C-section rate obscured at request of healthcare provider

January 16, 2012 1:38 PM

How do you determine a hospital (and doctor's) c-section rates? Is there a database of this data available to the layperson? Do I just call all the local doctors? Send them a letter? Is there a state agency that would respond to this information request? Relevant states: South Carolina, North Carolina

I'm not pregnant, but I'd like to be in the next year. I don't really have a doctor that I'm strongly attached to locally. (There are a lot of retirees in my area, and I think many of the locals specialize in elder care.) After researching birth options around here, I feel like I'm running out of resources. Hospital seems to be my only option.

Ok, I'm accepting this, but I'd still like to choose a provider that doesn't have a sky-high c-section rate. (After watching all the movies, I think that this number probably matters, at least to me.) How can I find this number for the hospital and doctors in my area? There are several lists by state, but none for mine. And to make it more complicated, I live .2 miles south of the state line, so I'd also like to compare providers in my neighboring state to the North. Googling has proven useless.

*I know there are a lot of what-ifs as to whether this will ever be relevant information to me, but let's just say I'm a planner.*

posted by Kronur to health & fitness (10 answers total)

I don't think that it matters what the hospital and doctor say, rather, what your insurance says.

When I was pregnant, there was a part of the insurance company's website that said what they'd pay.
posted by k8t at 1:58 PM on January 16, 2012

This appears to be a 2008 list for North Carolina (by hospital, not by doctor).
posted by charmedimsure at 2:00 PM on January 16, 2012

k8t, I think the OP means not "how much does a c-section cost", but "how many c-sections does this hospital perform"... or at least that's where my answers are coming from, if I'm wrong, my apologies.

You might find some of these useful:

North Carolina's 2008 numbers by hospital.

I couldn't find anything for South Carolina, unfortunately. Here are the numbers for 2009 on a state-by-state basis, but not split out by hospital.

ICAN (the International Cesarean Awareness Network) has an Upstate SC chapter, no data is included at that link as far as I can see, but if you contact the group leader she may have some for you.

(The Birth Survey unfortunately also doesn't have numbers for SC, but may be a good resource for people in other states, so I'm including it anyway for google.)

Do you know which hospitals are close to you? You may be able to get the information from them by calling the maternity ward. (Or not. Some hospitals are cagey about this.) You may also want to think about focusing on specific doctors who have low C-section rates, which are often (but not always by any means) doctors who work with midwives. And even if they don't, the midwives in your area are likely to know who the docs with the best and worst records are. It may be worth a call to any midwives in your area to see if you can scare up a recommendation. You could also try the local-area Mothering.com (ignore the anti-vaccine paranoia, look for phrases like "homebirth back-up", "natural childbirth-friendly", etc.) for recommendations for doctors in your region.

I think, for what it's worth, that you are totally right to research this stuff in advance. Cesareans are absolutely sometimes necessary and life-saving, but some hospitals have really, really, really high rates of what is still hardcore abdominal surgery, and if you can find a hospital with lower rates, your chances of an ordinary vaginal birth do go up. So, good for you.
posted by thehmsbeagle at 2:05 PM on January 16, 2012 [1 favorite]

You might see if there's a chapter of ICAN (International Cesarean Awareness Network) somewhere near you. They do a lot of advocacy and should know what providers and hospitals in your region have good c-section rates.

You may also want to look into having a doula. The presence of a doula has been associated with lower Cesarean rates (disclosure: I'm a doula). (Also, check your Memail.)
posted by linettasky at 2:25 PM on January 16, 2012

Also, rates aren't necessarily going to be helpful by themselves. My current OBGYN has a very high c-section rate; but she specializes in high risk pregnancies. That makes a difference. Really, you want to talk to the doctor specifically about when they indicate a c-section. I was very nervous about needing one because of some complications, and talked at length with y doctor about under what circumstances we would go that route. I talked at length with my spouse about it, as well. You may also want to look into use of a doula who can help you advocate your position during birth - they can't ultimately override a doctor, but really you should have the kind of relationship with your doctor where that hopefully be necessary.
posted by dpx.mfx at 2:54 PM on January 16, 2012 [3 favorites]

Ooh. Duh. Yes, the rates are helpful to a point, but like dpx.mfx said, the "best OBGYN in town" may also have more high risk pregnancies.

In my view, talking through your concerns with your doctor is the key. Hopefully c-sections are used only when they're required. Telling your doc that you have opinions about this is a good idea.

I didn't have a c-section, but as an aside WRT doctor/mother communication -- I had ideas about my pregnancy and labor that I stuck to and would debate/negotiate with my OBGYN about. One specific example: my OBGYN suggested that I induce labor around my due date after an ultrasound showed low fluid. She told me the pros/cons and wasn't alarmist. But I had a notion that induction was "bad" and that natural was "good" and let that overshadow my thoughts about what she was telling me.

My son was born late (and we did have to induce anyway) and had complications that resulted in a huge scare as well as a NICU stay. We don't know 100% for sure that his complications were "caused" by not inducing when my (pretty crunchy) OBGYN suggested, but it is pretty likely.

If I were to go into pregnancy again, I'd continue being a natural skeptic and researcher, but I'd give my OBGYN's opinion a lot more worth than I did last time. And this would also be the case if a c-section was suggested.
posted by k8t at 3:42 PM on January 16, 2012 [1 favorite]

I second what k8t and dpx have said. The c-section rate is only a small part to consider. The quality of the OBGYN matters so much more. I went with "the best in town" even though she has a high section rate because she performs a lot of high risk deliveries. Her opinion is generally to let things progress naturally. It was nice to know that I could trust her to give good direction and if there had been an emergency I was in experienced hands.
posted by saradarlin at 4:17 PM on January 16, 2012

If you get in touch with your closest ICAN group, as suggested above, or even better, go to a meeting, you may get quite a bit of info on the doctors in your area, or at least some leads. Our local group has an informal list of docs and often relate stories to each other of who did and didn't work out for them and why.

In other words, ICAN is not going to put it's organizational ass on the line by publishing good doc/bad doc lists, but face-to-face, people will give you whatever anecdata they have from personal experience, good or bad.
posted by emjaybee at 4:58 PM on January 16, 2012

[Folks, OP is not anon, you can send non-answers to them over MeMail.]
posted by jessamyn at 9:23 PM on January 16, 2012

Thanks for the answers everyone. You've given me some great things to think about and avenues to pursue. I am definitely going to reach out to the local midwives. Nevermind that the closest midwife is over 60 miles away!

And ICAN is also awesome! I'm going to contact the Southeast coordinator to see if there are any local resources. The only state chapter here is located a long way from me, but North Carolina chapters may be much more convenient.
posted by Kronur at 6:32 AM on January 17, 2012