Newb question on c-section rates

BunniKakes

Question from FTM hoping to have a natural birth.

My OB practice averages a c-section rate of about 27%, with some of the doctors as low as 22% and few trending toward 30%. (You get whoever is on call.)

Am I wrong to see this as a red flag? 

Obviously, healthy baby is the objective, but a rate that high makes me worry they're a bit... impatient.

TIA!

ncbelle

That's about the national average, right?  I wouldn't necessarily see their rate alone as good or bad - for example, a practice with more high risk patients will have a higher c-section rate.

What I would want to know is each doc's approach to labor - for example, what is their policy on induction?  What do they consider grounds for a section?  What are their "rules" on labor?   How many med-free deliveries do they see?  Etc. 

sbevmc09

ncbelle:

That's about the national average, right?  I wouldn't necessarily see their rate alone as good or bad - for example, a practice with more high risk patients will have a higher c-section rate.

What I would want to know is each doc's approach to labor - for example, what is their policy on induction?  What do they consider grounds for a section?  What are their "rules" on labor?   How many med-free deliveries do they see?  Etc. 

I agree.  I think you should definitely keep that they're around the national average in mind, but I think you'll find out far more about their philosophies on birth and how they will approach the birth process by asking other questions.  The way they answered those questions would be more important to me.  Yes, I would love to hear that their C/S rate was lower than that, but as PP said there are a lot of factors that go into that number and I don't think you can immediately see it as a big red flag.  Now, if their C/S rate was something like 50% I would run before even asking other questions!

nosoup4u

That's a little lower than the national average. Depending on where you live, 22% is actually a pretty low rate right now.

I would be more concerned about their induction rate, if they want you to have EFM during labor, things like that. This is a good post about what to ask: https://birthsen.tmdhosting930.com/?p=448

noraraeuc

If you are informed it shouldn't matter, you are the boss especially when you are educated.

nosoup4u

noraraeuc:

If you are informed it shouldn't matter, you are the boss especially when you are educated.

Nope, not true. 

robyn2201

nosoup4u:

noraraeuc:

If you are informed it shouldn't matter, you are the boss especially when you are educated.

Nope, not true. 

I have to agree.

When you are in the midst of labor, it's hard to be an advocate for yourself and baby. All you are trying to do is get through each contraction and if an unsupportive provider is suggesting your babies life may be in danger or just even telling you that they recommend an intervention, you may not be in a place mentally to ask questions or even be able to really process what they are telling you.

noraraeuc

Which is why every laboring mother should have an advocate who is knowledgeable as well, such as a doula, and have their wishes known by the hospital staff ahead of time. Also being educated on which obstetric matters are myth based, fear based, profit based, knowing which interventions to avoid to prevent complication, knowing yourself what is truly a cause for concern and what is not will absolutely help you regardless of who your provider is. Be a step ahead.

tokenhoser

Working with a trustworthy provider that you don't feel the need to "be a step ahead of" is much less stressful. Selecting the right doctor or midwife is an important step in achieving the style of care you want. Picking one you know you'll need to fight, deceive, and generally question all the time... is not a good choice if any choice at all is available.

I agree with the general advice - the c/s rate is not remarkable, either in a good or bad way. Ask lots of questions about what the general policies are, how they handle unmedicated births, and pay attention to the tone of the answers. If you feel talked down to or disrespected... move on.

BunniKakes

Thanks for the answers and perspective - as well as suggested questions to ask!

Many moms I know have ~not~ had the experience of getting to 'call the shots' during labor. An impatient doctor at the end of his or her shift has a lot more power than a laboring mom in most scenarios.

The midwives I'm considering have an 11% c-section rate as a practice. Comparing that to the possibility of going into labor on a Monday and getting the OB in my practice notorious for c-sections around 30$... well, it makes me think twice.

I might be naive, but I just don't think three out of ten first time moms ~need~ a c-section.

tokenhoser

If you have access to midwife care with that kind of record, I'd switch in a heartbeat. I'm really, really hoping to get in with a midwife here, but the demand is far higher than the supply of spaces with them. I went with my family doctor last time, and had a pretty good experience so I'm not worried if I don't get in but would still prefer to work with a midwife.

