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

I think many of the 'new' posters and members to BB who have come in here have to remember that Belly belly is a gentle parenting forum that supports vaginal and natural births, including VBACS. Maybe instead of repremanding those of us who are voicing for many silient woman suffering...you should go and have a look in the c/s birthing thread and the debreifing thread at the amount of woman who end up having c/s's and feel dreadful afterwards. Ha dyou thought that maybe having known the statisic might have helped with their choices at the time?

The reason for the article is to help woman see the bigger picture.
Take your dame rose coloured glasses off and think of others.

I agree Sushee, I can see the difference, my post before was personal, however thinking about it now about the general public, the more education and information the better. I think that the information should be available for women should they choose to research births and their choices before the birth so they are aware of all posibilities and not get pushed into something they dont want to happen.

Totally agree too MAZ :clap:

Yup at the end of the day, those who dont want to know wont care and it doesnt matter. But those who do want to know and see it is a very important piece of information towards having a normal and natural birth as possible, we miss out. It should be available for those who want it, those who do can miss out. I think the information will be presented professionally and media hype blows everything out of context.

So funny, those who dont care think there is choice. You can choose vaginal birth or c/s.... stats dont matter... but those who do care know there is a hell of alot more to it than that. There is NO choice in many regards, its not fair, its not equal, very lobsided and those who dont care wont care.

So true!

I just wish there were more birthing centres like the one I attended with my first birth (and will attend again in April!).

Its in a hospital but has no OBs or docs at all - only midwives. Its completely independent. They provide fantastic care and a brilliant education (their pre-natal classes are AMAZING and opened up my eyes to so many things), and they are pro-choice without shoving anything in your face!

I'm not sure if i'm allowed to say who they are - but if you live in Newcastle or surrounds - look up the Belmont Birthing Centre. I cant recommend them enough!!!

Belmont is BRILLIANT! Carolyn Hastie manages it, and she's awesome :)

I had a c for my first who was breech. In the old days we would have both died there was no way she could have been born. It is between the doc and patient and each does what is best for the individual concerned.

I agree with the below, the stats would have to say why each c-sect was performed to be valid and really the hospital aren't the ones who say yes or no to it anyway.

I have to wonder if some of the newer posters are actually reading the whole thread? Or even the last page of posts?

Because I'm starting to feel like one half of us is having one conversation, and the other half is having a completely different conversation.

Hope&Dreams, can I just ask that you please just read my previous post on this page. I'm getting really tired of saying the same things over and over again, is all, about how no one here is judging c/s mums and how we're talking about having access to statistics, not about birth choices.

ETA I'm really confused by the mindset that if you're somehow at peace with your c/s, that it means that people who WANT to make an informed decision, who WANT statistics, who WANT to know if their hospital has a higher than normal c/s rate shouldn't have access to that information because you don't want to be 'judged'. WT???? How is that even related??

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Belmont is BRILLIANT! Carolyn Hastie manages it, and she's awesome :)

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I know - Caroline is amazing! I birthed my son with Elise & Debbie and that was incredible (although not strictly 'by the book'! lol) and this time Kim is my midwife, tho who knows who i'll end up with on the day!! :lol:

OK, last time in this thread for me.

We all want what is best for our kids, yes? So we inform ourselves, yes? We look at information to make informed choices, yes?

Well this is about information. If the stats are not published how can we make an informed choice?

If you don't want to know, then don't look them up, simple. If you do want to know then why should the information not be available to you. Without this sort of information how will mothers yet to be, be able to make the right decision for them when it comes to birthing?

Sushee I agree with your last post 100%.

In response what I am saying is that I don't think that having access to the statistics of c/s in each hospital is of any relevance when it is the individual doctor along with patient that decides if a c/s is necessary and thus just releasing the statistics of each hospital doesn't give any further information to a mother to be.

I think it is important to remember that everyone is entitled to an opinion and that should be respected. Sharing of personal information should also be respected.

I respect your right to share information Hope&Dreams, when it's in context to the discussion. I too shared my opinion, and you know what? I read your post. Did you read mine though? Because I said in an earlier post that I was speaking of women who were coerced or scared into having an unnecessary c/s, and there are many of them.

The thread has already been derailed on numerous occasions by women posting saying that because their c/s was deemed necessary, that it means there must not be any value in knowing if your hospital carries out more c/s than medically necessary. It's as if to say that unecessary c/s don't happen, when it's apparent from the statistics that they do, and often, every day, with thousands of women.

I believe there is a value to having that information. The drs are not the only ones involved. The hospital develop policies that impact on women as well.

And just because you don't see the value, does that mean I shouldn't have access to information I believe would be valuable to me?

In a different light...if it wasnt for statiistics people wouldnt be as open to excepting people with autisum or disabilities now aday were 3 -4 years ago I use to hide at home due to stares, abuse and plain rudness of other people voicing their much unappropriate opinions at me.

Now thats to studies....statistics and INFORMATION given of the amount of autisic children there are in this world..people are more open to except us when out.

