Hospitals are required to disclose their cesarean section rates, but the information is hard to come by without a lot of searching. Most women are admitted to hospital without any prior knowledge of their c-section risk, and will often be surprised when the birth ends up in the operating room.
Each hospital in Canada has a different cesarean section rate because policies and procedures differ from institution to institution. These are policies related to how women are "allowed" to labour and give birth. Things like timing of induction (how long you can go past your due date), electronic fetal heart rate monitoring (EFM), use of Pitocin and IV fluids, and length of pushing time are all regulated by hospital protocol.
Recently, we've seen a number of stories in the media sounding the alarm bell on the rising c-section rates in our Canadian cities. I came across this handy website today, and thought it would be interesting to share the c-section rates at various hospitals here in Ottawa.
Montfort Hospital: 25.8%
The Ottawa Hospital: 29.17%
Queensway Carleton Hospital: 33.18%
Almonte General Hospital: 25.91%
Winchester District Memorial Hospital: 21.63%
The website also publishes each hospital's VBAC (Vaginal Birth After Cesarean) rate. Scraping the bottom of the barrel is the Queensway-Carleton Hospital, at a dismal 7.63%
Does this mean that women in Ottawa who want to avoid a cesarean section should plan to give birth where their chance of c-section is lowest? This, of course, is a personal choice, but I believe a wiser strategy would start with demanding more evidence-based care from our hospitals. In my opinion, policies and procedures are governed first by consumer demand, and second by evidence-based information (which is ridiculous, I know). The more you are complacent about what is being done to you, the more you pave the way for other women to have the same done to them. [and of course, some c-sections are necessary and medically indicated. Clearly this conversation does not apply to those women, although they still have a right to respectful and informed care]
So if you're under the care of a doctor or OB at one of these Ottawa hospitals, and you hope to avoid a c-section, what should you be asking about?
1) How will you monitor my baby's heart rate? (there is no evidence showing that continuous EFM is beneficial, and there is an increased risk of cesarean section when it is used)
2) If I go post-dates, when will I be induced? (Most OBs are following the 40+10 rule - when you are 41 weeks and 3 days, you will be induced. Again, there is evidence showing that healthy, low-risk pregnancies can extend to 42 weeks without increased risk to mom or baby)
3) When do you feel the need to use Pitocin during labour? What are my other options if you feel that my labour has stalled? (psssst...hire a doula. They have some neat tricks for getting labour to progress!)
4) Do you use routine IV fluids during labour, or can I eat and drink whenever I want?
5) If my baby is doing well, will I be able to push past the allotted time given for second stage?
Also keep in mind that the whole team of OBs needs to be on board with the terms/conditions you have in place. If you decide you absolutely do not want to be induced at 40+10 days, then you will need to be prepared to meet with resistance if your OB of choice is not on call around that time.
Pregnancy shouldn't be a time that women need to do battle to get the care they want. But as you can see above, the reality is, 1 in 4 women will have a c-section in Ottawa (and sometimes that number reaches close to 1 in 3). So it's up to you and your partner to fight for the care you need - doctors are often prepared to listen, but it's our responsibility to make sure we're heard.
And of course, you've heard the same old from me time and time again....hire a doula and that percentage goes down...blah blah blah....get a midwife and that percentage goes down...blah blah blah....have a home birth if you're healthy and comfortable with the idea...blah blah blah.
You get the picture!
What do you think? Are my local Ottawans surprised by these rates?