Women overlook C-section rates when choosing birthing hospital

A recent survey out of Boston-based Ariadne Labs suggests providers are not giving mothers the right information they need to choose the best possible setting to give birth.

The survey, which was published in the Jan. 26 edition of Birth journal, polled 6,141 pregnant women through a mobile app. It found most women (73 percent) chose their midwife or obstetrician first when making decisions about where to give birth. Only 17 percent chose their hospital first.

And while 75 percent of the women surveyed understood hospitals vary in quality of care, most of the women surveyed didn't know about or would give low priority to hospitals' cesarean section rates, unexpected injury rates, maternal trauma rates, obstetrical infection rates, neonatal trauma rates or episiotomy rates.

"What this study tells us is that there is a big disconnect between the way we currently measure and report quality of care, and the factors that women and their partners most value," Neel Shah, MD, lead author of the survey and director of Ariadne Labs' Delivery Decisions Initiative, said in a statement. "Our industry needs to do a better job of communicating why hospital choice matters."

For example, it is understood among providers that C-section rates are an indicator of hospital quality — they can vary from 7 to 70 percent at any given hospital, and C-sections are associated with increased health risk. However, 75 percent of the women surveyed said no matter how large the differential in C-section rates between two hospitals may be, it wouldn't influence their decision. Yet a similar proportion of those women said they would prefer not to have a C-section if they didn't need it.

The survey showed most women believe they are choosing an obstetrician or midwife to deliver their baby, but this may not always be the case. "For women with low-risk pregnancies who are planning a natural delivery, there are a lot of reasons why your doctor may not end up delivering your baby," Dr. Shah said in a statement.

"Encouraging women to use hospital-level quality metrics in choosing their childbirth hospital will require new ways to frame and disseminate hospital-level obstetric quality data," the authors wrote. "Closing this gap in patient knowledge is essential to having women value and use hospital-level quality data."

 

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