Cesarean Rates- Atlanta

One of the mamas on the local ican group (http://atlanta.ican-online.org) posted the stats from2006-2007 cesarean rates in the metro Atlanta area.

She calculated these from the gahospitalpricecheck.org. It’s July 2006-June 2007. The #s are total births/cesareans/cesarean rate. Piedmont & Northside are still highest, North Fulton still lowest. Now keep in mind this includes those who choose to repeat a cesarean birth after having had a previous one. (The rates have only climbed since these stats- so the 2007-2008 will only be higher!) I have put the stats that Atlanta Parent posted in italics under the ga hospital check numbers- they break down the primary and repeat numbers for you to consider.

Hospital…Total Births…Total Cesareans…Rate of Cesareans
Dekalb Medical—N. Decatur…4,435…1,161…36.3%
22% Primary • 13% Repeat

Dekalb Medical—Hillandale…1,316…395…30.0%
15% Primary • 10% Repeat

Emory Crawford Long…4,182…1,371…32.8%
10.7% Repeat 19.5% Primary

Gwinnett Medical Center…5,668…1,748…30.8%
14% Primary 13% Repeat

Henry Medical Center…2,129…701…32.9%
20.5% Primary • 44.9% Repeat

North Fulton Regional…1,981…452…22.8%
10.4% Primary • 10.9% Repeat

Northside Hospital…17,590…6,735…38.3%
C-Section rate: 36%,no break down was given

C-Section rate: 27%, no break down was given

Piedmont Hospital…3,450…1,366…39.6%
22% Primary • 12% Repeat

Rockdale Medical Center…1,287…653…31.1%
17% Primary • 12% Repeat

Wellstar Cobb Hospital…5,199…1,836…35.3%
23.8% Primary • 10.7% Repeat

Wellstar Kennestone Hospital…6,118…1,963…32.1%
19.8% Primary • 10.3% Repeat

And here are some that were not mentioned in the original findings but Atlanta Parent did mention:
Atlanta Medical 17.3% Primary 16 % Repeat
Emory Eastside 18.5% Primary 46% Repeat (guess you should avoid a VBAC here!)
Emory Johns Creek is too new to have statistics
Grady C-Section rate: 30% did not give a break down
NorthEast Georgia C-Section Rate: 26.9% did not give a break down
South Fulton 11.6% Primary • 6.4% Repeat
Southern Regional C-Section rate: 26% did not give a break down
Wellstar Douglas 13.6% Primary • 10% Repeat

Why do some numbers differ from one place to the other? Well there is no notation as to where Atlanta Parent got their information or how old the information is. A recent client of mine went on the tour of one of the largest hospitals in the area. She asked what their cesarean rate was to the tour guide. This seemed like a logical question to ask. The tour guide said she did not know nor did she know how to get that information. These are the kind of things that make you go hmmmm. They Atlanta Parent article did state “The information on this chart has been provided by each hospital.” But what year was this information about? And why did Northside not give the primary rates and the repeat rates?

It makes you wonder why there are hospitals with rates as high as almost 40% and in the same metro area have rates as low as 23%… North Fulton is the little birth center of Atlanta. They have six labor rooms and four of them have deep tubs for birthing in if you choose. The nursing staff find the normal sounds of labor natural rather than coming in to tell a mom to please quiet down as I have witnessed in other hospitals.

Doulas are welcomed additions at this hospital rather than being seen as alien or adversarial. Although I do feel welcomed in most hospitals, it is nice to not have to explain what I am doing there to a staff member who still does not know what a doula does.

There are a lot of factors that enter into why a woman ends up having a cesarean…AmericanPregnancy.org states the possible reasons are:
What are the Reasons that Cesarean Deliveries are Performed?

“There are many reasons why a health care provider may feel that you need to have a cesarean delivery. Some cesareans occur in critical situations, some are used to prevent critical situations and some are elective.”

Placenta previa… this is when your placenta is lower and over the cervix… a previous cesarean can increase this occurrance.
Placental abruption…rare situation 1%
Uterine rupture…can be caused by drugs used in labor but happens 1:1500 births
Breech position…can be done vaginally by an experienced practitioner, and external versions can be done, and positional things can be done to help change the baby’s position prior to labor, moxibustion is a valid approach as well. (http://www.medscape.com/viewarticle/565447)
Cord prolapse…may happen more often when the water is broken artifically but can be due to prematurity, breech or having a large amount of amniotic fluid
Fetal distress… this can be initiated by medical management of labor
Failure to progress in labor (FTP)…we often say this is more failure to be patient- failure to progress occurs often with an induction when the baby and the mom were just not ready to be born. Take the clocks out of the labor room! Is the baby okay? Is the mom okay? Then wait!Also the fear- tension- pain cycle is part of what FTP is created by as well- so we need to work with women to get rid of their fears and we must stop added to their fear once they are at their birth locations!
Repeat cesarean: “You may be surprised to find out that 90% of women who have had a cesarean are candidates for a vaginal birth after cesarean for their next birth (VBAC).The biggest risk involved in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs.” The fear around having a VBAC is more often propagated by fear of litigation and malpractice issues.
Cephalopelvic Disproportion (CPD)… a pelvis and a baby’s head issue- but how often is this due to rupturing the membranes and that shoving a baby into the birth canal in a malposition? – how often is this due to pitocin shoving the baby into the birth canal with contractions that do not allow the baby’s head to mold and rotate.
Active genital herpes…the studies are still unclear about this- the initial outbreak is the one that is known to cause problems- but this is a safe rather than sorry issue.
Diabetes…(http://www.diabetes.org/gestational-diabetes/pregancy.jsp) the concern is the baby will grow “too big” which we don’t know until you labor – or that the placenta may not work as efficiently- which is why a non stress test and bio physical will confirm.
Preeclampsia…preeclampsia.org says “Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms. ” but some women are induced with only one symptom- often just a little swelling or an increase in blood pressure.
Birth defects… some birth defects do provide a safer birth via cesarean
Multiple births… the position of the presenting baby causes some docs to prefer cesarean, others require both babies to be head down- not just the first one, others want to do all multiples surgically. I have had several unmedicated natural births of twins as a doula.

I just worked on my 2008 stats. I had one primary cesarean out of 19 births this year (my numbers were really low due to my surgeries this year). I had three moms attempt a VBAC and only one actually had a vaginal birth, the other two had repeat cesareans. The one primary cesarean was a mom who stayed at 8 cm for several hours and then received an epidural. The effects of the epidural dropped her blood pressure causing the baby to go into distress and her cesarean was immediate.

It is hard to hear that somehow almost 1 in every 3 women has to have her baby surgically removed. Our bodies did not change over the years. We do have diets that can cause problems- but overall the reasons do not lie with womens’ bodies- it lies with managed medicalization of births.