Statistics help...its not about (yet again) your personal name.......its about numbers people....we all cant live in this fantasty world were everything is happy happy, joy joy

The funny thing is, I am not pro-VB, I'm not a passionate vaginist. In fact, I'm pretty sure all I am is very confused.

I have always been confused about our nation's rising c/s rates. Because all evidence shows that it is NOT the safer thing for mothers and babies, except in extreme situations. But time and time again women are choosing it. Why? What is getting lost in translation?

Is it that we're not being told the facts? Yet when we get to vote on being more informed, we choose not to be!

What I'm passionate about is a woman's right to know all the facts before she makes a decision. I don't want to go in blindly, esp when it has to do with my child's life and well-being. I don't want to be 'told', I want to learn for myself. That's what I'm passionate about.

mmmm I'm thinking things are going around and around.....

I just don't understand why people don't think that it is a woman's right to check out these stats. I mean... if I were going to buy a washing machine (hear me out people :p) and I wanted to know which one to buy according to my desires... I would check out choice magazine and see the feedback, I would ask friends & family, and then I would check out prices.

Why can't we do this when we are talking about healthcare?? :dunno: In the veterinary world, we often have people phone asking for prices on things, and what is involved and sometimes where the best place is to go and get what they want. I mean, if someone had a dog with an orthopaedic emergency, wouldn't it be best to see an orthopaedic surgeon??

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I don't think many are reading anyone else's posts or responses Sush... everyone is coming in with their experiences and thats it.

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I agree Kelly. I worry about a society that can't see past the "my, mine, I". I fail to see how describing a personal account applies to this discussion... we are not talking about individual situations... this is a thread about information for ALL women. To be honest i'm skimming over the personal accounts of emergency c/sections... they are totally off topic.

Hoobley, Sush, Maz, Mayaness, Wintergreen, great contributions :clap: I have to share the love for some of you but I'll come back to your posts when i can.

One thing Wintergreen said has really stuck with me: the notion that giving birth is not like having a tooth pulled in a dentist's chair... it's more like driving a car. Great analogy. I wish more women could see it that way as well. A great way to illustrate that one is a passive experience (tooth pulling) and the other (birth) should be an active experience. Get your "baby on board" car sticker and put it on your bellies.

Sometimes the riskiest attitude is the "ok how can I get this baby extracted with the minimum of pain" one. Pain doesn't have to be feared... athletes (eg marathon runners) embrace pain as a means toward an end. I think that many OB's take advantage of a woman's fear as they coerce them into unnecessary c/sections. That really needs to stop. If c/section stats were published and made easily accessible it might be more likely to stop.

I am possibly going to be repeating what others have already said- forgive me! Every time I sit down to read this thread I don't get through it all and by the time I get on again there're a million more posts!
I'm going to vote yes. We trust our health care providers to give us the best possible information and outcomes. IMO the high c/s rates show that SOME OBs are not giving their patients that service.
This may get people's backs up because likely they were told there was no other alternative for them but to have intervention. I've no doubt that in some cases this is true. But in others it is not.
Inducing a labour is soooo commonplace! And I know of many people who are induced for convenience or policy rather than health. AND they are obviously not being fully informed of the very real risks to them and their babies. If they were, why would they agree?
And as to mothers making the choice to have c/s, are they fully informed of the risks associated with that? If so, great. It is their choice after all. BUT I seriously doubt so many women would choose to have the c/s if their OBs fully disclosed to them the risks, rather than just being agreeable to their uninformed request.
This is the 'shaming'. Hospitals and OBs who do not fulfil their responsibilities to their patients are failing them. That is shameful.
Our freedom to access information is something we must actively protect and fight for, simply because it is our basic right.

oh gee its getting ugly in here.

all personal opinions about weather someone should or should not choose a c/sect or if its rushed into or even necessary or just wanted.
I'm still not convinced that these stats should be published (or shamed) just ask your OB or the hospital what their opinions on C/sects are. people can access this information if they want it.

and FYI my ob didn't want to do a c/sect for DS1 i begged for it and also made them book me in for number DS2&3 aswell.

Or the stats could be published and the people who don't want to know don't have to read it, and the people who do want to know can find it easily.

Because I don't think hospitals or obs will generally admit to favouring c/s. Nether of mine did, and yet the hospital I went to had a high c/s rate, as did my ob for someone who said he was pro-VB. Stats don't lie.

Here's one for you girls

I have a g/f that is over due...she was due last monday....she has the docotor at the hospital PUSHING her into a c/s because her first 18 year old son was...dont worry about the fact that her 2 children afterwards were VBACS.....she is in tears begging for them to let her go natural and all the doctor keeps saying is that she had a previous c/s and its hospital policy.

the doctor even went to the extreme of booking the c/s for next tuesday without her consent and has booked the anethetists appountment and sent the paper work out for her to fill in and drop in to the hospital today.

This is why statistics are needed...this is happening NOW!!!!!! Wouldnt you consider that bullying? We need to know why doctor's in hospitals are doing c/s and if statistics give us the clues by telling us the % that are done electively, medically or whatever...its might STOP doctors from throwing around the c/s's like lollies and refrain from jumping in for no reason like this.

