DMV low C-section rates?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Midwives have lower c section rates. I am with a midwife now despite being a VBAC.

This is true because OB GYNs are not trained on uncomplicated births. They are only trained on managing risks- real or perceived. To a hammer everything's a nail. Go with midwives if you want to avoid a c-section.

This is simply incorrect. Do you have any idea how many uncomplicated vaginal deliveries an OB/gyn will do before they graduate from residency? Literally hundreds.

[Anonymous]

Anonymous wrote:I had both my kids with the midwives at GW. During my 2nd labor, the midwife bought me a few extra pushes to get the baby out myself and for that I am thankful. My husband said the OB team was literally in the doorway ready to wheel me to surgery.

My first labor I was the last L&D bed at GW before they started diverting to Sibley. My labor was long and my doula told me frankly “if you had gone to Sibley, that baby would not have come out of your vagina”

Story 1: how lucky you are to give birth in a hospital and to have a medical team ready to help your baby to be born safely. What good fortune to live in a Western country with good medical care and access to obstetricians who can be called upon immediately to ensure your baby is born alive and doesn’t suffer brain damage. Women in developing nations literally die for lack of access to OBs and C sections, and develop fistulas and deliver stillborn babies for lack of this access. Your perspective that somehow the OBs wanted to, what? Rob you of an experience? Avoid your kid having oxygen deprivation and ending up brain damaged or with cerebral palsy is really messed up.

Story 2: That’s total speculation.

[Anonymous]

I also have a friend who felt a bit pushed into a c-section at Sibley due to a labor that was failing to progress.

But it's basically impossible to know if a given c-section was truly needed or not. The Dr has to make a judgment call.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had both my kids with the midwives at GW. During my 2nd labor, the midwife bought me a few extra pushes to get the baby out myself and for that I am thankful. My husband said the OB team was literally in the doorway ready to wheel me to surgery.

My first labor I was the last L&D bed at GW before they started diverting to Sibley. My labor was long and my doula told me frankly “if you had gone to Sibley, that baby would not have come out of your vagina”

Story 1: how lucky you are to give birth in a hospital and to have a medical team ready to help your baby to be born safely. What good fortune to live in a Western country with good medical care and access to obstetricians who can be called upon immediately to ensure your baby is born alive and doesn’t suffer brain damage. Women in developing nations literally die for lack of access to OBs and C sections, and develop fistulas and deliver stillborn babies for lack of this access. Your perspective that somehow the OBs wanted to, what? Rob you of an experience? Avoid your kid having oxygen deprivation and ending up brain damaged or with cerebral palsy is really messed up.

Story 2: That’s total speculation.

Way to weirdly skew this person's experience to suit your own narrative?

PP, I have two toddlers at home and would also be happy to avoid c section recovery if I could do it safely. Glad you were able to do so.

[Anonymous]

I delivered vaginally with a certified nurse midwife (outside the DMV). It was successful -- but I wish I'd known that C-section vs. vag birth isn't everything. It is really, truly overblown (and some of my friends have had pelvic floor damage because of forceps/vacuum injuries when they felt pressured into vaginal births). I could have saved myself hours of misery if I had just said, you know what, this isn't working out, but I felt pressured to be a hero.

My Brazilian and Eastern European friends think I'm totally insane for wanting a vaginal birth in the first place; it is standard operating procedure in those countries to do elective C-sections.

[Anonymous]

WHC - 17.5%

Georgetown University - 24.5%

GWU - 25.6%

Sibley - 33.9%

Source - Leapfroggroup.org

https://www.instagram.com/p/CNUuy9kg7Kb/


tipsfromadoula
C-Sections are the most common surgical procedure performed in the US. They are a necessary and life-saving tool. There is no perfect way to make your family or meet your baby, and there is no wrong way to give birth.
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The World Health Organization recommends C-Section rates between 10-15% for low-risk, first-time parents with babies who are head down.
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Consumer Report (May 2018) states the most significant factor of who will need a cesarean section is where a person chooses to deliver.
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One of the greatest factors of delivery outcome is the place where someone gives birth. Inside DC, there is a lot of variances. We have WHC with the lowest c-section rate, at 17.5%, and Sibley Memorial Hospital with 33.9%, with Georgetown and GW coming in at the middle of the pack at about 25%.
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Leapfrog Group allows hospitals to voluntarily report number and is only collecting data on a full-term, first time birthers with one baby who’s head down. I.e., when someone says their rate is higher because of breech babies, twins, or repeat c-sections, they’re referencing a different statistic.
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It is your right to ask your provider what their induction of labor, Pitocin use, epidural, and c-section rate is--It is easier and more efficient to align yourself with a provider who shares your values. Going into labor supported by every member of your team ensures no matter the outcome, you’ll feel you made the right decisions for yourself, your baby, your family, and your body.



drsarahcigna
Such an important post! I’m not sure what the LeapFrog groups numbers are from in terms of time frame but recently reported GW’s numbers for 2020 are:

27.6% was the total cesarean delivery rate
17.5% was the primary (first time) cesarean delivery rate
39 sem2 Me gustaResponder


tipsfromadoula
@drsarahcigna while LeapFrog states that hospitals self report, they don’t give a window in which they collected data. Thank you for providing this necessary, valuable and helpful Information!



drsarahcigna
@tipsfromadoula no problem! Our OB group is very proud of our low Cesarean rate and our collaboration in our Midwifery colleagues!

