Many pregnant women believe that choosing a doctor is the most important delivery decision they'll make. But it's often the choice of the setting, not the doctor, that determines whether a patient will have an unplanned C-section. And it's more than just basic facility policies; a new study suggests that even hospital design can affect C-section rates, according to Slate. Previous studies have shown that hospital design can contribute to patient satisfaction, but floor plans actually have much more impact than that.
It's no surprise that birthing centers would have lower C-section rates than hospitals, as they're typically staffed by midwives rather than doctors, and the goal of such centers is generally to provide the bare minimum of medical intervention. But even among hospitals, the C-section rate can vary widely; in 2009, the variance among U.S. hospitals was anywhere from about 7 to 70 percent. It's easy enough for expectant mothers to look up their hospital's C-section rate, but it's also important to understand what causes the rates to be so different, even among hospitals in the same city. It turns out that many seemingly unrelated factors actually make a big impact, in ways we're just now beginning to understand.
Some factors might not be too surprising. Unplanned C-sections are often performed when labor isn't progressing fast enough, but "fast enough" is subjective, and there's no official threshold, no hard and fast rules. So if a hospital has a high delivery rate overall, there's more pressure to free up a labor and delivery room for the next patient, and doctors would (perhaps even subconsciously) be more likely to call for a C-section earlier than they would in a slower, more relaxed environment.
But other environmental factors matter, too. An Ariadne Labs report found that increased access to overflow rooms and decreased access to operating rooms also correlate with lower C-section rates. And although patients naturally prefer larger rooms, there is such a thing as too large of a room; increased walking distance for staff can waste time and lead to more C-sections. But rooms shouldn't be so small that labor support equipment, such as birth balls and tubs, aren't readily available and visible. And the overall hospital size and floor plan matter, as well; staff break rooms should be close by (again, to decrease walking distance), but there should be adequate space for laboring patients to walk, if needed.
That's a lot to consider, especially for someone who's already very busy planning the life of a new human! When considering a facility for delivery, patients should investigate the overall birth rate and the C-section rate, then ask for a complete tour of the maternity ward to make sure they're comfortable with the room they'll be laboring in, and that the staff aren't too far from the action when they get called to duty. Then, go home and have a nice, big bowl of ice cream and a nap.