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?
Showing posts with label c-section. Show all posts
Showing posts with label c-section. Show all posts
Wednesday, April 11, 2012
Wednesday, November 30, 2011
{Ottawa Doula} Swimming Upstream: Vaginal Birth after Two Cesareans
I have been immersed in a dilemma lately - not my own personal dilemma, but one of my client's.
This woman would like to attempt a vaginal birth after two cesareans. We hear A LOT of information out there about VBAC (pronounced v-back) after one cesarean, and most doctors and midwives would agree that it is a safer choice than scheduling a repeat cesarean (as long as you meet the "qualifications" - no ongoing medical problem where another c-section would make sense, and a low, transverse incision).
The American Congress of Obstetricians and Gynecologists (who issued the report I linked to above) also agree that a Trial of Labour (TOL) for a woman with two or more cesareans is a viable option. The risks of uterine rupture are higher, but variable. Studies differ in their methods and conclusions, and "risk" is communicated to patients in different ways.
For example, read this statement, as stated by my client's doctors (the numbers are not accurate here - this is just to illustrate how they have portrayed risk):
Your risk of uterine rupture triples after 2 cesarean sections. In all the cases of uterine rupture I've seen, the baby has ended up with cerebral palsy.
Now, read these statements, as a properly conducted study may present them:
Women who attempt TOL after 2 cesarean sections have a 1.9% risk of uterine rupture. Of these, only 0.06% experience a complete rupture (where the baby actually enters the abdominal cavity).
1 in 6000 women who attempt TOL after multiple cesareans experience uterine rupture.
The first one sounds a lot worse, doesn't it? If you're trying to scare a woman into scheduling a c-section, the first statement packs a lot more oomph.
OBs who have personally witnessed a uterine rupture are much more likely to inflate the risks, because their perception of risk has changed. It's no longer a magic number (eg. 0.5% of women who attempt a TOL after one cesarean section risk a uterine rupture), and instead the one case they've seen colours the way in which they treat all future patients.
To make matters worse, there are no doctors here in Ottawa (at least none I have come across) who support a woman desiring a TOL after multiple cesareans. My client has been continually hassled about her decision, and with each prenatal appointment she attends, a new resident provides more scary stories. No one seems to talk about the risks associated with another cesarean section, which I find interesting.
When you want to do something that goes against the grain, and no one in your community is willing to support you, what should you do?
1) Remember that as a patient, you have rights. You have the right to refuse interventions and treatments offered. You have the right to informed consent.
2) Become armed with research. Doctors are busy people, and often don't have time to stay abreast of new research. Do your own looking around, and begin compiling all the papers that support your decision (start with the new ACOG guidelines, which support your decision to try for a VBA2C). Bring them with you to every prenatal appt., as you'll often be seeing many different doctors and residents.
3) Yes, the health of you and your baby is important. But so is your experience, and oftentimes, doctors will play the "healthy mommy, healthy baby" card, in order to dissuade you from your desire for a positive birth experience. Seek the help of a professional (social work, counsellor, or doula) who can look at the benefits/risks objectively with you, and help you come to the right decision.
4) Did I say that health was important? You betcha! If you're desiring a VBAC (or VBA2C), you best be sure that you're eating really well (see a nutritionist or naturopath for help), exercising every day (gentle exercise such as walking, swimming or yoga) and reducing stress (do some yoga and you'll check two things off your list!). Many women also seek treatment from alternative health practitioners, such as acupuncturists, homeopaths and chiropractors.
5) Read the positive stories. There are women all over the world who have tried and successfully had a VBA2C (I've even read of a VBA4C!!)
Bottom line: if you're taking the plunge, first make sure you know how to swim. Oh...and a little faith goes a long way. Faith in yourself, your body, and your ability to do something that others think is impossible.
Share your story below of something you have accomplished when others tried to tell you it was impossible.
