I am getting some interest and feedback from Hoag nurses about a post I did over 2 years ago.

A Tale of Two OC Hospitals.  

A Mom commented that Hoag has a 98% epidural rate.

A nurse said this:

I am an RN at Hoag Labor and Delivery, and our patients are all educated individuals, no one forces them get an epidural. They choose to get an epidural. It is their right to choose their birth experience. I support their choice, epidural or natural. If someone asks my opinion on elective inductions or elective c-sections, I discourage them on both. We also have a very impatient society and a very scheduled society that likes to know where when and how something will happen. Doesn’t work that well for waiting for your body and baby to be ready.

Of course!  As a doula I support my clients in whatever they want for their birth, if they want an epidural that is fine with me.  I am sure that most of the hospitals in this have a 95+% epidural rate.

And YES let’s be patient and wait for our babies to be born.  Sometimes it is the Mom and sometimes it is the OB pressing for induction.   Unless the hospital has regulations in place – such as not allowing elective inductions before 40 weeks, then it is not related to the hospital.  However some hospitals do have similar regulations and so if a mom is birthing there, her OB isn’t going to be pressuring her into an induction.  Which then can lower the cesarean rates.

Statistics skewed because number of patients?

I’m also an RN at Hoag in Labor and Delivery. In no way, shape or form are epidurals pushed on any patient. Patients make their own, educated, decision on whether they would like an epidural or not. Often times, I see patients who come in with a doula who end up with an epidural. What are the statistics on that? Hoag does double the deliveries that Saddleback does, so it makes sense that our c section rate is higher. Do you tell your followers that most of those are repeat c sections by patients who were offered a TOLAC? Or that some of those are emergency c sections, in an attempt to save the life of the baby or mother? I think it is unfair for you to degrade Hoag just because you prefer Saddleback. I am sure Saddleback is a nice facility with great amenities, but so is Hoag.

It isn’t about an epidural vs no epidural, again I support my moms in whatever it is they want.  I am not anti-epidural.  I had one with 2 of my births and they were good choices at the time.

Double the deliveries does NOT change the cesarean statistic rate.  It is a looking at the percentage of patients that are having cesareans. (using stats from calhospitalcompare.org)

Saddleback has a cesarean rate of 15%  so out of 100 patients – 15 would have a cesarean. If they had 200 patients – 30 would have a cesarean
Hoag has a cesarean rate of 24%  then out of 100 patients 24 would have a cesarean. If they had 200 patients – 48 would have a cesarean

So having more moms birth there doesn’t explain why Hoag’s c-section rate is higher.

• Of course some are emergency cesareans.
• Some may be moms who have chosen elective cesareans.

But the statistics say a higher percentage of moms at Hoag are getting cesareans. There are so many factors that may play into this.  I can’t know them all.

I wish there were more up to date statistics and more information to share with moms about different hospitals. I know in many hospitals even Saddleback not all OBs offer TOLAC. It is hard to find an OB who will support VBAC moms.  I would love to know the names of any OBs at Hoag that are truly VBAC supportive. That would be great!  But if you look at the overall supportiveness of VBAC neither Mission or Hoag the hospitals themselves say they are NOT supportive of VBACs.  Whereas Saddleback definitely supports VBAC moms.

I think 2 things go hand in hand – a supportive care provider and a supportive birth location.  If you have one but not the other, then it doesn’t really matter.  The one can undermine the other.

I actually found this good site Cal Hospital Compare and here it is comparing the 3 hospitals I usually attend births at.  They have different rates listed.

 

Do I hate Hoag?

No, I actually have attended some lovely births there.  I have had amazing nurses there too.  Same with Mission.

But for overall support of Moms wanting unmedicated vaginal births, Saddleback has the better rates.

• Lower episiotomy
• lower cesarean
• supports VBAC moms
• telemetric monitoring

I don’t love everything about Saddleback, especially that moms start in triage.  That really bugs me.

But when a mom asks me what I think about the local hospitals I share that statistics and my experiences.  I encourage moms to find supportive care providers as well as a supportive birth location.  Using information they gather and by following their intuition they will know what that is for them.

Care Providers Count!

One of the nurses who commented above has a blog and she says this on one of her posts

Just a final note while I am thinking of it, there are many doctors that care if you are going to increase your chance of a cesarean section, and to be brutally honest, there are many doctors that would rather do a cesarean section. That is the truth of the matter. It is important to ask your doctor what their c-section rate is. In my opinion, that does tell you something.

YES!!! This is what I am talking about.  Cesarean rates matter, if you have an OB who would prefer to do a cesarean then a mom who has him will be much more likely to have a cesarean than another mom.  Regardless of birth location.  From Hoags rates I would gather that more OBs that practice there prefer to do cesareans.  Hence the higher rate.

She also says

The RN will call your OB and get admit orders. We have what we call “standing orders.” Most of the time the doctor will say, “Usual orders, AROM (Artificial rupture of membranes- Breaking your water.), they will say you can have an early epidural, or they will say, IV pain medications prior to epidural, or even epidural when she is 3-4 centimeters. They will also give orders for Oxytocin. Odds are if you aren’t three or four centimeters in active labor, your labor will be augmented with oxytocin (Pitocin). If you are trying to avoid Pitocin, then you probably should have been a little more active before you arrived. But, either way, you will wind up with a baby in your arms!

Another reason why Hoag has a higher cesarean rate.  At Saddleback a mom is typically sent home if she isn’t 3-4 centimeters! Why stay just to get induced????