5 Signs Your Hospital Will Probably Give You a C-Section
Nearly one in three women give birth by Cesarean—and about half of those may be avoidable. A new study reveals that the hospital itself may be the biggest reason whether or not you get major surgery. Read on to learn more.
Why is the C-section rate so high?
While there may be a lot of myths surrounding getting a Cesarean section, this is for sure: the surgical procedure has become 500 percent more common in the last generation or two, says Neel Shah, MD, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. Why rates have shot up is one driver behind a new study that Dr. Shah co-authored, which is published in the journal Obstetrics & Gynecology. The research team looked at 53 hospitals around the country and a total of more than 226,000 patients. After compiling a list of 16 different things that hospital managers pay attention to, they gave the management team a score of one to five based on how proactive they were in certain areas (meaning anticipating problems before they happen, and trying to deal with them). That sounds like a very good thing and something you want in medicine, but on the labor and delivery floor, the study found that being proactive is associated with a greater risk of surgery (C-sections), and heavy bleeding. “Part of what this study reveals is that in 2017, the biggest risk factor for having a C-section is not personal preference or medical risk, it’s what door you walk through,” says Dr. Shah. For instance, in parts of Southern California or Florida, even within the same zip code, you have vastly different risk of having a C-section depending on the hospital you deliver at. If you’re currently pregnant or thinking about getting pregnant down the line, these are five signs that the hospital you’ll deliver at is more likely to give you a C-section.
Their C-section rate is high
Yes, this is obvious, but it might surprise you what’s actually considered acceptable. Given there can be such a wide range between hospitals—anywhere from 7 to 70 percent of deliveries may be by C-section—you’d think that you should avoid the upper echelon of those numbers. However, you’re looking for far lower. “For low-risk moms, there’s broad agreement that having a rate greater than 23.9 percent is higher than it needs to be,” says Dr. Shah. Sometimes you can find these numbers via Google, otherwise, the hospital will be able to give you their rates. That said, another study by Dr. Shah and his colleagues found that having that info wouldn’t sway 75 percent of women. It’s vital. Think about it: Once you near a 50 percent C-section rate, that’s basically a coin flip in the prospect of having major surgery, he points out.
Your doctor doesn’t know what you want
When it comes to delivery, “tell us your preferences and we should be able to accommodate them,” says Dr. Shah. And that includes voicing that you want to have a vaginal delivery. Of course, babies are unpredictable both during pregnancy and labor, so know that you may need to compromise on that if your or your baby’s life is in danger. More importantly, your doctor or midwife should be willing to entertain your questions, and answer all of the nitty gritty stuff that no one tells you about giving birth. If they’re not, you may want to consider finding someone else.
They’re too busy
A busy hospital doesn’t itself ensure that you’ll have a C-section. In fact, there are large hospitals that deliver a lot of babies every year and manage to keep their rates in line with the recommendations. However, what matters is the labor floor’s ability to handle their busy times. “Most moms in labor are only aware of the delivery room they’re in, but it equally depends on what’s happening in every other room around them,” says Dr. Shah. “High traffic moments, especially if the labor floor is not ready to deal with them, can have an impact on women’s care,” he adds.
You go to the hospital super early
Maybe you ate some pizza and it sent you into labor—like it did for these moms! No one wants a situation where you’re racing to the hospital screaming at your partner to drive faster, and luckily—though you hear about women giving birth in the car on the news—it’s rare. The majority of the time, labor is a longer event, and you have time to wait. And that’s important to keep in mind. “The later you go into the hospital, the lower odds you have of having a C-section,” says Dr. Shah.
Your doctor follows outdated rules
Once you get to the hospital, the clock starts. Whereas doctors may have believed that labor progressed faster, there’s now evidence that it actually goes slower. Women may benefit from being allowed to labor longer, which can help prevent unnecessary C-sections, according to a 2014 statement from The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine. For instance, they suggest allowing for more time for labor to progress into the active phase and women to push for at least two to three hours with an epidural. Talk to your doctor to see where they stand on those recommendations.