Saturday, February 18, 2012
C-section rates by state - The Unnecesarean
I highly encourage you to go to The Unnecesarean's new site with C-section rates. She did an awesome job! Unfortunately, it's going to take more than just publicizing the horrendous c/s rates to get things to change. But, it's a start.
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8 comments:
At least she's (and you're) unbiased, right?
I think the ideal c-section rate is whatever it takes to deliver healthy babies. I am grateful for the one that delivered mine and would never consider giving birth any other way.
The ends do not justify the means. There is no way that more than 1 in 3 deliveries requires a c-section. I cannot fathom the reasons for such. On an individual hospital level I understand if the rates are higher if they have a specialty neonatal ICU or something like that. I delivered via c-section after an unsuccessful version at 40 weeks and it still nags at me. Not to mention the extreme rise in the cost of delivery with a major surgery, even if "routine".
There is a hospital on the list in a very poor area of the state and it has over a 50% c-section rate. The pessimist in me believes that the doctors nudge their patients to c-section so they can bill medi-cal more for the surgery than a vaginal birth.
This is disturbing, in many levels. As a future Ob, it saddens me tremendously. But, at the same time, I also agree with poster Paula and strongly believe that the ideal c-section rate is whatever it takes to deliver a healthy baby. Does that mean a 50% c-section rate? Probably not. But this depends greatly on how many of those patients are high risk and truly needed the C-section - everything has two sides to a story, and if all we're seeing are percentages (as in this website's case), but not a breakdown of the types of patients that are receiving the procedures, then we're not getting the whole picture. Remember, the huge increases in maternal gestational diabetes, obesity, IVF treatment (and subsequent multip gestations), and the like, are going to skew any data we currently have. So, before we start judging, we need to analyze what we're being presented with.
I think this information is presented in a vacuum. There is no context. No analysis of changes in term stillbirth. No analysis of changes in injuries from operative deliveries. No analysis of changes in NICU stays. No analysis of changes in hypoxic injury. Nothing. It is a blanket declaration based on an ideological commitment to an unstated magical preferred rate of interventions. And, when it is stated, it is based on a complete fabrication.
I do think the convenient centralization of the hospitals and physicians offering VBAC services is great. Trying to dig that information out of anecdotes in message boards is a nightmare. And some women who have not had surgical births prefer to use the services of physicians who provide VBAC.
But I have been reading her other site for a few years now and I am unconvinced that she does much beyond insist rather blindly that the rate is too damn high.
It's very easy to lower C/S rates.
[1] Just cap the amount all plaintiffs can demand in compensation when a doctor does not do a C/S and there is a bad outcome. Since the first question a prosecuting attorney asks is "Why didn't you do a C/S?", this would relieve pressure on doctors to do them. It would be interesting to correlate C/S rates by states with those states which have the maximum rates of lawsuits and/or the highest damage awards.
[2] Accept higher rates of perinatal morbidity and mortality. Tell mothers that it is more important not to do a possibly unnecessary C/S than to insure a healthy, living infant.
"Unnecessareans" are only so in hindsight. Until the methods we have for knowing exactly what is going on in utero are better, we cannot take the chance.
Interestingly, I have run into a number of cases recently of primip breeches who have been pressured into attempting ECV and denied elective C/Ss. Out of 6 such cases, only one was a successful ECV [and the mother wound up with a C/S for failure to progress], and of the other 5, 2 had to have emergency C/Ss because of fetal distress at the time of the ECV, and three wound up as elective C/Ss. The mothers were put through significant risk, pain, anxiety [2 babies had to go to NICU] and wound up with C/Ss anyway.
As for VBAC, it must be remembered that not all women are candidates for one due to the reason for the initial C/S. Too many people automatically assume that ALL women ought to be offered VBAC when that is not the case.
Lastly, in a system which is OB, rather than CNM, led, there will be a tendency -- I repeat, tendency -- to go to C/S somewhat more rapidly, for the reasons I mention above. But delaying an indicated C/S in order to "lower rates" is even worse. Tell a mother with a child of 5 who can't yet sit up, or can't learn to read that it was better to "lower C/S rates" and let her labor, in spite of fetal distress or prolonged length, to go to vaginal delivery, than to give her child the best care by getting him out in time.
And let's stop this drivel about doctors doing C/Ss in order to "get home for dinner" or "to the golf course". As a CNM, I'm sick of hearing such nonsense.
Well *somehow* the hospital where I had babies #2 and #3 (both unmedicated VBACs) has a 14.1% c-section rate, and their morbidity and mortality rates are the same as anywhere else (possibly better). Such a great place, I wish I had had baby #1 there too.
"the ideal c-section rate is whatever it takes to deliver a healthy baby"
really? how about keeping the mother healthy so she can parent that healthy baby?
I guess I shouldn't be surprised about all of the defending of the c-section rate in this country. It just always surprises me that more people don't actually look at the data and think "huh, why are there so many differences in the rate in the same state serving the same (relative) group of people? My town has two hospitals, both of which have a rate around the national average. One serves high-risk population, and the other does not. You would think that the one that doesn't would have a lower c-section rate, but it doesn't. 50 miles away a high-risk hospital has a rate almost 10 points lower! 25% vs. 35%. I would like to think that more people are asking "why?", but I guess it's too emotional of an issue for most people.
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