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

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Yeah, it's not a statistic that you can just blindly go by tho. Like you said Kelly, if the rate is 60-70% I'd want to know why. If it is because all the high risk cases are transferred there, then that's something you can take into account.

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This is the thing - the large, public tertiary hospitals that get all the high risk and tough cases aren't the ones with the caesareans rates through the roof.

The hospitals with 50-80% c/s rates (and there are many) are private hospitals. They are hospitals where every birth is overseen by an obstetrician.

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This is probably a dumb question.. but are the statistics available already if you want to know? Is this about publishing an article and naming the hospitals? or is it simply about making the information available? I guess I should have asked before voting huh. hehe.

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All public hospitals are required to disclose their c/s rate.
About 10 years ago (coincidentally when the c/s rate started to rise) private hospitals in QLD began burring up about this being on the public record and they no longer have to disclose. The only indication a woman can get up here is to look at the rate of ALL private hospitals lumped in together, which can be found in the state perinatal data, or rely on the honesty of the hospital/obstetrician. I can tell you right now that the hospitals and OB's that are sporting those rates are NOT telling them to anyone who asks. Why should they? There's no one telling them they have to.

For everyone who doesn't understand why this matters, let's put it another way.

If you were wanting an elective caesarean, and the hospital you were planning to birth at wouldn't tell you how many caesareans they do, or wouldn't tell you whether you could have one until you were due, or already in labour would you not feel that critical information that you need to make an informed decision about where to birth was being with held from you?

For a woman who wants a natural birth, this information is absolutely imperative. In the work I do, I often see women who have obliviously booked into a hospital or taken on an OB with a caesarean rate that I know is going to make their natural birth an uphill battle all the way. There is little point planning for a natural birth, engaging a doula and then walking through the doors of a hospital with an 80% caesarean rate.

I'm sorry I really can't understand how anyone could object to women being able to access this information. It just baffles me.

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I wouldn't say these women are stupid and putting their babies at unnecessary risk though.

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I didnt see anywhere the OP said they were stupid?

Good for the women who want a VBAC..

nothing wrong with it, and def not against it.


back on topic...

But again there are many many different reasons behind a c sect and we do not know these.. each and every labour has different circumstances so naming and shaming hosptials with high c sect percentages does no good without the info behind it to back them up.
what some women think is a legitimate reason to have a c sect other could be dead set against..

I see absolutely no reason why statistics shouldn't be freely available.
The name & shame label is perhaps counterproductive, since it sets people's backs up, but really, what have these hospitals got to hide that they don't want to release stats? If they've done nothing wrong and are acting correctly in their patients' best interests then what's the problem?

hmm.. I never quoted the OP? Just saying that these women aren't stupid.. they're probably the most informed of the lot of us for these 'riskier' births.

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All public hospitals are required to disclose their c/s rate.

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Thanks Tobily for answering my question.. thought it might have got lost back there ;)

Well, if the information is already available, then I guess I'm not really for the whole naming and shaming if the shaming is it's sole purpose. I kinda jumped in thinking it was just about making the information available.

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what some women think is a legitimate reason to have a c sect other could be dead set against..

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Well said hun. I think most women weigh up the risks and the information they are given, and try to make the best decision for them and their baby. In some cases, yes they are misinformed and choose to have c/s for reasons that are not valid (like the too posh to push brigade on 60 mins saying they didn't want their veejays stretched) but even then, they believe they are making their decision based on what they think is fact. They obviously havent researched extensively enough but that is the choice they have made for reasons they believe are valid.
As far as "risk"goes.... I was booked in for a c/s at 9 days because of "risk"I was able to push it out to 14 days because I was determined, had done my research etc.... Other women would have taken the 10 days at face value and agreed, just as I did with the magical 10 days over and getting induced with Isabelle. I still believe the info should be there for those who want to make an educated choice about what they think is best for them and their baby. I also think that what I see is "risk"is different to the next person- I know many people at my mothers group can't believe I went to 14 days considering I was "high risk"and I know others who probably though I should have gone longer, but my "risk"assessment ended at 14 days. Ugh not sure what I am getting at but hopefully you all get the point.

As I believe in Freedom of Information and Transparency in public services I will be voting Yes.

Some people have posted opinions based soley on their experience without seeing the big picture... I see this as a bit futile, no one is suggesting womens' choice will be compromised... only the ease at which women can inform themselves. This is a discussion about a policy that will affect everyone, not just an individual.

