In Cesarean Surgery

In an article entitled “Your Biggest C-Section Risk May Be Your Hospital,” Consumer Reports looks at the variation in cesarean rates among more than 1200 U.S. hospitals in 1st-time mothers carrying one, head down, full-term baby, those being criteria that help ensure that apples are being compared to apples. In its usual format, CR provides an overview of the topic, rates individual hospitals, and includes links to other relevant CR resources.

As valuable as this report is, it has its limitations. For one thing, as CR acknowledges, reporting was voluntary, and many hospitals chose not to participate in the source surveys. For another, CR uses the Department of Health & Human Services “Healthy People” benchmark of 23.9% as its threshold for acceptable cesarean rates in this population, but that number is far from optimal. Out-of-hospital studies tell us that 24% is roughly twice the safely achievable rate. Twenty-four percent merely represents a 10% reduction from the 2007 cesarean rate—although, it should be added, 60% of hospitals failed to accomplish even that modest goal. Finally, while choosing a hospital based on cesarean rate has some value—especially at hospitals at the high and low ends of the scale—it’s the care provider’s rate that really matters, and care provider rates are likely to vary widely at most hospitals. Even if clinician rates were available, it would be next to impossible for women to assure themselves of a birth attendant with a reasonable cesarean rate. Most clinicians practice in large groups with on-call schedules, and hospitals are increasingly using laborists, obstetricians employed by the hospital to ensure 24/7 coverage. All that being said, the report is an eye-opener and should be required reading for pregnant women.

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