Wednesday, April 11, 2012

{Ottawa Doula} Hospital Cesarean Rates

Hospitals are required to disclose their cesarean section rates, but the information is hard to come by without a lot of searching. Most women are admitted to hospital without any prior knowledge of their c-section risk, and will often be surprised when the birth ends up in the operating room.

Each hospital in Canada has a different cesarean section rate because policies and procedures differ from institution to institution. These are policies related to how women are "allowed" to labour and give birth. Things like timing of induction (how long you can go past your due date), electronic fetal heart rate monitoring (EFM), use of Pitocin and IV fluids, and length of pushing time are all regulated by hospital protocol.

Recently, we've seen a number of stories in the media sounding the alarm bell on the rising c-section rates in our Canadian cities. I came across this handy website today, and thought it would be interesting to share the c-section rates at various hospitals here in Ottawa.

Montfort Hospital: 25.8%

The Ottawa Hospital: 29.17%

Queensway Carleton Hospital: 33.18%

Almonte General Hospital: 25.91% 

Winchester District Memorial Hospital: 21.63%

The website also publishes each hospital's VBAC (Vaginal Birth After Cesarean) rate. Scraping the bottom of the barrel is the Queensway-Carleton Hospital, at a dismal 7.63%

Does this mean that women in Ottawa who want to avoid a cesarean section should plan to give birth where their chance of c-section is lowest? This, of course, is a personal choice, but I believe a wiser strategy would start with demanding more evidence-based care from our hospitals. In my opinion, policies and procedures are governed first by consumer demand, and second by evidence-based information (which is ridiculous, I know). The more you are complacent about what is being done to you, the more you pave the way for other women to have the same done to them. [and of course, some c-sections are necessary and medically indicated. Clearly this conversation does not apply to those women, although they still have a right to respectful and informed care]

So if you're under the care of a doctor or OB at one of these Ottawa hospitals, and you hope to avoid a c-section, what should you be asking about?

1) How will you monitor my baby's heart rate? (there is no evidence showing that continuous EFM is beneficial, and there is an increased risk of cesarean section when it is used)

2) If I go post-dates, when will I be induced? (Most OBs are following the 40+10 rule - when you are 41 weeks and 3 days, you will be induced. Again, there is evidence showing that healthy, low-risk pregnancies can extend to 42 weeks without increased risk to mom or baby)

3) When do you feel the need to use Pitocin during labour? What are my other options if you feel that my labour has stalled? (psssst...hire a doula. They have some neat tricks for getting labour to progress!)

4) Do you use routine IV fluids during labour, or can I eat and drink whenever I want?

5) If my baby is doing well, will I be able to push past the allotted time given for second stage?

Also keep in mind that the whole team of OBs needs to be on board with the terms/conditions you have in place. If you decide you absolutely do not want to be induced at 40+10 days, then you will need to be prepared to meet with resistance if your OB of choice is not on call around that time.

Pregnancy shouldn't be a time that women need to do battle to get the care they want. But as you can see above, the reality is, 1 in 4 women will have a c-section in Ottawa (and sometimes that number reaches close to 1 in 3). So it's up to you and your partner to fight for the care you need - doctors are often prepared to listen, but it's our responsibility to make sure we're heard.

And of course, you've heard the same old from me time and time again....hire a doula and that percentage goes down...blah blah blah....get a midwife and that percentage goes down...blah blah blah....have a home birth if you're healthy and comfortable with the idea...blah blah blah.

You get the picture!

What do you think? Are my local Ottawans surprised by these rates?


  1. What do you feel are the valid medical reasons for warranting a c-section?

    1. I guess anything that would put me or my baby in danger. For example, placenta previa (when the placenta is covering some or all of the birth canal). Or maybe a breech presentation that couldn't be delivered safely vaginally. There's also pre-eclampsia and HELLP syndrome. In rare cases, cord prolaspe (where the cord slips down in between the head and cervix). Or, if there's a true indication that the baby is not responding well to labour - sometimes the cord is getting squished, although this can often be rectified by moving around. There are a lot of valid medical reasons for doing one...I think what people term "unnecessareans" are when women are subjected to a cascade of interventions (that they didn't want), and then those interventions lead to problems that require a c-section.

  2. Thanks for that, Misty. Will be sharing.

  3. During my last client's labour I had a talk with the nurse. This was only my second time at this particular hospital. I was shocked when she told me that the epidural rate at this hospital was 90%. What are you thoughts on that?


    1. I think most hospitals have about a 90% epidural rate. I'm hesitant to talk about that topic, though, as I feel like I start pitting women against each other (those who strongly believe natural childbirth is "the way" to have an intervention free birth, and those that believe the choice of have pain relief is a woman's right). I see both sides to this story, but I also believe there's a middle ground. The evidence does show an increased risk for cesarean section with an epidural (although some studies have conflicting findings). I think the fact that epidurals are portrayed as a risk free option is wrong, but I also believe they have their place in certain kinds of labours. Anyway, this is probably a whole separate post :) I deliberately left epidurals out of this, but maybe I will write something to address the question!

    2. NINETY?! Wow, I never would have guessed that! Crazy. You should definitely write about it! FWIW I had two with and two without, so I guess you could say I also believe in middle ground.

  4. This is great! I would love to see it compared with the Outaiouais region, as well as with data on transfers from the birth centre in Gatineau (if available). I've heard pretty horrible things about the hospital in Gatineau, which is why I opted for a hospital birth in Ottawa supported by a doula rather than the birth centre in Gatineau with possible transfer to Gatineau hospital.

    1. Yes Annie, have heard the same myself, although I've never actually been a doula at that hospital. I did have one Outaiouais client whose biggest fear was progressing too quickly and ending up at Gatineau. Luckily it all worked out and she birthed in Ottawa :)

    2. Hello, I am also trying to make a decision to deliver at Montfort or working with the midwives in Gatineau (with a risk of being transferred to the hospital as I had to be for my 1st child) since the Gatineau hospital has such a bad reputation. Can I ask what specifically accounts for GH's bad rep? Would there possibly be a different experience if staying with the midwives once at the hospital? Thanks!

    3. Hi! I think their bad reputation is based on old policies/procedures...unfortunately they haven't gotten with the times and updated policies based on good quality evidence. I would suggest getting on the waitlist for the midwives and then asking them straight up what some of the issues are - I would assume your experience would be better with a midwife, but if their hands are tied, they may not have the authority to advocate for you. That said, I've never practiced at GH personally, so I'm only speaking from what I've heard. Definitely talk to a midwife before you decide which way to go! Good luck!!

  5. Those rates are fascinating; especially the Winchester hospital's low rate. When my c-section was planned back in 2009, I was asking why I couldn't have my breech baby vaginally and was told the only Dr. in the area who was able to catch a breech baby was at Winchester hospital. I wonder if that's true, especially given the changes in the guidelines from the OB society since then, and if that has impacted their rates at all. I'd also love some really clear evidence of how first time mom's c-sections impact their subsequent births, and if there's anything that could be done to support those first timers better and cut the c-section rates that way. More of the women I know having babies these days (in Ottawa and everywhere else) are having c-sections than anything else, and I can't imagine they are all THAT necessary.

  6. Im attempting vbac2 in july with the support og my ob at the general, she never fails to mention and rememtion however my odds of rupture and infant mortality. I have secured a birth diula for additional support and i feel i have made an informed decision however with these constant reminders i have days where i doubt my choice... What r ure thoughts in vbac2 being a safe decision


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