Friday, February 27, 2009

Why to choose your place of birth carefully

The Unnecesarean discusses a new c-section report out of Massachusetts. She has some great commentary, including on the claim that the hospital network with the highest cesarean rates does c-sections mainly because of problems like a big baby or "the shape of the mother's pelvis". Ah! There's the problem! All the funny-shaped pelvis women must have signed up to give birth at those hospitals!

Take a look at the list, too, and scroll from top (highest c-section rates) to bottom (lowest). First, notice how long it takes to get to facilities that are even below 30%. Second, notice how big the difference is between top and bottom. Now think: what are your chances of having a vaginal birth at the ones at the top of the list and the ones at the bottom?

If it ever sounds like I'm driving these points into the ground, it's because I am always amazed myself: half of the women you meet who had a c-section didn't need one. But they were told, and still think, they did - and when you hear their stories after the fact, it's so hard to tell who really needed it and who would have had a vaginal birth if they were at a different hospital, with a different provider. But it's a virtual guarantee that if you scooped up a handful of the women from the highest-rate hospital and put them at the lowest - funny-shaped pelvises and all! - some of those women would have a vaginal birth who wouldn't have otherwise.

How can we make women's medical care so randomly and hugely dependent on where they give birth?

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