The Mass. Dept. of Public Health keeps statistics on birth and publishes an annual report, found here. Unfortunately, unlike in New York, hospitals do not track labor interventions.
The data is pretty interesting. Some bullet points from the most recent report (2006):
- Massachusetts has only 2 freestanding birth centers, the Cambridge Birth Center and the North Shore Birth Center. I am planning to give birth at the slightly larger one, Cambridge, which had 114 births to North Shore’s 83.
- The C-section rate for Cambridge Hospital, the hospital that the Cambridge Birth Center is affiliated with, is 29.2%, lower than the state rate of 32.5%. The primary C-section rate (as opposed to repeat C-section rate) for Cambridge Hospital is 19.8%.
- Infant mortality rates have been steadily dropping since about 1870, and continue to do so. The current rate for Whites in Massachusetts is around 5 deaths per 1,000 live births.
- Massachusetts has around 25 pregnancy-associated deaths per year.
The most intriguing data is on Table 32, “Cesarean Section Deliveries for Singleton Births by Licensed Maternity Facility and Number of Previous Births, Massachusetts: 2006,” which suggests that whether your first birth is vaginal or cesearean has an extreme, almost determinative, influence on your subsequent births. Here is the data for Cambridge Hospital:
First Birth
Births: 675
C-sections (number, percent): 171, 25.3%
Second or Later Birth without prior C-section
Births: 430
C-sections (number, percent): 41, 9.5%
Second or Later Birth with prior C-section
Births: 181
C-sections (number, percent): 158, 87.3%
The Mother-Friendly Childbirth Initiative says that a “mother-friendly” hospital, birth center, or home birth service has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals. It’s clear from the evidence that that target is only met in cases where there is a second or later birth without a prior c-section. For first-time mothers, not having had the prior experience of a natural birth increases the risk of cesearean. Why? I would guess it’s because women who have not previously given birth do not know what is normal for them and what is not. If you can make it through the first birth vaginally, then you are much more likely to have subsequent vaginal births, whereas if you have a c-section, you are very unlikely to have subsequent vaginal births. In addition, the more cesarean sections you have, the greater the risk of complications with each additional surgery, while the risk with multiple vaginal births remains the same.
I wonder why more doctors don’t talk about the two paths for birthing, the importance of the first birth for putting you on a path, and the long-term consequences and risks of each path if you plan on having multiple children. I mean, obviously there will be 10-15% of women in any case who need cesarean sections, and obviously they should get them, but the numbers indicate that more than just medical need is driving the rates.
