Two years ago I was teaching a Bradley Method natural childbirth class and posed the question, why the Bradley Method? I like having some insight on what parents are thinking about when they choose a birth class as well as getting to know what are their expectations of a birth class. One mother responded one of her relatives is a retired Connecticut OB-GYN and had told her, when she announced her pregnancy, that our state’s c-section rate is at 40%. One year later a mother who was also, at that time, doing her surgical residency at Yale-New Haven stated the hospital is “aiming for” a 40% c-section rate. The interesting fact to me is that the CDC’s 2006 preliminary reports cites a 34.1% rate for my state. Yet, another mother in my class who works in a patient advocate office gave me a 2007 “unscrubbed” rate of 38%. Unscrubbed? Scrubbed?
What the public doesn’t know about the reported C-Section rates: they are confusing because no one is taking on the cause of telling the stories behind the numbers in a way that is clear to the consumer. Therefore, we who are in the field supporting laboring women will tell you the shameful truth behind the organizations that can’t get out of their own way and are hobbling themselves at every turn in providing women with quality maternity health care.
I began by asking the CDC to clarify their data received and how it is sorted. Here is their response:
Subject: RE: RE: YBFW: Stats
Date: Mon, 7 Jul 2008 21:08:12 +0000
> Thank you for your inquiry to CDC-INFO. Please find below information in
> response to your request on why Cesarean sections are performed.
> The National Center for Health Statistics (NCHS) collects and publishes data.
> NCHS does not make policy comments or interpret data, nor does NCHS conduct
> NCHS can provide you with data on Cesarean sections. However, we cannot
> translate the data.
> For more information about birth data, please visit the CDC website:
> Thank you for contacting CDC-INFO Contact Center. Please do not hesitate to
call 1-800-CDC-INFO, e-mail email@example.com or visit http://www.cdc.gov if you have
> any additional questions.
> CDC-INFO is a service of the Centers for Disease Control and Prevention (CDC)
> and the Agency for Toxic Substances and Disease Registry (ATSDR). This
service is provided by Vangent, Inc. under contract to CDC and ATSDR.”
They do NOT conduct research. They only tell you what they are told they can tell: the numbers as given to them.
Here’s what Independent Childbirth does know: not all hospitals participate in programs for reporting their statistics to the state. That’s right. Not everyone is giving their information therefore the CDC’s report does not include ALL of the data that is out there; only what is given to them.
The data provided to the CDC is reviewed by hospital staff and administrators to determine what is reported how. That is to say the data is “scrubbed.” How does that affect the reporting of the numbers? Let’s give you a clear cut example. Independent Childbirth member Louise Delaney relays this story told at this year’s CAPPA conference in response to our online discussion the scrubbing of statistics: “At the CAPPA conference this weekend someone brought up that stats at her hospital were indeed scrubbed. For instance, if a c/s was done due to placental abruption, it was listed as a PA, NOT a c/s. So there are FAR more c/s being done than are reported. ”
To which another member responded that Placental Abruption is not a mode of delivery so how could that c/s be listed under PA and not C/S. Well, you see that is the point (and which she was underscoring with incredulity). Each person working in the hospital system has a worldview limited to their patient, their office at the point of time in which she is delivering. That’s it. Period. They do not look at what others are doing therefore they lose the benefit of learning from dialogue. That is not a surprise to Independent Childbirth. We have been reading for years about new methods of training for medical personnel across all field to teach them communication skills!! I’ve walked into one hospital to support a premature birth and had to explain to the doctor that another hospital in our state uses blood analysis to determine lung maturation versus just assuming the baby’s lungs are not mature and trying to persuade the mother to consent to mag sulfate, a drug with horrible effects and unproven benefits to the baby. In fact the evidence points to more deaths from its use! D. Bernucca: Helping Women Avoid Unnecessary Interventions; Midwifery Today, Number 85 Spring 2008
More importantly, while many would assume that placental abruption can only mean cesarean it’s simply not true. Perhaps today that is the protocol However, either it wasn’t so eleven years ago when my youngest was born vaginally 8-weeks premature (at 32+ weeks) or the lack of dialogue is proven right here: everyone is making their own assumptions regarding outcomes. Incidentally, my son’s premature birth was the consequence of placental abruption due to a cesarean birth two births earlier. That’s right. I’ve birthed two babies vaginally after one cesarean!! Again, the stats are confusing because numbers are open to the interpretation of the very small worldview of the individual practitioner.
