Q&A: Hospital C-Section Rates, Group B Strep, Deciding on Induction
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If you are choosing to birth in a hospital setting, there is an excellent resource that pulls together statistical data from hospitals across the United States. The Leap Frog Group website shares everything from safety and infection rates to key maternity care indicators such as:
High Risk Deliveries: based on quantity of “very-low birth weight babies per year” OR “lower-than-average morbidity/mortality rate for very-low birth weight babies.”
Cesarean Sections: a percentage defined as “first-time mothers giving birth to a single baby, at full-term, in the head-down position who deliver their babies through a C-section” (aka percentages reported already remove “high-risk” pregnancy and labor factors). Hospitals should have a rate of C-sections of 23.6% or less according to Leap Frog Group.
Global epidemiological studies from the last decade suggest the optimal CS rates in developed countries exist somewhere between 15-19% (Source: J Womens Health (Larchmt). 2017 Dec 1;26(12):1285–1291. doi: 10.1089/jwh.2016.6188)
Early Elective Deliveries: defined as “mothers being scheduled for cesarean setions or medication inductions prior to 39 weeks gestation without medical reason.” Hospitals should have a rate of early elective deliveries of 5% or less according to Leap Frog Group.
Episiotomies: defined as “mothers having an incision made in the perineum (the birth canal) during childbirth.” Hospitals should have a rate of episiotomies of 5% or less according to Leap Frog Group.
Screening Newborns for Jaundice Before Discharge: Hospitals should screen at least 90% of babies for jaundice according to Leap Frog Group.
Preventing Blood Clots in Women Undergoing Cesarean Section: At least 90% of women undergoing a cesarean section should receive treatment to prevent blood clots according to Leap Frog Group.
Number of Live Births: quantity of live births during the reporting period
Midwives: whether or not the hospital has Certified Nurse-Midwives and/or Certified Midwives deliver newborns
Doulas: whether or not the hospital employs/contracts with doulas or allows patients to bring their own doula
Lactation Services: whether or not, and when/where, the hospital provides lactations services (in the hospital, in the outpatient setting, and at home after discharge)
Vaginal Delivery After Cesarean Section (VBAC): whether or not the hospital allows VBACs
Tubal Ligation: whether or not the hospital offers tubal ligation during the labor and delivery admission
Simply type in your state, metropolitan area, or exact facility to see the statistics. Once you’re on the hospital’s stat page, scroll down to “Maternity Care” and expand (+) for the specific data. You can also tab over on the main page to “Maternity Care” and look-up hospitals in your area that meet the criteria you check off on their list.
The Leap Frog Group collects information from all hospitals who send in their data. If your hospital does not submit their data, that is a red flag. (And I suppose credit must be given to even those hospitals with below-stellar statistics, because at least that means they still reported their data so you could make an informed decision!)
For example, here in Columbus, Ohio the Ohio Health system (Riverside Hospital, Grant Hospital, and Dublin Methodist Hospital) do not report their data to Leap Frog. However, the Mount Carmel system (Mt. Carmel St. Ann’s Hospital, Mt. Carmel East, and Mt. Carmel Grove City) do.
All of these data points are incredibly important if you’re looking for a low-intervention hospital birth, and can be key indicators of “standard practice” the providers delivering at those facilities abide by. Does your current provider deliver at a hospital that gave less-than-desirable statistics? I’ve got a FREE guide that walks you through why and how to Keep, Fire or Hire a new birth care provider during pregnancy. Download it here.
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What is GBS? GBS, also known as Group B Strep, or Group B Streptococcus is a common bacterium naturally present in the body. Carrier rates differ around the world, and from Evidence Based Birth’s website, about 18% of pregnant people are carriers of GBS. It is generally harmless to adults but can sometimes cause infections in newborns during labor and delivery.
How is GBS detected? Around 36-37 weeks of pregnancy, your care provider will perform a simple GBS test by swabbing your vagina and rectum. Testing positive means you’re a GBS carrier at the time of testing, not that you have an infection.