ETA:

Yes
38% (475 votes)
No
46% (571 votes)
Only in extreme cases
14% (184 votes)
Total votes
Total of 1230 votes

its only the public hospitals that Have to share their statistics... private hospitals dont and this is ultimatley what sandra knack is trying to change.
so that eveory one can see which hospital has the higher rates of c/s and intervention.
then from that point look at why these hospitals are having such high rates.
i dont think they would ever name and "shame" an ob......

also most of the stats dont go in to to much detail either a vag birth is still a vag birth doesnt matter that you had an every thing from gels to synto with gas to epidural or episiotomy to suction.
the only time its not a vag birth is when bubs comes out the sunroof!
which isnt a good way to do the statistics as we all know because there are so many variables.

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Kellxx, I don't know about anyone else, but your words have kind of offended me. Maybe you could think about re-wording you first post?

As for there being nothing wrong with caesareans....well as long as they're necessary! Which obviously some are, they do save lives. But you are aware that a caesarean is major surgery? That is not without risks?

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Um.. im an unsure how my post offended you?? Saying that as long as mum and baby are ok at the end of the day is offending? i dont get it. I have reread my post and i dont think i needed to reword it, because its how i feel. If i did offended you, i would think you would do the right thing and pm me regarding this.

And yes i know it is major surgery, but the thing is vaginal birth is pushed to be this most beautiful pleasant easy experience when it always isnt the case. c/s are put to shame because they are major surgery, you may have a longer recovery period and the baby may need assistance once born.. but what i was trying to put across in my post is, what is most important is that mother and baby are ok and are both alive to see the next day. As i also said, in my case, my first vaginal birth was a nightmare. It put my son's life at risk. Thankful he was born before quite fast otherwise i would have had a c/s and would have totally agreed to it. As for recover, i could not walk for 3 months afterwards, nor stand for longer than 10 minutes at a time. I could not DTD without being in pain to the point my eyes watered until my DD was born. So not every vaginal birth is wonderful. I just dont see the whole negative aspect of c/s that the article is trying to portray, when the majority of the time they are there for a reason.. to save lives.

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???
I have never heard of a mother, IRL, or on this forum, or any other, try a vaginal birth if they have been told it is too risky for mum or bub.

I dont know anyone who would do this to their child???

And even if some do, I doubt the numbers would be very high at all, enough to sway the c'section rates anyway....

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A good friend of mine lost their child because they refused to have a c/s when they were advised it was the best option for mother and baby.. but she had her mind set on a vaginal birth. I also know of another 2 people who i dont know personally, but have lost their babies due to the same reason. It does happen, and i think these OBs give advice that a c/s is neccesary because they are trained in that area and know what they are talking about.

QUOTE: Saying that as long as mum and baby are ok at the end of the day is offending?

I would say it could be quite upsetting... birth trauma is a very real situation and by telling a mother that she shouldn't be traumatised (by either a c/section or vaginal birth) because her baby is safe is very dismissive and will make the trauma worse. But that is off topic. If women feel fully informed then trauma is less likely to occur. A policy allowing women to be informed could reduce birth trauma.

ETA: and I would suspect that if there were less women with birth trauma there would be less women with PND. This is why being dismissive of "how a woman gives birth" can be upsetting.

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A good friend of mine lost their child because they refused to have a c/s when they were advised it was the best option for mother and baby.. but she had her mind set on a vaginal birth. .

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I find it extremely sad that anyone would put a vaginal birth over the true safety of their baby.....

Actually, I find it a little disturbing.....



ETA... By true safety I mean, REAL stats, not just a Ob saying so... My ob said a c/section would be safer if Little Girl stayed breach, and that is JUST NOT TRUE....

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QUOTE: Saying that as long as mum and baby are ok at the end of the day is offending?

I would say it could be quite upsetting... birth trauma is a very real situation and by telling a mother that she shouldn't be traumatised (by either a c/section or vaginal birth) because her baby is safe is very dismissive and will make the trauma worse. But that is off topic. If women feel fully informed then trauma is less likely to occur. A policy allowing women to be informed could reduce birth trauma.

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ok so you would prefer me saying the opposite?
ETA.. im sorry, but i dont see where i said a mother shouldnt be traumatised, nor that giving birth is easy.. If you would read what i said about my birth with my son, youll see it wasnt easy sailing for me either.

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I find it extremely sad that anyone would put a vaginal birth over the true safety of their baby.....

Actually, I find it a little disturbing.....

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As do i.. that is what i was trying to say.