[Anonymous]

The WHO target rate of 15 percent is made up. It is not evidence based. And it has been debunked thoroughly. Countries who have this rate have high levels of maternal and infant mortality. Please stop furthering this tired, incorrect, and outdated statistic like gospel. It’s damaging and irresponsible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had both my kids with the midwives at GW. During my 2nd labor, the midwife bought me a few extra pushes to get the baby out myself and for that I am thankful. My husband said the OB team was literally in the doorway ready to wheel me to surgery.

My first labor I was the last L&D bed at GW before they started diverting to Sibley. My labor was long and my doula told me frankly “if you had gone to Sibley, that baby would not have come out of your vagina”

Story 1: how lucky you are to give birth in a hospital and to have a medical team ready to help your baby to be born safely. What good fortune to live in a Western country with good medical care and access to obstetricians who can be called upon immediately to ensure your baby is born alive and doesn’t suffer brain damage. Women in developing nations literally die for lack of access to OBs and C sections, and develop fistulas and deliver stillborn babies for lack of this access. Your perspective that somehow the OBs wanted to, what? Rob you of an experience? Avoid your kid having oxygen deprivation and ending up brain damaged or with cerebral palsy is really messed up.

Story 2: That’s total speculation.

Way to weirdly skew this person's experience to suit your own narrative?

PP, I have two toddlers at home and would also be happy to avoid c section recovery if I could do it safely. Glad you were able to do so.[/quote
I’m pointing out the bias and privilege to be able to eschew medical care and to paint a team of dedicated health care hero’s as people about to whisk in and steal an experience from you. It’s a false binary perspective that’s really tone deaf.

Also, c section recovery is not always harder than vaginal. My vaginal recovery took years and I still have painful scar tissue from it and could hardly walk postpartum and had severe incontinence. My c section recovery was a walk in the park by comparison. Stop the black and white thinking.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I had both my kids with the midwives at GW. During my 2nd labor, the midwife bought me a few extra pushes to get the baby out myself and for that I am thankful. My husband said the OB team was literally in the doorway ready to wheel me to surgery.

My first labor I was the last L&D bed at GW before they started diverting to Sibley. My labor was long and my doula told me frankly “if you had gone to Sibley, that baby would not have come out of your vagina”

Story 1: how lucky you are to give birth in a hospital and to have a medical team ready to help your baby to be born safely. What good fortune to live in a Western country with good medical care and access to obstetricians who can be called upon immediately to ensure your baby is born alive and doesn’t suffer brain damage. Women in developing nations literally die for lack of access to OBs and C sections, and develop fistulas and deliver stillborn babies for lack of this access. Your perspective that somehow the OBs wanted to, what? Rob you of an experience? Avoid your kid having oxygen deprivation and ending up brain damaged or with cerebral palsy is really messed up.

Story 2: That’s total speculation.

Story 2 - I’m sure you know more than a very popular doula who has attended hundreds of births at a variety of hospitals in the area and knows the tendencies of each medial team.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My friend and her DH really felt bullied into a C-section at Sibley on their first birth. They did a home birth on the 2nd baby -- 2 pounds larger and a much happier experience.

Your friend is an irresponsible idiot.

NP and you are truly the idiot. You might wish to check your bias at the door if you want to be a productive contribution to this board and probably society as a whole.

OP- you're better off focusing on a midwife or OB practice that has low c-section rates and low interventions.

Home birth is irresponsible. It’s people’s choice to have one, but the infant mortality rates of home birth in the US and the fact that in an emergent medical situation you will not have access to the full scope of medical care and services you may need (forceps, vacuum, C section, blood in the event of you hemorrhaging, imaging, etc) should be a reason to avoid it. Is an uncomplicated homebirth likely to be a better experience for mom? Sure. But making the quality of your experience in one day the focus of your decision making (rather than the bigger goal of having a healthy child for the rest of your life and your child’s life) is a mistake. You have no idea if your birth will be complicated or not until is is over. And while there are things you can do to stack the deck in your favor to have an uncomplicated birth, at the end of the day it is a huge roll of the dice as all sorts of problems can come up from out of the blue during delivery, which you often cannot anticipate. And that have nothing to do with if you did prenatal yoga, ate well, and exercised.