This woman would like to attempt a vaginal birth after two cesareans. We hear A LOT of information out there about VBAC (pronounced v-back) after one cesarean, and most doctors and midwives would agree that it is a safer choice than scheduling a repeat cesarean (as long as you meet the "qualifications" - no ongoing medical problem where another c-section would make sense, and a low, transverse incision).
The American Congress of Obstetricians and Gynecologists (who issued the report I linked to above) also agree that a Trial of Labour (TOL) for a woman with two or more cesareans is a viable option. The risks of uterine rupture are higher, but variable. Studies differ in their methods and conclusions, and "risk" is communicated to patients in different ways.
For example, read this statement, as stated by my client's doctors (the numbers are not accurate here - this is just to illustrate how they have portrayed risk):
Your risk of uterine rupture triples after 2 cesarean sections. In all the cases of uterine rupture I've seen, the baby has ended up with cerebral palsy.
Now, read these statements, as a properly conducted study may present them:
Women who attempt TOL after 2 cesarean sections have a 1.9% risk of uterine rupture. Of these, only 0.06% experience a complete rupture (where the baby actually enters the abdominal cavity).
1 in 6000 women who attempt TOL after multiple cesareans experience uterine rupture.
The first one sounds a lot worse, doesn't it? If you're trying to scare a woman into scheduling a c-section, the first statement packs a lot more oomph.
OBs who have personally witnessed a uterine rupture are much more likely to inflate the risks, because their perception of risk has changed. It's no longer a magic number (eg. 0.5% of women who attempt a TOL after one cesarean section risk a uterine rupture), and instead the one case they've seen colours the way in which they treat all future patients.
To make matters worse, there are no doctors here in Ottawa (at least none I have come across) who support a woman desiring a TOL after multiple cesareans. My client has been continually hassled about her decision, and with each prenatal appointment she attends, a new resident provides more scary stories. No one seems to talk about the risks associated with another cesarean section, which I find interesting.
When you want to do something that goes against the grain, and no one in your community is willing to support you, what should you do?
1) Remember that as a patient, you have rights. You have the right to refuse interventions and treatments offered. You have the right to informed consent.
2) Become armed with research. Doctors are busy people, and often don't have time to stay abreast of new research. Do your own looking around, and begin compiling all the papers that support your decision (start with the new ACOG guidelines, which support your decision to try for a VBA2C). Bring them with you to every prenatal appt., as you'll often be seeing many different doctors and residents.
3) Yes, the health of you and your baby is important. But so is your experience, and oftentimes, doctors will play the "healthy mommy, healthy baby" card, in order to dissuade you from your desire for a positive birth experience. Seek the help of a professional (social work, counsellor, or doula) who can look at the benefits/risks objectively with you, and help you come to the right decision.
4) Did I say that health was important? You betcha! If you're desiring a VBAC (or VBA2C), you best be sure that you're eating really well (see a nutritionist or naturopath for help), exercising every day (gentle exercise such as walking, swimming or yoga) and reducing stress (do some yoga and you'll check two things off your list!). Many women also seek treatment from alternative health practitioners, such as acupuncturists, homeopaths and chiropractors.
5) Read the positive stories. There are women all over the world who have tried and successfully had a VBA2C (I've even read of a VBA4C!!)
Bottom line: if you're taking the plunge, first make sure you know how to swim. Oh...and a little faith goes a long way. Faith in yourself, your body, and your ability to do something that others think is impossible.
Share your story below of something you have accomplished when others tried to tell you it was impossible.
Thursday, November 10, 2011
{Ottawa Doula} What to do when you're afraid of birth
After posting about the NHS's plans to offer c-sections for free in the UK, I have noticed an increase in traffic from people googling "scared of birth, should I have a c-section."
This has really touched me, and I wish there was some way I could reach out to these women and give them a hug. So here's my way - a blog post!
Preparing for birth can be a scary and overwhelming experience. I remember coming home from my first prenatal class, curling up into a ball and having a huge cry. The reality of what I was about to face hit me over the head like a ton of bricks, and I didn't know how to deal with the fear.