The stats are skewed - that 30% is likely an overall stat, including repeat c-sections. Midwives won't have any planned RCS. They won't take high-risk patients. So there probably should be a gap between the rates, but if you're picking your own personal caregiver, why not stack the deck in your favour?

Amelia4

tokenhoser:

If you have access to midwife care with that kind of record, I'd switch in a heartbeat. I'm really, really hoping to get in with a midwife here, but the demand is far higher than the supply of spaces with them. I went with my family doctor last time, and had a pretty good experience so I'm not worried if I don't get in but would still prefer to work with a midwife.

The stats are skewed - that 30% is likely an overall stat, including repeat c-sections. Midwives won't have any planned RCS. They won't take high-risk patients. So there probably should be a gap between the rates, but if you're picking your own personal caregiver, why not stack the deck in your favour?

It posted before I typed anything, so this is all the edit. 

But, I agree with what tokenhoser said - is the OB c-section rate an overall rate or just first time moms?  My OB had an 11% c-section rate for FTMs and about 20% overall.  Obviously the 20% takes into account RCS, etc, that a midwife wouldn't have.  Also, my OB's 11% includes patients that became high-risk at the end and a midwife may have transferred out those patients.  So you'll want to look at all the information.

BunniKakes

twatley:

BunnyBites:

Thanks for the answers and perspective - as well as suggested questions to ask!

Many moms I know have ~not~ had the experience of getting to 'call the shots' during labor. An impatient doctor at the end of his or her shift has a lot more power than a laboring mom in most scenarios.

The midwives I'm considering have an 11% c-section rate as a practice. Comparing that to the possibility of going into labor on a Monday and getting the OB in my practice notorious for c-sections around 30$... well, it makes me think twice.

I might be naive, but I just don't think three out of ten first time moms ~need~ a c-section.

Do you have any factual evidence to support the claim that doctors would perform a c-section because they are "at the end of their shift and impatient"?

 

You can be a flippant brat about it, but there is a lot of evidence that unnecessary c-sections are on the rise. I saw your other thread. Super appreciated your intentional misrepresentation there. How dare you imply I was judging a medically necessary c-section? That's ridiculous and offensive.

Evidence? No, nor did I say I did. I said it was a concern. I have friends who have had experiences with impatient doctors at hospitals around the country. Indeed, that's why I've had several friends decide on a different option for their second and third children.

I'm not your mom, so I'm not going to do your research for you and your situation. A simple Google search of legitimate medical journals should do the trick. There's no call to be an obtuse instigator. 

annabelle.27

I am really confused as to the comments that midwives wont jave scheduled rcs. This may vary by practice, but is not true as a blanket statement. I had a midwife with my second child and she asked me early on if I wanted a vbac or an rcs. She made it clear that I could change my mind at any time and still continue to see her prenatally, and that she would be there to assist with a csection should I choose to go that route. I would have seen an OB for a consult towards the end of my pregnancy but nothing else would have changed about the prenatal care I received from her.

Amelia4

annabelle.27:

I am really confused as to the comments that midwives wont jave scheduled rcs. This may vary by practice, but is not true as a blanket statement. I had a midwife with my second child and she asked me early on if I wanted a vbac or an rcs. She made it clear that I could change my mind at any time and still continue to see her prenatally, and that she would be there to assist with a csection should I choose to go that route. I would have seen an OB for a consult towards the end of my pregnancy but nothing else would have changed about the prenatal care I received from her.

There are no midwives in my city that will take you if you've had a c-section previously.  Now I'm curious as to which is the norm.

jess9802

Ask about each doctor's primary C-section and inductions rates.

And I agree that finding a health care provider you trust, who answers questions, doesn't dismiss your concerns, and is reasonably supportive of your desires regarding labor and delivery is most important. If you desire a low/no intervention birth, then that is especially crucial for two reasons. One, you want to actually get it, and two, if you NEED an intervention, you'll trust the recommendation a whole lot more if you know your OB or midwife doesn't use this intervention with all patients out of convenience/matter of course.

iris427

noraraeuc:

If you are informed it shouldn't matter, you are the boss especially when you are educated.