What Increases the Risk of GBS Passing to Baby? Several factors can increase the likelihood of GBS transmission:
Preterm labor (before 37 weeks).
Prolonged rupture of membranes (water breaks 18+ hours before delivery).
Fever during labor (greater than 100.4°F/38°C).
A previous baby with GBS infection.
GBS detected in your urine during pregnancy (indicating a high bacterial load).
What does a positive GBS test mean for your care plan?
Antibiotics Will Be Recommended During Labor: If you’re GBS-positive in the US, your care provider will likely recommend intravenous antibiotics during labor to reduce the risk of passing the bacteria to your baby. The goal is to prevent early-onset GBS infection, which can cause serious but rare complications in newborns, such as respiratory issues, sepsis, or meningitis.
Timing of Antibiotics: Antibiotics are most effective when given at least 4 hours before delivery. If you have a fast labor or do not receive antibiotics, your baby may be monitored closely after birth for signs of infection.
Alternatives: You can always opt not to have the antibiotics if that is your choice. If you’re allergic to certain antibiotics, alternative options will be discussed. Those planning out-of-hospital births may need to discuss antibiotic access and protocols with their provider, if antibiotics are desired.
If You’re GBS-Negative: No antibiotics are necessary, and your care plan won’t change regarding GBS.
What else should you know? GBS status can change between pregnancies, so testing is done with each pregnancy. GBS is unrelated to personal hygiene—it’s simply part of the body’s natural flora.
What can you do? Be informed about your GBS status and care plan. Discuss any questions with your provider, such as options for monitoring your baby or alternative care preferences if antibiotics aren’t your choice.
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First, for any induction, this should be a shared decision- not your provider scheduling something and telling you to show up. Clarify with your provider by asking directly “Is this induction medically necessary? If so, why? If not, why are you suggesting it?”
Based on their answer, run through the BRAINS acronym.
BRAINS stands for:
Benefits: What are the benefits of this procedure or intervention?
Risks: What are the risks of this procedure or intervention?
Alternatives: Are there any alternatives to what is being suggested?
Intuition: What is YOUR intuition telling you about the situation or what you’re beingn told?
Nothing or Not Yet: What happens if we do nothing, or just wait a little bit?
Space: Allowing space to process the conversation and make an informed decision.
Generally speaking, non-medically indicated reasoning includes:
That you’re 39 weeks, without any other contraindication. If your provider references the ARRIVE trial, I highly recommend reading/listening to the Evidence Based Birth (R) summary of the ARRIVE trial
“Big baby” (Evidence Based Birth(R) has some great resources here)
The holidays
Your provider’s vacation schedule
One high blood pressure reading with no other symptoms of pre-eclampsia
Why might you want to avoid an early induction? The American College of Obstetricians and Gynecologists (ACOG) and other leading health organizations stress that inductions should ideally be reserved for medical indications unless very specific criteria are met (e.g., the birthing parent is past 39 weeks, and the cervix is favorable).
The Risk of Unnecessary Interventions. Inducing labor when the body isn’t ready (i.e., the cervix is not ripe) significantly increases the likelihood of cesarean delivery, especially for first-time parents. Induction often leads to epidural use, IV fluids, continuous monitoring, and potential need for assisted delivery (vacuum/forceps). These interventions increase recovery time and reduce birth satisfaction.
Longer, Harder Labor. When the body isn’t naturally ready for labor, induction can lead to longer labors that are more physically and emotionally taxing. We’re talking 1-3 days long, folks. A “failed induction” (no progress after hours of labor) often results in a cesarean, which could have been avoided by waiting for spontaneous labor.
3. Risk to Baby. Babies born before 39 weeks gestation—especially through elective induction—are at an increased risk of respiratory distress syndrome (RDS) and other breathing difficulties due to immature lungs. This occurs because the final weeks of pregnancy are critical for lung maturation. Early elective inductions can lead to higher rates of neonatal intensive care unit (NICU) admissions, often related to feeding difficulties, temperature regulation issues, and hypoglycemia (low blood sugar).