Also, midwives have low C section rates because they cannot perform them. They also don’t do vacuum or forceps births. This can mean they use more creative techniques to get babies out vaginally, but it can also mean they do crazy things (like purple push for HOURS!) that can damage women and their pelvic floors permanently for the goal of getting the baby out the vagina. Your vagina is going to be with you the rest of your life - if you injure it or your rectum during birth, it is often not easily fixed and can mean incontinence (flatal, urinary, fecal), severe tears, difficult recovery, chronic pain, dissatisfying sex, inability to wear tampons, pelvic organ prolapse, and a bunch of other stuff. Not to say these things don’t sometimes happen with C sections, but with a scheduled C section if you don’t go into labor you will absolutely not risk tearing your vagina or pelvic floor muscles.

I was with the midwives and had a forceps birth. It was a horrible horrible 49 hour long birth experience, but they will do them if needed. I was begging for a C section, and they wouldn't do it, saying, You told us and in your birth plan you didn't want one. I just wanted that kid out. My second child, I received care through the midwives, but then convinced them I needed a scheduled C (I had PTSD after my first) and they gave in. That was a 3 hour only slightly uncomfortable experience. What I am trying to say is that you don't know what you don't know as a first time parent. I bought in 100% to wanting a super organic hippie birth, and I did not have that. You don't know what your body will do. Be open to whatever the safest experience is, and focus more on the after birth time. Do not buy into any philosophy around birth. There will be so many decisions in those first years that make you nervous, but in this case, you just want that kid out and safely.

[Anonymous]

Anonymous wrote:VHC has drastically lowered their c-section rate by basically putting in an after-action reporting mechanism to try to figure out why *unplanned* c-sections are happening. Not “baby is breech we’ve been scheduling a c-section for weeks” but why people who were good candidates for vaginal birth and wanted one were getting c-sections. I would deliver there, because the doctors doing the delivery are aware that “convenience” c-sections are not in the cards, so if you have a c-section there that you didn’t want, you at least know you needed it.

Thank you for this information.

[Anonymous]

Anonymous wrote:

Anonymous wrote:VHC has drastically lowered their c-section rate by basically putting in an after-action reporting mechanism to try to figure out why *unplanned* c-sections are happening. Not “baby is breech we’ve been scheduling a c-section for weeks” but why people who were good candidates for vaginal birth and wanted one were getting c-sections. I would deliver there, because the doctors doing the delivery are aware that “convenience” c-sections are not in the cards, so if you have a c-section there that you didn’t want, you at least know you needed it.

Thank you for this information.

It’s cute you think it’s possible to know if a C section was needed in hindsight. Would love to see the crystal ball you’ve got that plays the alternate reality so we can know for sure.

[Anonymous]

OP another thing that matters is your practice. Yes the hospital matters (whether the nurses are well trained on positioning etc.) but your practice and primary OB is the first indicator— do they do ECV for malpositioning, what is *their* c-section rate (are they willing to share that rate…).

L&D in the DMV is a competitive business. There is no reason to see a provider whose preferred management of your birth doesn’t align with yours— and I say this also if someone wants a fully elective c-section, there will be a provider for that!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:VHC has drastically lowered their c-section rate by basically putting in an after-action reporting mechanism to try to figure out why *unplanned* c-sections are happening. Not “baby is breech we’ve been scheduling a c-section for weeks” but why people who were good candidates for vaginal birth and wanted one were getting c-sections. I would deliver there, because the doctors doing the delivery are aware that “convenience” c-sections are not in the cards, so if you have a c-section there that you didn’t want, you at least know you needed it.

Thank you for this information.

It’s cute you think it’s possible to know if a C section was needed in hindsight. Would love to see the crystal ball you’ve got that plays the alternate reality so we can know for sure.

I don’t think I have a crystal ball. But the doctors who run their c-section program seem to think they do so I’m not going to argue?

https://www.washingtonpost.com/brand-studio/wp/2019/08/30/feature/one-hospitals-evidence-based-approach-to-reducing-c-section-rates/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:VHC has drastically lowered their c-section rate by basically putting in an after-action reporting mechanism to try to figure out why *unplanned* c-sections are happening. Not “baby is breech we’ve been scheduling a c-section for weeks” but why people who were good candidates for vaginal birth and wanted one were getting c-sections. I would deliver there, because the doctors doing the delivery are aware that “convenience” c-sections are not in the cards, so if you have a c-section there that you didn’t want, you at least know you needed it.

Thank you for this information.

It’s cute you think it’s possible to know if a C section was needed in hindsight. Would love to see the crystal ball you’ve got that plays the alternate reality so we can know for sure.

The “crystal ball” appears to be an analysis by the medical team. Maybe you could work on your reading comprehension. I get that you are defensive about c sections but you are really ruining a thread where the OP wanted information based on the type of birth she preferred.