Looking for information about DC area hospital Cesarean rates? Many people decide to enroll in my classes because they would like to avoid a Cesarean with their first baby, or because they would like to have either a vaginal birth after Cesarean (VBAC) or an unmedicated birth with their second baby. This is awesome! But I do need to offer the disclaimer that sometimes, no matter what a person does or doesn’t do to prepare, their chances of having a Cesarean are higher simply because of the birthing facility they have chosen. I’m going to explain why. A great place for you to start would be to check the DC area hospital Cesarean rates. To do so, click here.
What is it exactly about certain facilities which cause their Cesarean rate to be higher than other facilities? There isn’t just one answer and truthfully the powers that be are not even sure themselves. It’s why the work of Dr. Neel Shah at Harvard is so important. His team is currently testing the idea that “management matters” when it comes to a hospital’s Cesarean rate. What they’ve observed when focusing only on low-risk birth, is that because there are no rules about how many rooms a hospital has to have, that the more births happen in a place, the more Cesareans are done. “The only way that’s possible,” says Dr. Shah, “is if they’re moving people through much faster.”
This staffing/rooming issue is a problem as a result of a few major challenges: 1) A high number of patients being induced. 2) The mandate of continuous monitoring. 3) Paying lip service to evidence-based practices but failing to stand by those words.
- Induction. “You’re past your due date.” “Your baby is getting big.” “Your fluid is decreasing.” “Your baby might have had their first bowel movement already.” “Your placenta could be deteriorating.” “Your baby could die.” Do any of these sound familiar? It’s extremely common for people who are still pregnant past their due date to hear one or more of these phrases in order to convince the person that inducing is necessary. I could delve into each of these phrases individually but it would take too long. I can assure you we will cover all of this and more in class. In the meantime, check out Evidence Based Birth to begin researching.
- Continuous monitoring. Once an induction process is underway, continuous monitoring is required because babies commonly become distressed as a result of drugs used to induce labor. Many hospitals require continuous monitoring even if the person is in labor naturally, and this is due to the staff-to-patient ratio. Nurses have to care for multiple patients at once, and continuous monitoring allows them to view patient data on a screen at the front desk rather than bouncing from room to room to check on the safety of each person. Where are the doctors in all of this? Great question! They are often seeing pregnant patients during daylight hours. Midwifery practices often split their providers evenly between office care and labor care, so that they can more adequately supervise labor & delivery.
- Lip service. “As long as everything is OK with you and your baby, you can have a natural birth.” In practice, this can often come down to an individual provider’s risk tolerance. So how do we balance what the provider is comfortable with versus what the parent’s intuition may be saying? A person who is told all of the above mentioned scary statements may also have a sense that their baby is healthy, that perhaps their due date was miscalculated and they are not actually overdue. Many babies shown to be greater than 9 lbs. on an ultrasound are actually an average, healthy size. And oh, by the way, 9 lbs. and even larger babies can easily be birthed vaginally in most cases, particularly where an unmedicated person has total freedom of mobility.
So because there’s so much to learn here, I would like to point out that doctors who practice conservatively (frequently inducing between 40 and 41 weeks), probably do see fewer stillbirths in their practice, particularly among patients who are age 40+ (though being over 40 is not necessarily a risk factor by itself). So I want to acknowledge this fact and not minimize it. However, the big question here is: “At what cost to our mothers?” Many pregnant people are going to have to be pressured to undergo unnecessary inductions in order to prevent one stillborn baby, and unnecessary inductions will lead to more Cesareans. Is it worth it? Of course it is — stillbirth is not something any family should ever have to face. Ever. But the harsh reality of what this means is that we must take control of our individual experiences. We can say “no” to an induction we know we don’t need. We can request (or demand) further testing which gives us peace-of-mind that our decision is the correct one for us and our baby. We can encourage the midwifery model of care by choosing it for ourselves, which not only helps to minimize unnecessary inductions but also helps encourage life-saving measures such as baby kick counts, inductions for decreased fetal movement, and Cesareans for babies who are truly in distress. And if we decide an induction is the best option, we very carefully manage the use of medications as well as the entire care plan to minimize the risk of distress in the birthing person and the baby.
I hope that this post has been helpful as you begin to sort through your understanding of DC area hospital Cesarean rates. I hope that you will join us in class for a chance to learn a comprehensive approach to childbirth, including pain minimization techniques and enhancing the provider-patient relationship.