I believe it would be best if all women had realistic expectations of the kind of birth that is right for them. A women who enters a hospital who has an expectation far removed from reality is going to be at risk of birth trauma.

I fail to see how fully informing women will be against their best interests. There is nothing wrong with having an emergency c/section, that goes without saying.... but there is something very wrong with allowing women to attempt to give birth in an environment that is going to statistically lead to a very different outcome to what the women believes will be true... and that applies equally to natural or c/section births.

This is not about who should have what and what is the best way to give birth... can we please stay on topic? This is about if the rates should be published for consumers to see... some may not want to but many also make their healthcare choices based on things like this.

I would be very interested in seeing different Dr's individual rates if I was going private and could choose who I saw.

If you don't have an OB (I don't have one, never have, never will ) then knowing the rate of the hospital you are going to can be a useful thing to know. It can also be a good idea to have a chat to a few of the midwives where you are thinking of booking in - many will be quite honest in telling you if they think too many unnecessary c/s are being performed.

She may as well name and shame women who have abortions too while she's at it. :rolleyes:

MP's with nothing better to do bore me.

There are so many factors like people say. Sigh, and we financially support these people in our government. Meh. :wall:

Are World Health Organisation Recommendations superfluous to our needs? Should they just save their breath as they attempt to advise us of best practise health policies? Maybe they have an evil secret agenda? Why on earth would they recommend a c/section rate of between 5 - 15% ??? Why I wonder?

YES!
Our local private hospital has a rate of above 80% - they bulldoze people into intervention and then decide to caesar them when it gets close to knock off time.
Prospective clients need to be made aware of this!:pray:

But I agree that the figures need to be carefully categorised - but of course no money-making venture like that will agree to releasing that information.

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YES!
Our local private hospital has a rate of above 80% - they bulldoze people into intervention and then decide to caesar them when it gets close to knock off time.
Prospective clients need to be made aware of this!:pray:

But I agree that the figures need to be carefully categorised - but of course no money-making venture like that will agree to releasing that information.

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That is seriously messed up. That is the exact sort of thing that people need to know about!

Basically on the grounds that this article is surface only. The comments made by MP Sandra Kank seems to be sensationalised for the mere purpose of getting attention and barely covers any really substance at all.

Why are these hospitals performing caesareans?
How many of these stats were elective?
What are the age & circumstances of all these women?
Why does she view the practice in such a negative manner?
Why are there more stats for private hospitals over public?
What other options were these women offered?
What were the risks if a caesarean was not performed?

Just a few questions not factored in to this shallow survey.

When you get to the bottom of her comments, she mentions the 'worst performing' hospitals.

What does this mean anyway? Very vague. Does she imply that caesarean procedures bring down the standard of a hospital?

I would be more interested in understanding the reasons behind an increase in caesareans and then taking a look at success rates (I mean healthy baby & mother), low death rates, reduced birth complications than wondering which hospital does more surgery and why they should have a black mark put across their name.

I dont think its is any of her business to start with. from what i understand of the situation is that an OB recomends it in thier professional opinion as being the safest option for mother and baby. Is she an OB? and is it going to stop peolpe from delivering in that hospital? I would have to say i would favor it for the reason that if it was going to look trickey at least they are not affriad to do one!

I'm sure Kelly would have the exact stats but I believe that the countries with the highest c/section rates (Australia and USA) have much higher infant/mother mortality rates than countries with lower c/section rates; Scandinavian countries for example. I wonder how that works then if c/sections are so "safe"?

I really can't believe that this is an issue that an MP is involved.

Seriously though, why should private hospitals release these details. Yes I get that you want to know to choose where you want to have your baby, but really. This is nobody's business from the private hospitals prespective. The rate will be higher in private hospitals anyway, everyones knows that. So why not then just choose to go to public hospital?

This is really small things amusing small minds. There are much worse things going on in the world than worrying about what the c/s rate of your local hospital is. I am so over people in Australia having a opinion on c/s. It is the mother's choice and she will make that choice by recommendation from her doctor.

So my vote is NO

Yup Aus is *just* higher than the USA, but the USA has the highest infant mortality rate in the developed world. More isn't better, best care and best technology are completely different and far apart. I'm shocked so many people don't care for the statistics of where they are giving birth, but what is important to one isn't the other.

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So no-one would be concerned at a hospital with a 60-70% c/s rate? You wouldn't question that and what's going on there? Because some of our Obs/hospitals have rates that high. I'd definitely choose a hospital with a 20% rate over 70%, if I birthed in hospital again.

