Need for Transparency Increases as Cesarean Section Rates Rise

For further information, contact Melissa Maimann at Essential Birth Consulting.

Raleigh, NC (March 19, 2009)—CIMS, the Coalition for Improving Maternity Services, a group working toward transparency in maternity care, today announced that the 2007 US birth statistics, just released, show that 31.8% of births are via cesarean section.

- This is the same in Australia: in 2006, our CS rate was also over 30%

The percentage of cesarean deliveries has increased by 50% since 1996 and is more than double the World Health Organization’s recommended rate of 15%.

- In fact, WHO recommends 10% for healthy women, and 15% for women with complicated pregnancies.

Currently, cesarean rates vary widely across the US.

- As they do in every part of Australia!

The 2007 birth data highlight this variation; for instance, a woman giving birth in New Jersey has a 73% higher chance of having a cesarean than a woman in Utah. This strong variation in rates isn’t only geographic; it is also seen among individual hospitals in a community.

- Again, we have the same sitiation in Australia. In 2005, Kareena Private had a caearean rate of 46.4%. In 2006, The Mater's CS rate was 46.2%, and Prince of Wales Private's CS rate was 44.3%. Considering these hospitals take the healthiest women (women with significant risk factors or very prem babies are transferred to nearby large public hospitals whose services can cater to women and babies with higher lavels of need). In contrast, Auburn (public) hospital's caesarean rate was a mere 15.8%. Should women be informed of this before they book into a hospital? I think so!

Many believe that this variation is due to high risk sicker mothers and babies that these hospitals serve; however, that is only part of the story.

- Actually, it forms no part of the story in Australia. The healthiest, wealthiest, and most highly educated women access private hospital care. In my experience, well informed women choose natural birth and natural birth methods. Once they have full and impartial information, they understand that when you work with nature, nature works with you. The women and families who access private obstetric / private hospital care are clearly not incapable of receivign information, considering their options and making an informed decision. For these professionals, business people, CEOs etc, this forms part of their daily routine. So why do so many private women have a CS if this is not the safest way to bring a baby into the world? Are the mis-informed by the one or two sources they rely on so heavily for information? Are they only given two choices, when really there are at least five? Are they told their baby will die if they don't do as the doctor recommends? I have my ideas - what do you think? Read on ....

Extensive research has shown that these huge variations are strongly linked to the practices and policies of individual hospitals and providers not just the health status of mothers and babies.

- I believe this is the answer. It's certainly been my experience in my career as a midwife. Working in 23 different hospitals on contracts and as an employee, it was strikingly obvious to me that this was what was at play here. In one hospital, as soon as a woman asks for an epidural, she is given one. Even if her baby's head is visible and will be born in the next few minutes. While in another hospital, when a woman asks for an epidural you provide emotional and physical support - suggest a position change, a shower, bath, something different. Then, if she still feels she needs an epidural, she has one. The difference? An epidural rate of 80% versus an epidural rate of less than 20%. A caesarean rate of 45% versus a caesarean rate of 20%.

The average women accessing hospital services is not well informed compared to the average woman accessing home birth services. The average women accessing hospital services will believe what you tell her. Sad, but true. If you tell her that she needs a caesarean, she'll consent. If she was in another hospital that was not as pro-surgery, she would not hear the word caesarean. Most women do not ask for caesareans: they have them on the advice of their care provider.

“Most women believe that they will only have a cesarean section if they experience complications in pregnancy or labor.

- Do most women know what constitites a complication? When women have a caesarean because their baby is too big, too small, has not engaged, has not come by 40 weeks and 1 day, I wonder. And where do they get this information from? Which sector (public / private) are you more likely to hear this sort of mis-information?

But research tells us that most of the factors affecting a woman’s risk of a cesarean have nothing to do with her health or that of her baby. One of the most effective strategies for avoiding a preventable cesarean is choosing a provider and birth setting with a low cesarean rate.

- Absolutely! From :

Homebirths Australia-wide have an 8% c/s rate compared to a nearly 40% c/s rate nationally.

Other studies have found that home birth has a 90%+ normal birth rate. And really, it's very simple: if you want surgery, see a surgeon (obstetrician - a surgical specialist). If you want a vaginal birth, see a midwife (natural birth specialist) for home birth or hospital birth. If you want to have control over what happens to your body as well as having a vaginal birth, see a private or independent midwife. Do you go to Michel's Patisserie when you want to buy fresh apples? No, because the closest you'll come to fresh apples at Michel's Patisserie is apple crumble. Likewise, if you want a natural birth, seek out a care provider (midwife) who actually provides it.

In the United States, we are seeing increased public reporting of outcomes and procedure rates for facilities in surgical and cardiac care, but, access to maternity care data remains almost non-existent,” says Amy Romano, MSN, CNM. ... C-section can be a life-saving procedure, but it is a major surgery that carries extensive risks for both mother and baby, risks that are not present in a vaginal birth. Research conducted by the World Health Organization shows that these risks of cesarean outweigh the benefits when the c-section rate exceeds 15%. Currently, women have no way of knowing if their local hospitals exceed this recommended rate.

- As in Australia. In NSW, we are fortunate that stats are published per hospital (albeit we have no current data - the most recent is from 2005. 2007 stats were due out at the beginning of this year ....) However, in other States, hospital data is not published. How are women to make informed decisions on where to have their babies if there is no published hospital data that they can access?

“Women can unknowingly increase their risk of unnecessary surgery based on their selection of where and with whom to birth. To enable women to make informed choices, maternity care data must be available at the facility level. Whether requiring a c-section or planning a natural birth, women need data in order to choose the facility that most closely matches their needs,” said Elan McAllister, Founder of New York’s Choices in Childbirth and Co-chair of the Transparency in Maternity Care Project. ... Studies have shown that public reporting of intervention rates and outcomes leads to better healthcare ...

Melissa Maimann, Essential Birth Consulting.