Delivery Failure: Gotbaum Report Finds Alarmingly High C-Section Rates; Hospitals Fail to Provide Maternity Information Required by Law
New York City Public Advocate Betsy Gotbaum released a report today showing that the percentage of cesarean sections, or c-sections, performed at public and private city hospitals are, in some cases, twice the recommended average; at one hospital, nearly 40 percent of all deliveries are performed via c-section. Gotbaum’s investigation also found that none of the City’s hospitals could provide current information about c-section rates and other maternity care statistics, as required by state law.
“This is unacceptable. We’ve got hospitals all over the city that are delivering a third of their babies by c-section. The Department of Health has to get to the bottom of why this is the case. I also want to know why not one hospital out of 44 could provide the information they are required by law to provide,” Gotbaum said. Her report points out that leading medical agencies, such as the World Health Organization and the Centers for Disease Control recommend a cesarean rate of 15 percent or less.
Citywide, c-sections account for 26.4 % of births. In 1970, only seven percent of babies were born by c-section nationally but the rate has been steadily climbing since 1996. Among the City hospitals with the highest rates are Flushing Hospital Medical Center (35.6%), St. Vincent’s of Staten Island (35.6%), Brooklyn Hospital Center (34.8%), Columbia University Presbyterian (34.8%), New York Hospital (Weill Cornell) on Manhattan’s Upper East Side (37.3 %), and Lenox Hill Hospital (31.7%), where Gotbaum released the findings of her report. She was joined by Elan McAllister of Choices In Childbirth, Maureen Corry MPH, Executive Director of the Maternity Center Association, and Meredith Finnerty, who recently became a mother.
According to Corry, “The best research evidence is clear: unless there’s a compelling and well-supported reason for cesarean section, vaginal birth is the safest way for women to give birth and babies to be born. Women need full and accurate information well before labor about what is at stake in decisions about how to give birth.”
“It is critical that expectant parents have access to all data relating to c-sections. We know the risks associated with c-sections. The City’s hospitals should be recommending what is best for the health of the mother and newborn, so when 43 of 44 hospitals surveyed by my office fail to provide this data, we have to ask ‘What are they trying to hide’,” Gotbaum said.
A New York State Law known as the Maternity Information Act (MIA) requires that statistics on medical interventions during labor and delivery be made available to expectant parents and the general public in a leaflet format. Among the information that must be included under the MIA are the frequency with which cesarean section, induction of labor, episiotomy, and other procedures are performed, and a brief description of the procedures. Only one hospital was able to provide representatives of the Public Advocate with any maternity data, and the material dated back to 1998.
Gotbaum commissioned the report in part due to the debate over whether c-sections are being performed at a rate higher than advisable. C-sections are a lucrative, time-saving procedure with less of a potential for liability than vaginal delivery, so there may be a temptation to perform them even if they are not necessary. Gotbaum’s report cites several potential health risks associated with c-sections including: infections, hemorrhage, injury to organs, anesthesia complications, infertility, and psychological trauma. Risks of premature birth and respiratory problems for the newborn are also heightened by c-section deliveries.
Gotbaum cited statistics showing that mothers who give birth by c-section have hospital stays of between three and five days, and as a result pay hospital costs that are 1.7 to 2.4 times higher than for vaginal births. In 1994, the national consumer advocacy group Public Citizen estimated that half of c-sections are unnecessary and result in infections, over a million extra hospital days, and high costs.
Gotbaum called on the State Department of Health, the City’s Health and Hospitals Corporation (HHC), and the City Department of Health and Mental Hygiene (DOHMH) to enforce the law requiring that all city hospitals distribute maternity information. She also demanded that the State DOH disseminate all 2004 birth data to hospitals as soon as possible and develop a system to prevent it from falling behind again in reporting data.
Gotbaum also called on the New York State Legislature to amend the MIA to authorize a fine for hospitals that do not comply with the law and recommended that the State and City health departments make all legally required information available on their websites.
Gotbaum announced that New Yorkers can access the latest maternity data available by calling her office at 212-669-7250 or visiting the Choices in Childbirth website at www.choicesinchildbirth.org. Visit www.maternitywise.org for the Maternity Center Association’s consumer booklet, What Every Pregnant Woman Needs to Know About Cesarean Section.
