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

[midi27]

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.

[maz]

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.

[prego3]

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.

[maz]

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!

[sushee]

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.

[Tanya]

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.

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?

[midi27]

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.

[sushee]

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?

[suse]

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 . 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.

[Snacks]

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 .

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'.

[*Belle*]

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.

[sushee]

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.

[canberramomma]

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.

[Tobily]

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.

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.

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.

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.

[sushee]

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.

[Kitt3n]

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

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!

[canberramomma]

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!

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.

[Trillian]

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.