Misleading facts about cesarean rates

Writing in the Times Union a few weeks ago, A. Garry Finkell, President of Perinatal Data Solutions Inc. in New York, made a very interesting contribution to the debate over rising cesarean rates, and one that I hope might help women in the U.S. in particular - but also elsewhere - when making their decision about where to give birth.

While I don't necessarily agree with his choice of words in the last paragraph, "undesirable increase in C-sections" (after all, some of the cesareans contributing to the increase - mine included - was very much desired - by me, at least...), I thought his points were worthy of posting here.

Here's an extract of what he says:

"One common feature of almost all articles on this topic is the inclusion of C-section rates for individual hospitals, implying that hospitals can be compared on this basis. There is some validity to this, but it can also be misleading.

As Dr. Camille Kanaan of Albany Medical Center pointed out, for example, AMC's rate is highly influenced by its role as the Northeastern New York Regional Perinatal Center. As such, AMC has women with high risk pregnancies transported into its birthing center from other hospitals in the region. These women have a much higher than average likelihood of needing C-sections, and this raises AMC's rate.

Further, it is the individual provider who makes the decision to perform a C-section. In any hospital with more than one obstetrical provider, the hospital's average is really the average of all the providers. In my experience, providers in a single hospital can vary widely in their C-section rates.

At the same time, an individual provider may deliver babies at more than one hospital, presumably bringing their same likelihood to do a C-section to each hospital.

An expectant mother should look to her obstetrical provider rather than to the birthing hospital in order to determine her chances of ending up with a C-section. The same is true for analysts who want to understand the dynamics involved in the undesirable increase in C-sections."