Want to see for yourself? If you go to the original document, there's a small hyperlink about rate explanations. The link brings you to a page that, at the bottom in very very small print, has the following text:
Rate Explanations:Cal me paranoid, but I doubt the extremely small font is accidental.
Cesarean Delivery Rate
Number of Cesarean Section Deliveries per 100 Deliveries (excludes abnormal presentation, preterm birth, fetal death, multiple gestations, and breech procedure). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
Cesarean Delivery Rate – Primary
Number of Cesarean Deliveries per 100 deliveries among women who have not previously had a Cesarean section (excludes abnormal presentation, preterm, fetal death, multiple gestation, and breech procedures). Cesarean delivery may be overused in some facilities, so lower rates may represent better care.
Vaginal Birth After Cesarean (VBAC) Rate
Number of vaginal births per 100 women with a previous Cesarean delivery. VBAC may be underused in some facilities, so higher rates may represent better care, though this rate includes some women who were probably not good candidates for vaginal birth.
Vaginal Birth After Cesarean (VBAC) Rate, Uncomplicated
Number of vaginal births per 100 women with a previous Cesarean delivery (excludes abnormal presentation, preterm birth, fetal death, multiple gestation, and breech procedures). VBAC may be underused in some facilities, so higher rates may represent better care.
WHOA!!
ReplyDeleteNice find, Rixa! The fine print was so fine, I had to click twice to enlarge the text just to make it barely legible. You are absolutely NOT paranoid. They are fudging numbers, and shame, shame, shame on them.
So the rates say nothing, do they? Because cesarean for breech, multiples, or PTL is not even necessarily indicated. I can't think of what they express. Except maybe the absurdity of the status quo.
That is outrageous. Now the question is, how many hospitals are not even that upfront about the fine print? How many put it only in documents that are "available to the public" but not offered?
ReplyDeleteI was shocked when I realized that there's no reason at all to trust the information we're given about rates, because there is little true accountability. It amounts to self-reporting for the initial figures, making them suspect to begin with, and on top of that information can be hidden or obscured. Making whatever statistics they give up essentially meaningless.
I was there and equally horrified. I wonder if our Canadian hospitals are doing the same. Does anyone know?
ReplyDeleteThat is frightening, yet somehow doesn't surprise me at all. :(
ReplyDeleteSince I'm in California, and lived through one of those c-sections as a low risk, first time mama with a posterior babe...I wish I could say I was surprised but I'm not. I'd really like to be surprised by something this horrific just once, it's all so common now. Juding from my butcher, a.k.a. OB, and his loud boasting about the woman he's done 12 sections on, I am so so not surprised.
ReplyDeleteThere are no effective transparency laws or enforcement to force hospitals to be honest about *any* of their rates, to my knowledge. I have always assumed they were fudging the numbers, but it's interesting to get such a blatant example.
ReplyDeleteBut hey it's corporate healthcare, we can't expect them to do something that's bad for business!
What's really interesting is that many OBs and hospitals pretend to believe that high C/sec rates aren't a bad thing--but if that were true, they'd be running ads about their custom c/secs for all. One might think, deep down, that they know the rate is too high and are trying to keep it on the down low.
Our rates are so bad (30+% for c/s; ~1% VBAC), that I *hope* they are correct . . .
ReplyDeleteHi Rixa, that is a very important issue that needs to be addressed internationally. I recently went to a seminar by a specialist from Ireland who want everyone to use the same categorization of CS (have reported it in my blog if anyone's interested in reading about it - http://sarah-stewart.blogspot.com/ ). But even then, the category can be fudged.
ReplyDelete