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

AdelaideNow... MP Sandra Kanck wants to 'name and shame' over caesareans

Have a read of this article and you need the link to vote - do you think hospitals should be named and shamed for their c/s rates? No is very much ahead... hmmm this link must be circulating around the AMA and RANZCOG!!!

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MP Sandra Kanck wants to 'name and shame' over caesareans
Article from: AAP

November 17, 2008 01:15pm

SOUTH Australian hospitals performing a high number of caesarean section births should be named and shamed, says Democrats MP Sandra Kanck.

SA's official figures show more than 32 per cent of all babies born were delivered by caesarean section, which is more than double the recommended World Health Organisation standard, Ms Kanck said.

"WHO guidelines recommend 5 to 15 per cent of births as a safe level," she said.

"Yet in SA the breakdown of caesarean rates are 28.4 per cent for all public hospitals, both metro and country, and 43.7 per cent for metro private hospitals."

She said rates across five private metropolitan hospitals ranged from about 35 per cent to more than 54 per cent.

"Because choice in childbirth needs to be informed choice, I urge the minister for health (John Hill) to name and shame the worst-performing hospitals."

Ms Kanck said fear of pain should not a reason for having a caesarean.

Mothers must be informed of the risks involved with surgical deliveries and the circumstances in which they should be used.

"It is vital that a caesarean is not seen as an option of convenience for either obstetrician or mother," she said.

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I voted!!

It's now:

Yes 35% (405 votes)
No 49% (567 votes)
Only in extreme cases 15% (180 votes)

I voted NO! which seems to be in fornt in the pole so far.

i don't think its anyone elses buisness, its between the pariend and her doctor . and also there is no shame in a C/sect anyway (Sandra Kanck) my twins were an elective c/sect (tho emergancy in the end) and i think they are fantastic i really enjoyed it. if i have more i would definatly have another c/sect.

but thats just me.

I voted yes, its just a statistic, just like anything else, and I believe we should all have the right to know such rates at our local hospital/hospital of choice.

I voted yes. Why go to a hospital that could potentially perform an unnecessary or preventable c/s. Don't want people being too quick with the knife thank you! :)

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I voted yes. Why go to a hospital that could potentially perform an unnecessary or preventable c/s. Don't want people being too quick with the knife thank you! :)

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my thoughts exactly!

i vote no


On the fact that you have absolutly no idea why these c sections are being carried out. Unless you were able to find out why ever c sect was performed the the basis the info was collected on is wrong..

by showing which hosptial has the most c sects is scare mongering.. isnt that what you call it? dont go here cause you more likely to have a c sect?



And yes i understand some c sects are performed unneccesarily

Was just thinking - the way they word these things always affects how people vote I reckon. "naming & shaming"... i dunno.. why not just say "release each hospital's statistics to inform women".

I don't think the hospitals need to be 'shamed' as such.. but I think the info should be available.

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i vote no


On the fact that you have absolutly no idea why these c sections are being carried out. Unless you were able to find out why ever c sect was performed the the basis the info was collected on is wrong..

by showing which hosptial has the most c sects is scare mongering.. isnt that what you call it? dont go here cause you more likely to have a c sect?



And yes i understand some c sects are performed unneccesarily

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I completly agree, also a tertiary hospital will have a higher cs rate as they deal with a lot of high risk pregnancys so how is that fair. Tertiary hospitals are thought to be best and safest. people go to them assuming that if something is wrong it will be dealt with according to safety of baby and mum.

Not everyone can have a vaginally birth unfortunatly, cs rates have gone up for many reasons including bigger babies due to diabetes, more multiple births etc. Yes some Drs are more cs happy than others but they r not the majority.

I had a cs and i pre emptyed it as i had knowladge of what was happening and i aggredd with mw and ob decisions at all times and would change nothing.

I haven't read or voted - i'm in the UK, c-section rates are published as a matter of course here. We have a national health service. When public money is used these things HAVE to be transparent.

And yes, the section rate at my local hospital (nearly half of all 1st time mums) DID put me more in favour of homebirth. The rate of epidural uptake did too - 80%, 91% of all first timers... I just could see it was unlikely i'd get the sort of birth i wanted there. If i'd wanted a section i'd have gone there. Surely knowing the figures gives women more choice. If you want a section you wouldn't have a homebirth, so if you want a natural undrugged experience why would you go to a place which specialises more in the medical model of care?