That limited worldview has wave upon wave of reverberations to the public. When you say you trust your careprovider you limit yourself to their worldview and interpretation. While that sounds noble, you trust your careprovider, the fact is your careprovider may not have the time, the environment nor the skills for dialoging with others in their field in order to stay on top of the research. Case in point, repeat C-section rates are also soaring, 88.7%, yet data “support(ing) the notion that VBAC is unsafe” is still lacking (Lynda DeArmond, MD Waco Family Practice Residency Program, Waco TX). Further, “the most recent Cochrane Review … concluded that no trial existes to adequately help women and their caregivers make an informed decision between the two (VBAC or repeat c-section).” Lastly, Dr. DeArmond points out the flaw of the risk rate of 2.7% quoted the most in VBAC articles, “it is based on one (1) prospective nonrandomized cohort trial and one (1) retrospective cohort study.” (VBAC Rockville MD, Agency for Healthcare Research and Quality, 2003 and McMahon, Luther, Bowes, Olshan; Comparison of a trial of labor with an elective second cesarean section, NEJM 1996, 335:689-965).
Unless the maternal health policy makers start talking to each other honestly, forthrightly and bluntly “women’s healthcare options” remains an oxymoron and we are literally bound (to the delivery tables) and gagged (with unnecessary narcotics).
On Sunday, August 31, 2008 I was awakened at 3:57am with a phone call from a father whose wife was in labor at that very moment with a nurse insisting mom lie on her back in the bed so the monitors would stay in place. This mother presented at Hartford Hospital for IV antibiotics as she had consented to do for her GBS+ status. However, mom had NOT signed up for “birth my way” via Nurse Ruth who stated she’d been an L&D nurse for 37 years, attended thousands of births and she knew this was best, had coerced mom into pitocin and was now prepping mom for an Internal Fetal Monitor and a c-section via her negative commentary on how labor was progressing. A quick review of the facts of what mom was feeling with her contractions and her previous birth experience (I was their birth educator for that vaginal birth result) and I told dad roll mom over on her hands and knees with her butt up in the air … no one can force medical interventions on you and by the way if you’re still okay with pitocin make sure that pit isn’t being cranked up. Call me again in two hours and I’ll be on my way to the hospital if you need me.
At 5:05am while I was in the shower the phone rang and recorded a joyfully tearful message from dad … a beautiful little boy (6lbs) vaginally. I spoke to dad later in the day allowing the family to have their bonding time. Dad relayed the following: “I requested the presence of the charge nurse and dispatched with Nurse Ruth. L turned over to hands and knees in the hospital bed and the pitocin was turned off. She had one huge contraction and with the next huge contraction she said she wanted to push … I thought how could that be? She was only 1cm when I called you. The new nurse volunteered to check because L could very well be ready to push. She did a vaginal exam and found L to be 10cm and the baby was born with just a couple of pushes after that.” Oh, and I totally forgot to ask where the doctor was because honestly I figured if he/she was being told L is only 1cm then I’m pretty sure he/she was nowhere near the hospital on this Labor Day weekend.
From a Labor Day weekend cesarean to vaginal birth in less than one hour. Dad advocated for mom’s patient rights and helped her roll over to her hands and knees!! Is it any wonder the overall cesarean rate from 1995 to 2006 increased by 46%??
I recently stated to my online group that the real cesarean rate for the USA is 35% probably higher and was questioned on the validity of that stat versus the 2006 national reported rate of 31%. I may not be the Centers for Disease Control, the American College of Obstetrics and Gynecology, nor the American Medical Association. I am however independent counsel for laboring women. We are Independent Childbirth. WE ARE the source. WE ARE at the greatest variety of births in the greatest variety of settings. We are literally supporting mothers. We are members of a group who keeps REAL stats for REAL women for REAL options for their very REAL births.
Find an Independent Childbirth member for an independent childbirth class near you!! Mom’s ability to exercise her patient rights once she is in labor is no small feat. In fact, legally her every consent could be considered compromised. Attempts to deny her independent birth care counsel and support via her partner, her family or a doula is a serious red flag! Her birth support needs to understand labor, her birth care environment and how it impacts her choices.
Don’t be just another number! Talk! Let your birth help tell the story behind the numbers! Don’t let organizations that don’t speak to each other speak for you!
Share your positive birth experience and lessons learned!!