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Kelly I don't think that you would have to question what is going on there. I think it would be pretty obvious that a majority of women going to that hospital are electing to have c/s's. Just because that hospital does have a high c/s rate doesn't mean that you couldn't go there and have a v/b. I think it would be a matter of having a good relationship with your ob, and having a plan as to how you were going to approach the birth. speaking from my own labour and birth (vb without epi) I couldn't have had a more positive experience, and I am sure that the private metro hospy that I went to would have a high rate of c/s's. Even if they had a 70% c/s rate I would go back there again.

Many women are making a choice to have c/s's these days, and I don't think the beaurocracy (sp) of a hospital should have the choice in telling a woman that they are not allowed to have a c/s. therefore if we are going to be naming and 'shaming' hospitals for giving women what they want (whether you or I or anyone agrees with their decision or not) then we are also going to be 'shaming' the women for the decision that they have made. I am all for hospitals providing information on all of their practices from birthing through to medical operations, but I don't think that the hospital or the women involved should be shamed or feel shamed for making a choice.

This is the last time I am going to come in here and say this: Can we please all stay on the topic because this is NOT a vaginal v c/s birth debate. If anything is posted off topic or not relevant to the discussion then it will be removed.

I just checked out a chart on infant mortality rates... and yes, much safer to give birth in all of the Scandinavian countries who have low C/section rates, more in line with World Health Organisation recomendations.

If C/sections are the "safest" means of having a baby you'd think that the countries that have the most c/sections would have the best mortality rates... why is the opposite the case?

ETA: sorry Trillian... I hope I haven't been out of line in this thread. I'm just trying to work out if high c/section rates equate with safety... delete my post if I'm OT. I was just trying to compare country of birth to hospital of birth.... drawing a comparison. I'm not suggesting that all c/sections are unsafe.

I voted yes... simply to help aid those who wish to make informed choices. Hard to do if no-one gives the facts.

C-section rates should absolutely be available for all hospitals which have maternity services!!! Women have an absolute right to information which absolutely informs their chances of having an operative birth. Rates would be best broken down to elective and emergency c-sections, as well as c-section rate per induction.

How on earth are women supposed to make an informed decision about maternity services when this kind of information is not available? Private OBs in private hospitals are still seen as the "gold standard" of care. Perhaps if more women were aware of the greater likelihood of a c-section, regardless of an absence of pregnancy complications, they may be able to see more clearly what type of maternity care truly benefits them.

Another telling statistic would be c-section rate per obstetrician.

I agree that more important than the CS rate is the intervention rate. There are loads of unnecessary interventions which do lead to an emergency CS, but there are also loads of VBs with high intervention. A CS is an intervention.

I am concerned at the hospitals that choose to CS because the staff want to go play golf, or have dinner reservations and I would be wanting to see that stats on that, But I am more concerned about interventions than the actual CS rate. I think I will vote for the extreme circumstances, as I believe these will be the ones CSing for golf or dinner.

just to be clear I was not debating vaginal v c/section. I was simply stating that to me the c/s rates do not mean that the hospital is good or bad, therefore they shouldn't have to be published as part or a "name and shame" campaign which would or course shame the mother too. However all public hospitals should have to provide detailed information about their practices and procedures so that women can find a hospital that suits them best.

I voted "no" on the "shaming" aspect of the question. While there's no harm in information being available forums such as this one allow women to research and discuss hospitals and make informed decisions.

The hospital I gave birth at has a very high c-section rate, I knew that in advance and I spoke to my ob my about it because I was worried. He told me the figures are distorted because they include all the women who have chosen elective c-sections, of which there are a high number on the Gold Coast.

As it turned out, the number of emergency c-sections at my hospital was very low compared with other hospitals. My doctor never even suggested it to me, it never came up in conversation again after I asked about it on our first consultation.

Perhaps hospitals with high c-section rates are simply honouring a woman's right to choose the birth she wants, not forcing c-sections on unsuspecting women.

Yes! I strongly agree that these statistics should be made public! It is astonishing to hear about these unnecessary c-sections taking place in our hospitals. More awareness on the issue is needed! Child birth is a natural process & should be followed through in the natural way (vaginal birth!) unless you have a medical problem that could cause you or your bubba any trauma. When i fell pregnant i was amazed at the amount of people telling me i "should" have a c-section LESS PAIN! was there response. Pain is part of child birth!! I don't look back now & think about wow! how much pain was i in.. i look at the end result my beautiful healthy girl who entered this world in a natural way.

