| Releases & Statements
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.
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