Not all expectant parents have a choice where to have their baby today. However, those that do ought to ask good questions and take a tour of the birthing facilities prior to giving birth. One very telling question is to find out about the hospital or birth facility’s cesarean rate.
Why is the Hospital’s Cesarean Rate Important?
When planning for birth, many parents may be impressed by the numbers associated with a particular birth facility. They may like to discover that this hospital boasts the most number of deliveries in the region. Or that they have been in the “baby business” for the longest period of time compared to competing places of birth in the area. Parents may also appreciate that the maternity unit has recently been renovated to include larger rooms and private bathrooms.
Believe it or not, the hospital’s cesarean rate is a much better measuring stick to find out if that facility is in line with evidence-based care and meeting the individual needs of each family. There are several reasons for why this may be true. A high cesarean rate is a potential indication that other intervention rates (such as routine inductions) are also high. A high cesarean rate may also indicate that care providers tend to lack the patience required for longer labors. Care providers at that facility might also recommend cesareans rather than a trial of labor for mothers planning a VBAC.
Questions to Ask Regarding Hospital Policies
If a hospital has a low cesarean rate, this is also a fairly good indicator that their policies surrounding labor and delivery are also more flexible. Parents may want to ask what the policies in that birth facility are regarding:
- Eating and drinking during labor: What is allowed? Light foods? Clear fluids? Ice chips only?
- Monitoring: Are moms restricted to bed? Is intermittent or wireless monitoring possible?
- IVs: Are they required? Can mothers have a heparin lock instead?
Don’t be fooled into thinking that more technology means a safer or better birth experience. Unless the technology allows benefits for the mother or baby such as wireless monitoring to improve mobility, the more birth facility staff relies on technology, the more it can lead to a higher cesarean rate.
It is crucial for parents to read the current research about labor and birth so that they know when hospital policies are out-dated. For example, clear fluids during labor can add comfort to a woman’s labor, without increasing risk, according to medical experts including the American Society of Anesthesiologists (ASA) and the American College of Obstetricians and Gynecologists (ACOG).
What if the Care Provider Has a Low Personal Cesarean Rate?
In some cases, an individual care provider may have a low cesarean rate in his or her practice, despite a high cesarean rate in the facility. If this happens, it is important for parents to be sure that this care provider will be attending their birth. Could parents also interview the care provider’s back-up?
In cases where there are multiple providers in the same practice, it will be important that parents choose a group that has a low cesarean rate, even if the birth facility has a higher cesarean rate.
What is Considered to be a “Low” Cesarean Rate?
Depending on the country in which one lives, the cesarean rate varies dramatically. For example, the US has a 33% cesarean rate. Canada has a 26% cesarean rate. Cesarean rates are not consistent in Europe. While Italy has a 40% cesarean rate, the Netherlands boasts the lowest cesarean rate at 14%.
Within those countries, various regions, provinces or states can differ widely in their cesarean rates. For example, BC in Canada has a 30% cesarean rate, while the lowest cesarean rate in the country is in the province of Manitoba with only 19%. In the US, states in the southwest region generally have lower cesarean rates. New Mexico and Utah have cesarean rates of less than 25%, while Florida and New Jersey are among the states with the highest cesarean rates tipping over 35%.
In fact, the WHO (World Health Organization) recommends that the safest goal for cesarean rates are between 5 and 10%. Some research even suggests that rates above 15% may cause more harm than good.
Does the Hospital have a High Cesarean Rate?
Once parents have researched the cesarean rate in their own country or region, they should compare that rate to the cesarean rate in their local hospitals or birth facilities. Online resources are available to help parents find specific cesarean rates of the hospital in their local area.
Expectant mothers who are motivated to decrease their chance of having a cesarean should choose a hospital or facility that has a cesarean rate that is lower than the regional or national average in the area.
Remember that it is not the spacious rooms, wallpaper and hard-wood flooring that will be making decisions about health care. It is finding a provider and birth facility who are in line with practicing evidenced-based care, which includes having low rates of medical intervention and low rates of cesarean.