Guess who's going to accompany her g/f to the hospital on monday :)

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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

I am a midwife in a tertiary level hospital. We receive women with high risk pregnancies and complications from all over the state. Thus our C/S might rate higher than others, yet we also have a high VBAC rate and good vaginal breech rate. In addition we provide the option of midwifery-led care for low risk women and a collaborative midwife/obstetric team for women with high-risk pregnancies. Thus the rate of C/S alone does not tell the whole story. Also, don't forget, Inductions and C/S are not always the hospital's idea, quite a lot of women plead for an induction or C/S and there are valid reasons for C/S - such as a low placenta, pregnancy complications etc.

midi27 - its great to hear from a professional point...Im sure if the statistics were made to be compulsary that in the same breath or page what have you it could also be explained about the high VBAC and good vaginal rate. I think it really needs to be broken down to great detail so you know the who's, when's, what's and why's.

Maybe a leaflet should be given to each mother to be when they do their hospital book ing about the statistics ect. they give you other useless pamphlets and lets face it we all end up throwing away atleast half of the printed material.

i would definatley vote NO. I will be having my third in Jan 09 and have finally felt comfortble with my decision. My first 2 were through emergency c sections and the guilt that is overcast with it is ridiculous, after all it's the safe and successful outcome that really is important, to both mother and baby. Too many people focus on the "birth" and not the result.

DO you think that focussing on the birth can HELP the result?!??!

What happens when the RESULT doesnt turn out the way you planned??? If the result ends up being traumatic.

Check out my signature...I've had 4 C/S' YES bloody 4 and I would give my right arm to have had the vaginal births I longed for. My youngest son almost died from his 'BIRTH' and that was a C/S!

I think we are actually focusing on knowledge not birth, prego3. I know I am.

I think if I saw stats for, say KEMH, which takes on high risk pregnancies from all over Perth, and the stats reflect a higher c/s rate, I would imagine that as someone with some intellect, I would interpret that differently to, say, a private hospital which wouldn't touch a high risk birth with a ten foot pole, but still has a ridiculously high c/s rate.

So I think I'm able to make that distinction personally. But the idea of more information such as the 'why's of the stats would be fab too. Of course I'd want the real 'why's, and not just what the ob's reasoning was, though.

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i would definatley vote NO. I will be having my third in Jan 09 and have finally felt comfortble with my decision. My first 2 were through emergency c sections and the guilt that is overcast with it is ridiculous, after all it's the safe and successful outcome that really is important, to both mother and baby. Too many people focus on the "birth" and not the result.

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This is not about making anyone feel guilty...

Again this thread is not c/s v vag births.

Its about choice... Why is it so easy to choose a c/s but when women want to choose few or no interventions the numbers are hidden from us?

It would be interesting to know if a hospital would give out the stats if asked. I'll have to ask if that info can be supplied, it is certainly no secret to those of us who work there, in the public system at least. I am studying parenting education and in one of the classes I sat in on the midwife read out the stats, albeit from a few years ago, to the whole class. We do a gallon-load of paperwork to enable these stats to be figured out.

Can't say I was ever given stats during any of my 4 pregnancies. I did ask my antenatal class midwife though after 8 out of the 10 women there said they were having c/s, but her reply went something like our hospital supports vaginals births.

Of course if I knew then what I know now I might have been more tenacious about getting answers. Though rather than having to be tenacious, wouldn't just be easier if the stats were there published available for anyone to google?

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 :p. 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.

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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 :p.

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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'.

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.

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. :)

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

Also, the way that elective c/s's are recorded and what constitutes an elective, is very wide.

I had two failed VB attempts and for the 3rd, I was advised to have a c/s for risk reasons and the fact I had developed a condition which made a c/s most advisable.

It was still listed as and elective.

We don't know the reasons behind every birth story and we should not allow others to judge, IMO.

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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.

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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.

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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.

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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.

again that word 'judge'.

How is asking for hospitals to provide the number of c/s they do have anything to do with judging individual women about their birth choices? I honestly don't get it. One topic is about information, the other is about choice. Not related, as far as I can see.

Anyone who thinks there is a connection, please feel free to explain it to me.

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

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But this isnt the issue, as has been said previously, the issue is a matter of statistics, not whether or not a woman can have the birth she wants!

C section statistics are available country by country, why can that not be broken down state by state, hospital by hospital?

The numbers are already THERE, just not in the broken down format that should be readily available!

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But this isnt the issue, as has been said previously, the issue is a matter of statistics, not whether or not a woman can have the birth she wants!

C section statistics are available country by country, why can that not be broken down state by state, hospital by hospital?

The numbers are already THERE, just not in the broken down format that should be readily available!

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Yes, but for what purpose?

How would it be used against women and there choices in the future?

What is the motive behind this push.

Name and shame says it all to me really. Already judgmental language is being used.

Is nobody reading what I am posting in regards to keeping on topic and not getting emotionally involved in this? It's a VERY simple request people. If anyone continues to ignore this direction they will be temporarily suspended from posting in this thread.

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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.

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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.

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.