We Care!

The Boston Globe Magazine published a piece today, written by an obstetrician in the US.

C-section rates are highly variable, as the article points out. Some hospitals with different policies and procedures, and better support for OBs, have lower rates. Other hospitals skyrocket past the national average.

Here in Canada, our average rate is around 25%. Ottawa's cesarean section rate is higher - over 30%

There are some key points I'd like to highlight from the article:

• According to this doctor/author, many obstetricians just "don't care" about cesarean section rates
• There are multiple factors that influence rates. Here are just a few:
• hospital policy (does the hospital administration care about their rates?);
• surgical assistants on-staff;
• rates of women with previous cesareans (most women who have one will go on to have more cesareans);
• whether the hospital caters to high-risk pregnant women;
• liability; and
• individual OB preferences (for example, is the OB skeptical of traditional medical practices, or do they tend to make the call more quickly?)

So if a cesarean section rate comes down to individual hospitals, how is a national (or international) strategy ever to be successful? As the author writes,

"In 2000, the federal government set a goal of reducing the caesarean rate among first-time moms to 15 percent (from 18 percent in 1998) by 2010. Instead, officials watched it shoot up."


My question is this - how can we work to make hospital policy and "culture" more transparent? If there are hospitals in our city who have higher c-section rates, wouldn't it make sense for consumers to know why? Perhaps then we could do something about it. Just because we live in a country with universal health care, doesn't mean we can't demand better quality service.

I'll tell you this: many OBs may not care about their cesarean rates, but we pregnant women DO. Unless there is some extreme fear of labour/birth, the majority of women want to avoid a cesarean section. And yet, here we are, getting wheeled into the operating room despite our wishes.

Did you know that midwives have a 30% lower c-section rate than a family doctor who delivers babies? Who knows how much lower that rate is when comparing OBs and midwives - probably a huge difference. Doesn't it make sense to transfer the care of ALL low-risk pregnant women to midwives? Let's leave the surgical stuff and emergencies up to the experts.

It's time for change. Please take a look at the Association of Ontario Midwives "Benefits of Midwifery to the Health Care System." Speak out, and contact your local MPP.