ASK: How do I choose a hospital where I am least likely to get a C-section?

[TRANSCRIPT OF ANSWER]

Cesarean Section Rate

So, women are concerned about the cesarean section rate in the United States. We all have that concern. It’s unclear exactly what the rate needs to be, but we know it needs to be a lot lower than the current national average, which is about 33%. 33% of women in our country have a C-section. And that includes first-time mothers that have a C-section, but it also includes women who have a C-section after a prior C-section where they may not need it and would have been eligible for a vaginal delivery.

Factors to Avoid Cesarean Section

There are many factors that you need to look at when you are looking to avoid a cesarean section. One is your own role in that process. There are things you can do as a woman who’s in labor that help you avoid a cesarean section. Avoiding induction, avoiding unnecessary intervention, staying mobile, staying upright. Those are all things that are important. So if you’re interested in learning what you yourself can do to avoid a cesarean section, there are a lot of resources here on Birthpedia that can help you understand how you can avoid a cesarean section.

How to Pick a Provider

We know that one of the reasons women have cesarean sections is because of the provider they choose. There are providers who have a strong preference for cesarean section over vaginal delivery, or who believe that this is somehow safer or somehow something that’s easier for you and for them as well. So ask your provider what their philosophy is surrounding cesarean sections. And I would say your red flag is, ‘It’s up to me’. A red flag may also be, ‘Well, this is how I’ve always done it,’ or ‘I’ve never had a bad outcome,’ when the truth is that birth is essentially a normal life event and so a cesarean should be reserved for two specific things.

One, if your life or your baby’s life is potentially in danger or the risk outweighs the benefit fits. And also if you have a personal strong preference for very specific reasons, such as prior trauma or prior experiences that really make you so afraid of a normal birth that you need to really think about potentially scheduling a surgery because it’s somehow protective to you or your baby. That’s a controversial topic, but in the end, I’m a firm believer that your personal choices are also very important in this discussion. Again, this is something to talk about with your provider and to kind of do some soul searching on, to understand what it is that you’re afraid of. Because, in the end, we know that normal birth is the safest way for you to bring your baby into this world.

Hospital Cesarean Section Rates

There’s a lot of publicity currently that talks about if you walk into a hospital that has a high cesarean section rate, you are more likely to have a cesarean section. And I do agree with that to a certain point. But it’s not always the case. There are many hospitals that have fairly high cesarean section rates, but have outstanding providers who are good stewards of our cesarean section rate. Midwives in the United States, for example, tend to have a cesarean section rate lower than 15%. And in some hospitals, it’s even lower than that. And that’s because nurse-midwives are guardians of normal birth and are specialists in normal vaginal birth. Physicians tend to be specialists in pathology or disease processes and surgery. They essentially have a different toolbox. So look for the providers with the toolbox that promote vaginal delivery and seek them out.

The other reason that the adage isn’t always true that if you walk into a hospital with the highest cesarean section rate that you’re more likely to get as a cesarean, is that there’s a lot of variety among surgical providers. There are surgical providers who take a firm stance on cesarean section, and there are surgical providers who do a lot of cesarean sections, sometimes as high as 60%. So talk to your provider and have an honest conversation about what their personal cesarean section rate is. As a hospital administrator, this is a topic dear to my heart. It’s really important for me that women have the birth that they want, and also that we keep our cesarean section rates as low as possible. But what I’ve learned is that in some instances, there are so many factors that go into it that it becomes complicated.

How to be a Good Consumer

One thing that has concerned me is that women who want to be good consumers or women who want to drive good outcomes in care, avoid hospitals that are making the most change and avoid hospitals that work really hard to do a great job and tend to go somewhere where it’s already been figured out. The way we change care in the United States and the way we will change our cesarean section rates is by women standing up for what they want and being good consumers. And I promise you when you speak up and say, ‘This is what I want, and this is what’s important to me,’ for-profit hospitals will listen to you. Be a great driver of care. Be a great driver of change.

In a nutshell, if you’re looking to avoid a cesarean section, pick a provider that agrees with you. Pick a provider who can provide the care that you’re looking for. Do your homework and speak up and let the administrators know what’s important to you.