Surprise: For-Profit Hospitals = More C-Sections

I have written about my feelings about the rising number of c-sections in this country before:

I would feel better about these c-section numbers if I felt like women were choosing surgery because they had been given all the options, had weighed their possibilities, and then decided this was the best course of action for them.  But I’m not sure that doctors are having conversations with women about doulas (get one!), the different types of drug interventions (including none at all), the fact that IVs don’t have to stay in your arm the whole time you are laboring, that your due date isn’t some sure date, that inductions have ties to c-sections, etc.  If you want to know these things, you have to search all of this out on your own.  You have to have the time, the resources.  To have anything other than a doctor-deemed “normal” medical version of birth, you have to have levels of privilege.

Here is yet another example of why we need to care about the c-section rate and the rights of pregnant/laboring women. From California Watch:

For-profit hospitals across the state are performing cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found.

A database compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit.  A surgical birth can bring in twice the revenue of a vaginal delivery.

In addition, some hospitals appear to be performing more C-sections for non-medical reasons – including an individual doctor’s level of patience and the staffing schedules in maternity wards, according to interviews with health professionals. […]

The analysis challenges some common assumptions about C-sections, including that wealthier women are more likely to opt for a surgical birth. Higher C-section rates were found at hospitals catering to all ethnic groups and economic classes. And there was no correlation between C-section rates and the percentage of a hospital’s business from low-income or indigent patients receiving Medi-Cal, the state’s Medicaid program.

But of the five hospitals in California with the highest C-section rates, four were for-profit hospitals in poorer parts of Los Angeles County, where the African-American and Hispanic populations are above the state average. Hospitals in Southern California tended to have higher rates than in the north, which may suggest a cultural influence. […]

California Watch previously reported that the state’s maternal death rate has increased dramatically, and researchers are exploring the possible connection to the rise in C-sections during the same time period. Other media outlets, including ABC’s “World News” and the Los Angeles Times, followed up with reports about this trend. By comparing hospitals with similar demographics, the California Watch analysis revealed that rising C-section rates cannot be completely attributed to changes in patient health and preference.

The idea that a woman would be forced/manipulated/not given any other choice than to have invasive and unnecessary abdominal surgery because her doctor was impatient or because of staffing issues makes me sick to my stomach.

This never seems to be a large issue, though.  We aren’t having a larger cultural discussion about why these c-section numbers are so high.  It is something released in a study every once and a while, people like me fume, doctors deny the correlations and blame women, and then the c-section rate continues to climb.  What the fuck is going on?  More importantly, does anyone know how to stop this or, at least, start a discussion about this in a way that will actually have an impact on practice?  I feel so frustrated by all of this.  And helpless.  And scared.  Because I had a great birthing experience with my son but the more time that elapses since that birth and the more women I know who have had hospital births, the more and more I feel like my experience was simply LUCK.

I was lucky that I had the world’s best doula.  I was lucky that I was able to afford both the time and money for my childbirth class.  I was lucky that my water didn’t break before my contractions began.  I was lucky that my son came so quickly that there wasn’t time for a discussion about episiotomies.  I was lucky that because my son came in the middle of the night and came fast, my doctor simply wasn’t around until his head was crowning.  I was lucky that my nurses were so fucking cool that they let me do my fetal monitoring on my hands and knees on the bed (if I had had to lay on my back AT ALL, I couldn’t have done it.  I wouldn’t have made it.).  All of those – all of them – had to fall into place.  Next time, who knows?  That’s the problem.  And that scares me.  And makes me feel helpless, for myself and for other mothers.

So, seriously, what do we do?

Related: “The Rising Rate of C-Sections Exemplifies What’s Wrong with US Healthcare” (June 28, 2010)


One thought on “Surprise: For-Profit Hospitals = More C-Sections

  1. Pingback: Fetuses are people, women are places « Speaker's Corner

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