hospital stats... and not people's personal experiences of birth.

I think stats are important. I agree they can be misused but that is the risk with any type of information... information is power... power is prone to abuse... but it doesn't mean you should deny information.... that is just disempowering. Someone questioned the purpose of stats in this situation (c/s rates per hospital). Well, the World Health Organisation uses stats to explain what they believe are ideal rates.... should they not use stats either?

I had a chuckle at Hoobley's comment: "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 introduce the whole bottle/breast debate in!WTF girls?"

I think our education system has a lot to answer for. ETA: ok, that was harsh... but it's not hard to see through the poor (tabloid) manner in which the poll was worded and see the bigger picture: "give information or hide it?" THAT'S what this boils down to.

[BellyBelly]

OoOeeer it's now equal!



Yes
43% (603 votes)
No
43% (603 votes)
Only in extreme cases
13% (194 votes)
Total votes
Total of 1400 votes

[Ellibam]

How do they justify a difference like that - 43% and 5% between two neighbouring hospitals?

that is why it has been brought to the media's attention because there are huge difference and that is what needs to be addressed!!

[Kazznazz]

I would like to think all obstetricians and hospitals should have all their statistics available to us as customers (taxpayers or private clients).
If they feel that their practices are nothing to be ashamed of then they should have no problem with the idea of statistics being published. If they are ashamed of their statistics then perhaps they should look at the way they conduct their business and the reasons why they are embarrassed by them. I can't imagine that anyone should have a problem with this.
It is absurd to think that accountability is in any way an attack on the women who have had some sort of surgical intervetion during the birth of their children. We should all be concerned, however, when childbirth routinely becomes a matter for surgeons. The dangers associated with any surgery, the financial cost to the community and the social impact should all be matters for public discussion and scrutiny.
I think that women should most certainly be allowed choice in the way they give birth but I also think that transparency in obstetric practice is great incentive for obstetricians to offer more accurate discussion of options.
Loving support should be given to all new mothers, anything less is unthinkable, but this is a seperate question from the question of whether or not we should be allowed to know the philosophies and practices of the people we are going to surround ourselves with during the birth of our children.

[baby4]

Like many others out there I have had 2 c's and one vbac. Both of which I was reasonable happy with. My 2 cents is yes but put in the reason that the procedure was carried out.

[maz]

I think our education system has a lot to answer for. ETA: ok, that was harsh... but it's not hard to see through the poor (tabloid) manner in which the poll was worded and see the bigger picture: "give information or hide it?" THAT'S what this boils down to.

in all honest babe....I dont think the banner was poorly worded at all after Norquesta's post.

that is friggen amazing. I knew it was bad but ****....come on girls..all you out there that said DID WANT TO KNOW..dont say you didnt read it....arent you just a little concerned now?

[~mamaspice~]

I think the statisics should definately be available. Not necessarily to name and shame hospitals so to speak, but so that people can make an informed choice. I wouldn't mind knowing the individual stats on private OB's either.

I can definately see why tertiary hospitals may have higher than average cs rates due to handling more high risk cases but the same doesn't really go for private hospitals. Considering most are not as well equipped as the tertiary hospitals and some don't even have theatre staff ready and waiting 24/7 so they are not exactly the perfect choice for "high risk" pregnancies. Perhaps this has something to do with it? OB's prefer to book in CS or take a labouring women down to theatre for a CS at a time that is convenient to them JUST IN CASE of emergency. There is no doubt some caesareans are very necessary but you don't have to be Einstein to know lots aren't. And as someone else said - fair enough if someone wants to choose a caesarean, but those who want the best chance of avoiding one should have some statistical data to go by.

[plc1805]

I don't know why i was emailed about this thread but I was, so feel I have every right to put my 2 cents in. Basically, I could have written charlie08's post myself.

[Kazznazz]

It is important to recognise that the World Health Organisation recommendations take into account all kinds of pregnancies, high and low risk. Although high risk pregnancies are often funneled into hospitals that are equipped with higher care facilities these larger hospitals also frequently have a higher overall number of childbirth admissions. A higher rate of C/S, say toward the 15% rather than the 5% would be expected in these hospitals but it is very difficult to understand a C/S rate of 30% - 50%+. A a clear description of the circumstances surrounding the statistics would be important in assessing how reasonable the intervention rates in a particular hospital are. I think, as Baby4 pointed out, it is important to describe the whole picture - why the C/S was performed, the health status of the women on presentation, the demographics of the population accessing the particular hospital/obstetrician, the idea of what constitutes high risk in the minds of the particular obstetricians evaluating the health status of these women. As with many childbirth questions it can be difficult to process the details of these situations so we may need sometimes to look back at the big picture which tends to reflect the general philosophies that probably abound in the institutions in question.

[suse]

...it is important to describe the whole picture - why the C/S was performed, the health status of the women on presentation, the demographics of the population accessing the particular hospital/obstetrician, the idea of what constitutes high risk in the minds of the particular obstetricians evaluating the health status of these women.

Excellent point Kazznazz. I think that a majority of obstetricians who favour caesarean sections do genuinely believe that they are offering women a safer choice. In the mind of someone who is medically and surgically trained to deal with complications and high risk births, a caesarean may seem a safer option, as it offers a means of controlling some of the variables.

Also, it is a psychological trait to overestimate the general incidence of something based on your own experience of it. By this I mean that if an obstetrician deals with predominately (and genuinely) high risk births, and is asked what they think the incidence of high risk births in the general population, they are likely to overestimate by a significant factor.

Aside from being a good justification for a midwife led model of care, it is another reason that transparency in statistics relating to intervention and caesarean birth is potentially so valuable - it may help obstetricians to understand when they are overestimating risk factors in the women who present to them.

[midi27]

I agree wholeheartedly with Kazznazz. With the 2 hospitals with the 43% vs 5% C/S rates. If the hospital with high rates are frequently on bypass they might be open during the week & be able to do elective C/S and any inductions but being closed on weekends might actually have women who birth vaginally but do so at the other hospital. While this wouldn't explain such a high percentage it might explain part of it. Also 'elective C/S' doesn't mean asked for by the woman or her doctor, it just means the need for a C/S was decided prior to labour, while an 'emergency' is during labour, thus a pre-booked C/S for grade 4 placenta praevia is still classed as 'elective' even if not woman's preferred choice of birth pif all was well

[Ca Plane Pour Moi]

TBH, I'd like to see hospitals have 90-100% C-Sections. Because I'd like to see women going to Maternity Centres or having homebirths - and not having to pay extra for this. You only go to hospital if you NEED to.

So you have 50 women a year having sections in your hospital rather than 500, but that's 90% of your patients and not 50% of them, IYSWIM.

So I don't think publishing the rates alone is useful. Publish transfer rates, local other centres, publish WHY the sections are done there: maybe the most skilled surgeon is there so the first hospital with the low rate transfers to the high rate hospital for best care? I agree, just a percentage alone is not helpful whatsoever.