Tag: Hospital

Things Doulas Know

Unsolicited advice is not my style

I have stopped giving random advice to pregnant people that do not ask for it, essentially for two reasons. The first reason has to do with other people and the second because of me.

  1. Everyone seems to feel entitled to give pregnant people advice, and I do not want to add to the mostly annoying cacophony.

I do not know what it is about pregnancy that makes everyone feel like they need to give you advice and tell you what to do. I know that most everyone really means well, but holy moly it can be really exhausting to be constantly bombarded by people who think they know better than you about what you should do. I won’t even get started on the horror stories that people feel obligated to tell you like they can’t stop the flow of awfulness spewing from their mouths. I have a strict no spreading trauma policy when it comes to speaking to pregnant people, and I highly encourage all clients to tune out any and all negative messages surrounding birth and parenthood, especially while you are extra vulnerable and pumped up full of hormones!

2. I know way more than most people about pregnancy, birth, babies, etc than most people, and I have a tendency to go on and on about it.

I know a ton of really specific and sometimes seemingly random things that can really help people who are navigating pregnancy, planning for their upcoming birth, and getting prepared to take care of a new tiny human too. I am happy to talk about all these things all day long, and I do quite a bit, BUT not everyone wants to hear that. I respect people’s wishes and only expose my super birth geek side when requested.

As a doula and childbirth educator, I have extensively studied pregnancy, birth, and postpartum. I know where to find great evidence-based and unbiased information. I know different comfort techniques to get through labor and delivery. I make sure to keep up on all the local resources for new families in our area including great breastfeeding support services, chiropractors who specialize in the Webster technique, prenatal yoga classes, which physicians will provide parallel care for home birth, support for victims of abuse, stores that sell green baby products, and more. I am seriously committed to life-long learning and I want to help everyone be better connected with the resources and information that they need.

I never want people to feel afraid to ask me questions. I would rather my clients ask me anything rather than sit around worrying or wondering. I make an effort to not overshare or overwhelm people. I am always happy to answer questions, especially for my clients. BUT, I can’t send you answers that you don’t ask for, and I won’t, not because I’m protecting the information, rather because I know it is really hard to sip from a fire hose and it has taken me YEARS to gather all this information that you are trying to digest in 40-ish weeks.

What was the worst unsolicited advice you ever received about birth?

2018 Local Hospital Statistics

Progress!!

You can tell a lot about the culture of a hospital by their statistics.  Statistics tell us part of the story, and we should listen to them. Leap Frog Group collects voluntary data from hospitals all around the country and publishes them on their website.  You can put in your location and compare the hospitals in your area. I did exactly that 2 years ago, and so I wanted to revisit the information and see what kind of progress, if any, the hospitals I visit as a doula have made since I originally looked.

Photo by Piron Guillaume on Unsplash

In the below chart, I’ve compiled three maternity statistics for better understanding a hospital’s culture. Here are some things you should know before you see the numbers:

  1. Early Elective Deliveries are defined as elective induction or cesarean sections before 39 weeks.  This does not include medically indicated early deliveries. 
  2. This Cesarean Section data  is for NSTV (research speak for 1st time parents, 38+ weeks pregnant, with a single head-down baby) cesarean rates and does not include repeat cesarean deliveries. This is an important distinction. Leapfrog Group uses the Healthy People 2020 goal of 23.9% for primary cesarean deliveries in this category.
  3. Episiotomies are a cut made to the perineum during the birth process.  While sometimes necessary, routine episiotomies are not evidence-based practice.
  4. The numbers in (parentheses) are the previous numbers reported in 2017. I only looked at three hospitals that year, so apologies for not being able to compare for all the hospitals listed here.
Hospital Early Elective Deliveries Cesarean Sections Episiotomies
The Women’s Hospital 1.7% (1.4%) 22.9%
(24.3%) 		14.8% (18.5%)
St. Vincent’s* Medical Center of Evansville .8% (2.1%) 27.2%
(37.2%) 		6.8% (8.4%)
Owensboro Health 1.4% (2.1%) 29.7%
(30.7%) 		12.7% (19.5%)
Methodist Hospital of Henderson 2.4% 26.1% 2.4%
Memorial Hospital & Healthcare Center Jasper, IN 0.0% 12.8% 9.8%
Daviess Community Hospital Washington, IN 1.9% 15.2% 13.1%

*Listed as St. Mary’s Medical Center of Evansville on the website, but they have since changed their name to St. Vincent’s Medical Center of Evansville.
-Good Samaritan in Vincennes declined to respond
-IU Health in Bloomington, IN declined to respond

What a difference 2 years made!! Yes, there is always room for improvement, but these numbers give me serious hope that the needle is at least moving in the right direction. I take ZERO credit for these statistical improvements, but will most definitely celebrate these hospitals’ achievements.

The numbers certainly do not tell the whole story. As an anthropologist and doula, of course I would think that right? Qualitative data would be especially helpful for better understanding, and these are not the only numbers we as consumers should be discussing. I also want to know about quality of care and how people feel like they are being treated, including reports of obstetric violence.  

What about access to VBAC and hospital level data for VBAC? I can find state level data for VBAC, but nothing looking at the smaller and more specific picture. And in case you were wondering:

VBAC Rates by State, 2017

State Births after previous
cesarean as a % of all births 		VBAC rate of reporting state
Indiana 13.9% 12.8%
Illinois 15.6% 14.7%
Kentucky 16.9% 8.3%

What about physician specific statistics as well? I used to be able to find that data, but after much searching gave up. Where did it go? I’m also wondering why some hospitals chose not to report their data, though I can think of many innocuous reasons why they might choose not to such as deadline issues, personnel, etc.

Want to learn more? Start here:

Compare Hospitals at Leapfrog Group: http://www.leapfroggroup.org/compare-hospitals

Cesarean & VBAC specific information: http://www.cesareanrates.org

My Birth Matters by CMQCC: https://www.cmqcc.org/my-birth-matters

Do any of these numbers surprise you? Will this information influence your choice of birth location? Have you asked your provider anything about their statistics or those of the location where they work?