I fail to see how this is constructive. The whole "naming and shaming" thing bothers me. Having had one emergency CS and a VBAC, I'm left to ask who should be ashamed about my first birth- the hospital for helping to safely deliver my baby after a long and very difficult labour or me for not birthing as nature intended?
I don't really like the "shame" tag at all. Yes by all means publish CS rates, but leave out the shame bit please.

In this instance it's not a matter of one type of birth versus another type of birth. I agree the choice is a woman's - if she wants an elective CS she is absolutely currently entitled to find a doctor who will perform that service - but there are also other women who very much hope for a vaginal birth and to avoid a c-section. There ought not to be secrecy surrounding what amounts to the chances of having a c-section in a particular facility.

Even in hospitals with a "high" rate of c-section there are many, many women who will give birth vaginally. So what do hospitals have to lose by consumers having access to their individual birth-type statistics? I don't see a need to keep this information under wraps. With most medical procedures caregivers provide information on the risks and benefits of various procedures, so why should the risks of c-section, and indeed vaginal birth, be any differently undisclosed?

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I guess the stats need to be considered in context eg. elective vs emergency but ... I really can't understand why you'd want to have an OPERATION ... I'd much rather just have a BABY!!

I'm FOR any attempt at better educating prospective mothers and encouraging them to have faith in what their bodies are designed for.

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Unfortunately the name 'elective' doesn't give a good picture either. I had an elective csection with my daughters but I didn't have a choice, it just wasn't concidered an emergency situation. My 2nd daughter was lying across my stomach so there was no way she was going to come out and after many attempts and different things and many weeks, at 41 weeks I had a csection.

Lianne

The whole women's choice thing is not really relevant in the big scheme of things, so we have to wonder why the stats are so huge.

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Is there any truth to the assertion that many women are choosing a primary cesarean with the understanding that there is no medical reason?

The first national data from women themselves clarify that demand from women for a planned initial (or "primary") cesarean with no medical reason is infinitesimal. Despite some professional and mass media discourse about "maternal request" or "patient demand" cesarean when there is no medical indication, just one woman (0.08%) among 1314 survey participants who might have initiated a planned primary cesarean without medical reason did so. Just that one woman (0.4%) out of 252 survey participants who actually had a primary cesarean initiated a planned cesarean without medical reason. Two other women with a primary cesarean said that it was scheduled ahead of time without medical reason and initiated by a health professional.

All others (98% of women with primary cesareans) believed that there was a medical reason for their cesarean. The most common reasons cited were concerns about fetal distress, position of baby, size of baby, and prolonged labor.

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Full article here: Mothers Report Cesarean Views and Experiences: New National Listening to Mothers Survey Results | Alerts :: Childbirth Connection

I really don't see the point in "shaming" the hospitals with high rates of c/s birth rates as there is so many different circumstances which impact the reason for women having c/s births.
I for 1 had my baby delivered by c/s last year and by no means did i really have a chioce even though it states on all my records that it was "elective". I had a scan on the Monday night and sent to the delivery suite to be monitored as my fluid levels had decreased significantly and my placenta had stopped functioning.I was sent home to pack my things and told to come back the very next day to have my baby.

As far as I'm concerned my c/s saved my babys' life as along with the above medical issues he also had the umbilical cord wrapped tight around his neck and was knotted. I was told the next day that he would not have survived a single contraction or much longer in the womb the way things were. He was born 3.5 weeks early and in reasonable health.
He is now a very healthy 1 year old thanks to my OB and her decision.

I don't want to scare people but just wanted to share my situation... I certainly would not hesitate having another c/s in the future.

I voted YES. The results are now
Yes 39% (512 votes)
No 45% (584 votes)
Only in extreme cases 14% (190 votes)

I have had two traumatic c-sections and I'm now planning a VBAC! I had no idea that the hospital I went to had such a high number of c-sections. If I did I would have found another hospital. I believe it is our right to know.

I didnt vote because I dont think the whole "name and shame" thing is black and white. Too much grey for me. Will take alot of tinkering to get it acceptable to everyone I guess. I do agree that a) every hospital should be forthwrite with their statistics, and b) it has more to do with interventions and women's misinformation.

I would think its rare that there are cases of vaginal being more life threatening than csection. I fully intend to vaginal birth any baby I have thats breech for example because I dont think the risk is that great that I would need to undergo major abdominal surgery, that comes with its own risks, without trying a vag birth first. I would be considered putting my childs life at risk if you go off the scare mongoring of a high majority of OBs and hospitals.