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Hospital c-section rates


Forum: Labor and Childbirth

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  #1  
September 19th, 2010, 09:52 AM
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Chel's post about how far you go to get to a hospital that will let you have the birth you want got me thinking about c-section rates. My only thing that I really am concerned about is avoiding a c-section. I suffer from very bad PPD and I think that adding in recovery from surgery would only make it worse for me, so avoiding a c-section is important to me. But I didn't choose my hospital based off of c-section rates.

The hospital I chose is the closest hospital to me. That isn't why I chose it, it just worked out that way. The hospital just a little bit further down the road (but still very close) has a significantly lower c-section rate (my hospital is the 2nd highest in the area, this one has the lowest). But I didn't want to choose off of the rates, because I find them misleading.

The hospital with the lower rate is part of a group of hospitals. They force all scheduled c-sections to go to a different hospital--even if the woman would rather go to this one. So it artificially lowers the rate for this hospital (repeat c-sections, breech babies, etc are not included in their rate) without a woman being able to tell that she still might be pressured into scheduling a c-section during her prenatal care.

The hospital with a higher rate has a level III NICU. The hospital with the lower rate can only handle babies born at 34 weeks gestation or further. In fact, they refer to it as a "special care nursery" rather than an NICU. A higher risk pregnancy is more likely to be a c-section delivery (they sometimes will determine that the baby wouldn't be able to handle the stress of labor) and also more likely to go early. So this raises the c-section rates at the hospital with higher rates, as they have more high risk pregnancies/deliveries. But this increase in rate from more high risk mothers doesn't tell me if I'm more likely to have a c-section there.

The hospital with the lower rate doesn't allow VBACs, while the one with the higher rate does. I find this to be a better indicator of their opinion about birth.

The low rate hospital is the one that women who feel strongly about natural childbirth usually choose. But the fact that they go out of their way to make their rate low, yet don't allow VBACs says to me that having one tub for waterbirth and using a lot of midwives is more of a marketing thing than a belief that birth is normal. They decided that in order to compete, they needed to find a niche and fill the need for a "natural childbirth friendly" hospital.

I've had a NCB at the higher rate hospital and was completely supported by the nurses and my doctor in my decision to do so. I also had a birth there where I stalled at 9cm for five hours and neither "failure to progress" nor "CPD" (ie, baby won't fit) nor "c-section" were ever mentioned. So even though they have a higher rate (it's still below the national average), it's not like they're waiting with scalpel in hand for any reason to cut a woman open.

All this to say that sometimes you have to look beyond the statistics to see what's really going on at the hospital and the clinics where your prenatal care takes place.
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  #2  
September 19th, 2010, 11:56 AM
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This is really interesting. It all makes totoal sense, but is not something that most people probably think of.
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  #3  
September 20th, 2010, 07:07 AM
New_England_Girl's Avatar Platinum Supermommy
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Makes sense to me. I have no clue what the c-section rate is at my hospital...my midwife wouldn't give me one unless it was life and death anyway.

(That wasn't a hit on c-sections...I just don't want one and my doctor agrees)
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  #4  
September 20th, 2010, 08:42 PM
LJD3Tdance's Avatar Platinum Supermommy
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I don't think most hospitals c-section rates matter...I think more your own doctor and those in their practice is what matters...
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  #5  
September 26th, 2010, 06:19 AM
WhoaMomma!'s Avatar Danielle
Join Date: Nov 2008
Location: Northern Virginia
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Hospital policies can affect birth outcomes (though I totally agree that the individual provider's primary c/s rate is MUCH more important). My hospital's arbitrary policies directly contributed to mine. But you need to find stats on the PRIMARY c/s rate if you want to eliminate the ERCS from the mix. And also data in a vacuum is worthless. You need to compare it to the national and local average and previous years to see trends. My hospital was on par with the national average, but significantly lower than any other hospital in my area. Which tells me that while they may not be great, they're doing better than the rest bc my area in general is VERY friendly to c/s and inductions. Anything that lets you schedule your birth so you can be back to work quickly and make sure your husband isn't tied up in a senate committee meeting when you go into labor, etc. I also looked at the data over the past 5 years and what I saw was that my hospital had a slowly declining primary c/s avg with an increasing VBAC avg which shows trending in the direction that aligns with my beliefs. Another hospital (that was not in our area but IS in the same system as them and was included in the stats I was looking at) had a slightly lower c/s rate but had been on the rise for the past 5 years with a declining VBAC rate. That tells me that hospital is moving in the direction of creating more policies that will restrict choices.

So data is never going to be the end-all, be all. I would generally recommend finding a provider you trust and listening to their take on the hospitals since they spend way more time there than you ever could. But also be sure to ask: what specific policies of the hospital that you have no control over could affect my birth outcome? If they say none, they're lying. Bc there's always something.
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  #6  
September 26th, 2010, 03:02 PM
missmich
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I don't know what the rates are for the hospital I was at,I do know that they are very NCB friendly and don't allow c-sections for certain reasons. Like if I'd gone and asked my doctor if my baby can be born on a certain day so he could have a cool birthday or so I can attend a party by a certain time after his birth or some "silly" reason like that they would have said no way! They only do them for emergency medical reasons and maybe repeat sections. I think they also do VBACS. One nurse was joking with me and said if I wanted to try natural child birth then I could come back in 18 months! lol
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