This is a vast oversimplification of the issues in our maternity care system.  It kinda sounds like we are blaming uneducated mothers for a 33% c/s rate.  

OP, the national rate in the US is around 33%, including a lot of RCS.  92% of women who have a c/s will have a RCS in their next pregnancy. It's hard to judge an individual doctor's rate because we don't know things like what their c/s rate is for FTMs, how many high risk mothers they take on, etc.  I think it's a good idea to ask a lot of questions and try to get an idea of how interventive they tend to be.   

jcookie0723

twatley:

BunnyBites:

Thanks for the answers and perspective - as well as suggested questions to ask!

Many moms I know have ~not~ had the experience of getting to 'call the shots' during labor. An impatient doctor at the end of his or her shift has a lot more power than a laboring mom in most scenarios.

The midwives I'm considering have an 11% c-section rate as a practice. Comparing that to the possibility of going into labor on a Monday and getting the OB in my practice notorious for c-sections around 30$... well, it makes me think twice.

I might be naive, but I just don't think three out of ten first time moms ~need~ a c-section.

Do you have any factual evidence to support the claim that doctors would perform a c-section because they are "at the end of their shift and impatient"?

 I have read several times that there is evidence that more c-sections are performed at 4 pm and 10 pm- the thinking is because Drs want to be home for dinner or not be there all night. I know I have seen a study done on this, I will just have to find it...

sbevmc09

sweettalkin417:

nosoup4u:

noraraeuc:

If you are informed it shouldn't matter, you are the boss especially when you are educated.

Nope, not true. 

I have to agree. When you are in the midst of labor, it's hard to be an advocate for yourself and baby. All you are trying to do is get through each contraction and if an unsupportive provider is suggesting your babies life may be in danger or just even telling you that they recommend an intervention, you may not be in a place mentally to ask questions or even be able to really process what they are telling you.

ITA, and Sweettalkin nailed it on the head.

I went into my last labor with this kind of attitude and what I didn't count on was just how vulnerable you are while you are in that situation.  You're just not in a position to advocate for yourself.  I'm sure some women can, but I would never again count on my own knowledge to protect me.  I wish I had had a different perspective last time.  If I did I might not be planning a VBAC for this birth.  A provider whose pregnancy/birth philosophy aligns with your own and whom you can trust 100% is invaluable.

sbevmc09

Amelia4:

annabelle.27:

I am really confused as to the comments that midwives wont jave scheduled rcs. This may vary by practice, but is not true as a blanket statement. I had a midwife with my second child and she asked me early on if I wanted a vbac or an rcs. She made it clear that I could change my mind at any time and still continue to see her prenatally, and that she would be there to assist with a csection should I choose to go that route. I would have seen an OB for a consult towards the end of my pregnancy but nothing else would have changed about the prenatal care I received from her.

There are no midwives in my city that will take you if you've had a c-section previously.  Now I'm curious as to which is the norm.

I think it probably depends on a lot of things.  Some states even legally restrict how MWs can practice, of course they have to carry insurance and have to abide by what their insurance allows, etc. 

I'm planning a VBAC with a MW practice that's staffed with 3 CNMs.  There is a group of homebirth midwives in my area that are predominately CPMs and they will assist VBACs as well. 

angelacez

Oh goodness people of course they will never admit they are trying to get home!  Why would they?  Then they'd be sued.  But there are more c-sections done at 4pm and 9-10pm.  I know my dr went home to bed at 10pm while I was in labor already at a 7.  I didn't have much longer to go and he still left.  If you don't want to look it up it's on you.  I'm sure there are people who have been laboring for a long time, but it shouldn't be enough to back that info the way it is.  I know in my area hospital c/s rates are 30-40%.  That's really high.  I believe the number for my hospital is 37%.  This is supposedly a "good" state to give birth in.  Yeah, don't think so.