Why Are Women Giving Birth in the Dark?

Pop quiz: what is the most important factor determining whether a woman has a cesarean or not? How healthy she is? How big her baby is? Whether she has pregnancy complications? These all seem like reasonable answers, but the research tells a different story.

A large body of literature suggests that where a woman gives birth is one of the strongest – or even the strongest – predictors of whether she’ll have a cesarean. Yes, you read that right. The same woman could walk into two different hospitals and walk out having had either a vaginal birth or abdominal surgery. The same is true with care providers. Some have high cesarean rates and others have low cesarean rates, and most of that difference has little to do with how many women in their care actually need cesareans to give birth safely.

A similar pattern emerges with other interventions and outcomes. Which care provider a woman goes to is actually the strongest predictor of whether she will have an episiotomy. Induction of labor, access to pain relief options, and access to vaginal birth after a previous cesarean also vary widely across providers and facilities. Different hospitals may also be more or less effective at promoting breastfeeding, more babies may end up in intensive care in one hospital than another, infections may be rampant in one hospital and well controlled in others, and the list goes on.

A woman can increase her chance of a safe birth by choosing a care provider and birth setting with excellent outcomes, but currently only a few states mandate that facilities publicly report such safety data. No state provides that information for individual care providers. A grassroots, mom-led movement is aiming to change that. The Birth Survey is working to obtain intervention rates at the facility level in every state and has already published the data for 9 states. The site also collects robust consumer feedback about every maternity care facility and licensed provider nationwide and makes this consumer data available to the public. Over 22,000 women have taken the survey since the project launched last year. (If you have given birth in the last two years, you can give your feedback.)

Currently, you can find out more about the safety, reliability, cost, and consumer satisfaction of a stroller or bassinet than the hospital or care provider you are going to rely on for a safe birth. Blindly choosing where and with whom to give birth is bad for the health of mothers and babies. Transparency is the missing ingredient to informed choice and safer birth.


Published on: October 29, 2009
About the Author
Photo of Amy Romano MBA, MSN, CNM
Amy is a mother of two, a nurse-midwife, and an outspoken advocate for maternity care system reform. Since 2004, she has worked for Lamaze International to analyze, summarize, and critique research for childbirth educators, other birth professionals, and consumers.
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