Consumer Advocate Jill Arnold Talks to Babble about C-sections, Birth Wars & the Way ForwardCeridwen Morris
Jill Arnold, consumer advocate and founder of theunnecesarean.com, a widely-respected and followed blog (which was included in Babble’s 2011 Top 50 Pregnancy Blogs), recently launched Cesareanrates.com, a valuable resource for pregnant women, providers and childbirth professionals.
It lists the c-section rates by state and by hospital– you can learn quite a bit flipping around. Some hospitals have rates below 20%, some are closer to 60%. This can be important consumer information and has yet been unavailable in many places. Check out the rates in your state or hospital here.
(See interview with Jill after the jump.)
Arnold’s advocacy was not motivated by a negative personal experience with a c-section– she never had one– but by being thwarted in her search for good, reliable information when pregnant: “I was told I needed a cesarean because my baby was too big. As a curious first timer, I peppered my provider with questions about the risks of the cesarean and the risk of complications from attempting a vaginal delivery. To my great frustration, my requests for data were met only with anecdote and emotion.”
From that moment forward Arnold has been uniquely focused on making sure women have access the best information available needed to make medical decisions, and to be encouraged to share the decision-making with supportive doctors and midwives. Her blog– which has shifted focus over the years, along with Arnold’s views– has been an invaluable resource for expectant mothers, especially those considering VBAC. There are too many good things to say about Jill’s work to fit in a quick blog but here’s something I love:
“I want to introduce a new framework for looking objectively at geographical extremes in obstetrical procedure utilization rates and using long-standing research on informed choice, medical decision-making and practice variation that steers clear of the distracting and harmful ‘obstetric vs. natural’ or ‘obstetrician vs. midwife’ binary that wastes everyone’s time.”
To that end she has launched a campaign to raise funds in order to keep Ceseareanrates.com alive and growing. She hopes to add many more features to the site including data on other procedures in birth. This kind of work is so important. Birth advocacy really can get mired in a back-and-forth about home vs hospital, etc, etc, and in the middle of all that we forget that there are things we can actually DO to educate consumers and pull back the curtain on practices that may be motivated more by profit-based healthcare than research and good medicine. It takes five minutes to donate $5 (or $50) towards something that can actually make an impact.
In the meantime, Jill was kind enough to answer some questions about Cesareanrates.com for Babble. At times, this interview may seem a little “inside baseball” to some of you, which I totally understand, but it’s this kind of thorough, rigorous work that makes Jill Arnold someone to watch and someone to support.
Who cares if the c-section rate is high?
This is one of the questions that comes up quite a bit. We know that evidence shows that hospitals with cesarean rates at 15-20% have infant outcomes that are just as good and better maternal outcomes. This is part of the rationale used in the development of the Joint Commission Perinatal Care Measure Set.
The question of whether anyone really cares about cesarean rates came up in a meeting of the AHRQ task force I served on. The question I would ask in response is, “How can anyone form an opinion on cesarean rates unless they know what the rates are?” Ultimately, maybe no one does care and we will find out that a hospital with a 72.6 percent cesarean rate like North Mississippi Medical Center in West Point, Mississippi has a patient population that bucks the trend and is so high-risk that nearly three quarters of women need a cesarean section. Or it might be discovered through surveys that very high numbers of women are requesting cesarean sections and doctors are working with them to make decisions on how to deliver their baby in accordance with the patient’s values and preferences. Or some combination of the two. Either way, it would be interesting to clarify. If there is nothing to hide, then let’s make the data transparent and hospitals can proudly answer to the public about what is happening within those walls. See all available hospital-level cesarean rates by state.
Why isn’t this information already available?
If you ran a hospital, would you want information that might drive business away publicized? A hospital with a 55% cesarean rate probably isn’t going to hang a celebratory banner with their cesarean rate on it in the lobby.
Ideally, you would have a robust database that includes both administrative and clinical data. To be even more specific, the ideal for reporting could be defined as a “robust, evidence-based, comprehensive system for performance measurement and reporting, developed and implemented with broad stakeholder participation.”
A reporting agency could show both risk-adjusted and total cesarean rates to give both an overview of practice patterns and also allow for apples-to-apples comparisons between hospitals. Hospitals would voluntarily share their data, like those participating in the new California Maternal Data Center project. The problem is that cross-referencing and analyzing everything costs money and it’s obviously not viewed as enough of a priority on a national level to mandate reporting, even though the cesarean section is the most commonly performed surgery in the U.S.
One of my goals is to take on the federal government’s guarding of the rights, privileges and privacy of individual establishments (hospitals) in the data usage policy for government collected data. Patient privacy should be protected at all cost, but protecting individual establishments by assigning them rights at the expense of making data available to patients who might be wondering about procedure utilization rates at their local hospital is inappropriate.
How will tracking hospital statistics improve maternity care?
Technically, hospital data is already tracked in several places. The step that no one has been willing to take is publicizing hospital rates. The argument sometimes given is that total cesarean rates don’t allow for the same kind of comparisons between hospitals that risk-adjusted rates do. True, but what that also tells us is that there is a fear of being compared and a sense of market competition. If there was no fear of being compared or judged, there would be absolutely no problem publicizing total cesarean rates along with a clearly worded explanation of what you can learn from total cesarean rates and what you can’t.
As for how it will improve maternity care, it’s hard to really say because how exactly would “improvement” be defined and then measured? Access to information for making medical decisions is something patient advocates in all areas of medicine have endorsed for a long time. Cesarean rates are just one piece of information that can be used in deciding where to give birth
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