Cesareans more likely for women at for-profit hospitals

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Another article from the States, but the situation is the same in Australia. Reviewing the latest 2007 birth statistics, the caesarean rate within the private health sector was 40% whereas the overall caesarean rate was 29%. Births attended by private midwives have a 5-8% caesarean rate.

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For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals ...

... women were at least 17 percent more likely to have a cesarean section at a for-profit hospital than at a nonprofit or public hospital from 2005 to 2007. A surgical birth can bring in twice the revenue of a vaginal delivery.

In addition, some hospitals appear to be performing more C-sections for nonmedical reasons -- including an individual doctor's level of patience and the staffing schedules in maternity wards ...

... mothers with low-risk pregnancies had a 10 percent chance of giving birth by C-section at the public Santa Clara Valley Medical Center, ... whereas low-risk pregnancies at the for-profit Los Angeles Community Hospital ended in a surgical birth nearly half of the time.

The numbers provide ammunition to those who have long suspected that unnecessary C-sections are performed to help pad the bottom line.

"This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate," ...

This was the first independent analysis of C-section rates at the 253 hospitals reporting birth statistics to state health authorities. The data focuses on low-risk pregnancies where cesareans are more likely to be unnecessary -- excluding deliveries by older mothers, women with certain medical conditions and women with previous C-sections.

... For some, a C-section can have devastating consequences.

Heather Kirwan said her doctor at the for-profit ... [hospital] urged her to have a C-section, warning that the baby was too big ...

"She ended up being a 5-pound, 12-ounce baby," ... and who now believes she could have delivered vaginally.

There is a 15% margin of error on a third trimester ultrasound. They are, in fact, not designed to guesstimate the size of the baby as they are frequently inaccurate. In my practice, I find my hands are my best tool for judging the size of a baby.

When Kirwan got pregnant again, doctors discovered the embryo was developing outside the uterus -- a life-threatening condition called an ectopic pregnancy which is more likely to occur after a C-section. The embryo was removed along with one of Kirwan's ovaries and fallopian tubes. She has been unable to conceive since.

This is a valid point, and one that is often not mentioned: fertility diminishes for a variary of reasons after a caesarean has been performed.

... one important factor has always loomed over the debate about the rise in C-sections: the bottom line. In California, hospitals can increase their revenues by 82 percent on average by performing a C-section instead of a vaginal birth ...

California Watch examined the births least likely to require C-sections, those in which mothers without prior C-sections carry a single fetus -- positioned head down -- at full term, and found that, after adjusting for the age of the mothers, the average weighted C-section rate for nonprofit hospitals was 16 percent, and for-profit hospitals had a rate of 19 percent.

That may seem like a small percentage gap to the casual observer, but medical experts consider it significant. It means women are 17 percent more likely to have a C-section if they give birth at a for-profit hospital.

"That's a decent-sized difference," ...

Melissa Maimann, Essential Birth Consulting 0400 418 448