I studied for birth like it was a PhD comprehensive exam. When I would hear about other women's wonderful birth stories, I would suddenly become fearful - what if that doesn't happen to me? What if I can't do it? What if it all turns out "bad"?
The thing I've come to realize as a doula is that a woman who is well prepared, and well supported, can have a positive experience regardless of the outcome. Happy birth stories can happen in any hospital, with any care provider, as long as the woman feels like the director of her own experience.
Here are some information and tips for women out there who are scared of birth and considering a c-section instead:
1) What are your specific fears? There are most likely 2 or 3 things that you are dreading - for some women, it's the pain; for others, it's the possibility of a tear; others fear things like vomiting, being naked, or losing control (by making too much noise, fainting, or doing other "crazy" things)
2) Write out a plan of how you will deal with this fear if it does happen. Visualize it happening, and then visualize yourself dealing with the situation. Talk to someone about your fears, and have them work through them with you.
3) Hire a doula. Your husband can not be your "everything" and he will be scared as well. Most likely he has his own set of fears. If you can't afford a doula, ask for a friend or family member who has given birth (and who has a positive birth story to tell) to support you.
4) Make sure you have a good caregiver. You all know my thoughts on midwifery care. There is no one better equipped than a midwife to calm your fears.
5) Take a GOOD prenatal class. The classes offered at the hospital are usually biased and extremely boring. Look around for prenatal educators in your community who offer alternative classes. Here are a few great ones in Ottawa:
Ottawa Childbirth Education Association http://www.ottawacea.com/
Birthing From Within Classes http://primadoulas.ca/?page_id=22
Bradley Method http://www.healthy-beginnings.ca/
It's worth the money - another option is to hire a doula who is a childbirth educator, and ask her for some one-on-one classes in addition to your prenatal appointments.
Any other tips or thoughts out there for women who are afriad of birth?
This has really touched me, and I wish there was some way I could reach out to these women and give them a hug. So here's my way - a blog post!
Preparing for birth can be a scary and overwhelming experience. I remember coming home from my first prenatal class, curling up into a ball and having a huge cry. The reality of what I was about to face hit me over the head like a ton of bricks, and I didn't know how to deal with the fear.
I studied for birth like it was a PhD comprehensive exam. When I would hear about other women's wonderful birth stories, I would suddenly become fearful - what if that doesn't happen to me? What if I can't do it? What if it all turns out "bad"?
The thing I've come to realize as a doula is that a woman who is well prepared, and well supported, can have a positive experience regardless of the outcome. Happy birth stories can happen in any hospital, with any care provider, as long as the woman feels like the director of her own experience.
Here are some information and tips for women out there who are scared of birth and considering a c-section instead:
1) What are your specific fears? There are most likely 2 or 3 things that you are dreading - for some women, it's the pain; for others, it's the possibility of a tear; others fear things like vomiting, being naked, or losing control (by making too much noise, fainting, or doing other "crazy" things)
2) Write out a plan of how you will deal with this fear if it does happen. Visualize it happening, and then visualize yourself dealing with the situation. Talk to someone about your fears, and have them work through them with you.
3) Hire a doula. Your husband can not be your "everything" and he will be scared as well. Most likely he has his own set of fears. If you can't afford a doula, ask for a friend or family member who has given birth (and who has a positive birth story to tell) to support you.
4) Make sure you have a good caregiver. You all know my thoughts on midwifery care. There is no one better equipped than a midwife to calm your fears.
5) Take a GOOD prenatal class. The classes offered at the hospital are usually biased and extremely boring. Look around for prenatal educators in your community who offer alternative classes. Here are a few great ones in Ottawa:
Ottawa Childbirth Education Association http://www.ottawacea.com/
Birthing From Within Classes http://primadoulas.ca/?page_id=22
Bradley Method http://www.healthy-beginnings.ca/
It's worth the money - another option is to hire a doula who is a childbirth educator, and ask her for some one-on-one classes in addition to your prenatal appointments.
Any other tips or thoughts out there for women who are afriad of birth?
Subscribe to:
Posts (Atom)