Women should be able to access these figures so that WHATEVER kind of birth they want, they can know they're going to a place where they're most likely to get it. The whole "naming and shaming" aspect is a bit childish really. Part of the reason (NOT the whole reason) the hospital near me had such a high section rate is because it's an obstetric centre for complicated births and a teaching hospital. It's catchment area is gigantic and ALL the complicated cases are passed to it. If a hospital takes more high risk pregnancies it will of course have more sections, though i got a statistician friend to adjust for that and it still came out above the national average (which is WELL above what the WHO advise) which spurred me into asking for a homebirth. I was served by the midwives from that hospital and i was very happy with my experience. In fact i just found out i can elect for that team again at my new address and i'm doing a little happy dance ;)

Bx

Yes because the WHO says that with all things considered, from every angle, c/s rates should be no higher than 15%. So you can tell how a hospital is performing in line with the WHO and how many unnecesareans are being done.

The ironic thing is, if you look at the stats, private hospitals actually have higher rates of intervention than tertiary hosptials. Look up the Victorian Peri-Natal Data Collection Unit. I have some stats on BB already. I guess to make an informed vote you need to know the facts.

In the Waiting room at the new Royal Women's Hospital (Melbourne), they had copies of their Quality of Care Report '07 available for visitors. This contained rates of vaginal & caesarean sections over past 7 years, a breakdown of birth type by mothers age, induction of labour rates, incidence of CS for multiple births ove past 7 years, perinatal deaths,post partum haemorrhage rates, peripartum hysterectomy rates and incidence of 3rd & 4th degree tears. Also a table of maternity service performance indicators and the percentages that RWH has achieved over past few years and compared with Victorian average.

There was a lot of other info, and i was interested and really pleased to have it available.

I think many centres do provide this info, and so often people don't take the time to research or read the info when it is available.

The base numbers/percentages may not be meaningful at all without contextual information. For example, if you have a tertiary level hospital that routinely takes women with high risk pregnancies/situations etc that would not be admitted in smaller hospitals, then you would expect that hospital to have a higher CS rate - but the figure alone would not provide an explanation. The same hospital may also have a higher rate of midwife assisted births too but that would not necessarily stand out in the name & shame model either.

I note that the Victorian health department does publish its CS rates (remember reading them somewhere over the last few years)...could be that some of that information is already available in the public domain or to researchers already. But I don't believe that attempting to 'shame' the 'worst performing hospitals' is a helpful approach.

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.

I'd like to add that an analysis of caesarean rates also needs to be done in the context of previous birthing experiences - ie a vaginal birth that is managed poorly can result in the mother requesting an elective caesarean for subsequent births (due to trauma or physical damage from things like a rushed induction, forceps delivery etc). In which case the hospital that carries out the CS may not actually be the "problem".

In my case, the hospital that traumatised me got to record that birth as a vaginal delivery - whereas the compassionate hospital that treated me well and gave me an empowered, healing birth got to record that as a caesarean delivery. The second hospital was definitely "better" than the first but that is not reflected in my own contribution to the stats.

I was just coming back to post something similar Marydean. My friend recently had an elective section and her first birth was like something from a horror film. They intervened in every way possible, kept her strapped to the bed, took ages giving pain relief then mucked up the dose, eventually giving her a foceps delivery for her "he's just too big" baby who turned out to be just over 6lbs, and caused a haematoma inside her vagina which ruptured 3 times in the following days, causing her to need 3 more surgeries and 15 units of transfused blood. The same hossie wouldn't let her even think of attempting VBAC.

To me the epidural rate speaks more than the section rate because a well-supported woman having an uncomplicated birth probably WON'T need one. The epidural rate of my hospital put me off because it made me think probably there was no good support. I have since learned they do not assign midwives for a whole shift to one woman and routinely kick dads out at 10pm unless mum is actually pushing. No wonder so many women end up having spinal anaesthesia - alone and labouring without consistent care in the night...

Routine postnatal debrief and follow-up with patient-scored performance reports would be more useful than section rates alone.

Bx

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So you can tell how a hospital is performing in line with the WHO and how many unnecesareans are being done.

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But how do you know that even if a high number of c/s a performed that the majority aren't necessary? I know theres a lot of grey fuzz in whats necessary or not but unless every statistic was detailed, well naming and 'shaming' is pretty much pointless... I mean, a smaller hospital with inadequate c/s facilities who refer emergencies to other hospitals will have a very low rate... but does that mean they're better or that they're ill-equpied to deal with those situations?

I voted NO, because without all the details of every situation the numbers are pointless and I think give woman a false sense of security. A woman could go to the hospital with a 1% c/s rate and be in the 1% and have an unnecessary c/s performed.

Besides, hospitals don't perform c/s, drs do. I'd still vote NO but it'd be more accurate to propose publicising individual dr c/s rates...

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i vote no


On the fact that you have absolutly no idea why these c sections are being carried out. Unless you were able to find out why ever c sect was performed the the basis the info was collected on is wrong..

by showing which hosptial has the most c sects is scare mongering.. isnt that what you call it? dont go here cause you more likely to have a c sect?



And yes i understand some c sects are performed unneccesarily

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My thoughts also.