Sources:
American College of Obstetricians and Gynecologists (ACOG): ACOG emphasizes that non-medically indicated deliveries should not occur before 39 weeks unless there’s a clear medical reason. Their guidelines state that babies born before 39 weeks are more likely to experience respiratory distress. Reference:ACOG Committee Opinion No. 764
March of Dimes: The March of Dimes highlights that elective inductions before 39 weeks are associated with lung complications due to insufficient production of surfactant, a substance critical for proper lung function. Reference:Why at least 39 weeks is best for your baby
National Institutes of Health (NIH): A study from the NIH found that elective inductions before 39 weeks are associated with a 20-30% increased likelihood of NICU admission due to prematurity-related complications. Reference: NIH News Release on Risks of Early Birth (NIH.gov)
Society for Maternal-Fetal Medicine (SMFM): SMFM underscores that elective delivery before 39 weeks leads to a higher likelihood of NICU stays for newborns, particularly for complications like hypothermia, low blood sugar, and jaundice. Reference:SMFM Statement: Elective Induction and Cesarean Delivery
The American Academy of Pediatrics (AAP): The AAP has reported that term babies born between 37-38 weeks are more likely to experience complications requiring NICU care compared to those born at 39 weeks or later. Reference:AAP Policy on Non-Medically Indicated Early Term Deliveries
Spontaneous labor, when possible, is associated with the best outcomes for both parent and baby. Induction should only be considered when medically indicated or after informed, shared decision-making. Always advocate for evidence-based care and trust your intuition when navigating these conversations.
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00:00 Welcome to the Breath and Birth Co. Podcast
00:47 Introduction to Q&A Session
01:04 Understanding Hospital C-Section Rates
05:27 What is GBS and Its Impact on Your Care Plan
11:07 Navigating Induction Decisions
19:37 Childbirth Education and Resources
21:50 Closing Remarks and Encouragement
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Vanessa: Welcome to the Breath and Birth Co. podcast. I'm Vanessa, a hospital based, DONA- International certified birth doula and passionate childbirth educator. I love to merge the power of your intuition with the precision of modern medicine to help you navigate pregnancy and birth your way. Each week we kick off with Monday meditations to bring calm and connection to your pregnancy.
Then we build your confidence through insights, birth stories, and care provider perspectives during thoughtful Thursdays. Ready to feel supported, informed, and empowered? Hit subscribe to the Breath and Birth Co. podcast today and let's embark on this transformational journey together. As a reminder, any information shared here is not medical advice.
For more details, visit breathandbirthco. com slash disclaimer.
Okay, welcome to the second edition of the Q& A episode. I've got three questions lined up for you and I'll provide some answers along with the show notes for this episode with links and further resources. Let's dive in. We've got question number one Is there a way to find out my hospital C section rates?
Okay, the short answer is yes, as long as they're reporting it. Um, the long answer is that you can check out leapfrog group, which is ratings. leapfroggroup. org, which I'll link in the show notes, and they share everything from safety and infection rates to key maternity care indicators, um, for different hospitals, and you can search by city, area code, etc.
within a certain mile radius. And those maternity care indicators include high risk deliveries. So based on quantity of very low birth weight babies per year, or lower than average morbidity mortality rate for very low birth weight babies. They also include cesarean sections in their ratings. And this is a percentage defined as first time mothers giving birth to a single baby.
at full term in the head down position who deliver their babies through a c section. , A. k. a. these reduce the high risk pregnancy and labor factors of the percentages, but according to Leapfrog Group hospitals should have a c section rate of 23. 6 or less. There are some other global studies that suggest that the optimal c section rates in developed countries should be between 15- 19%, and I'll link that study and information in the show notes as well.
But basically any hospitals that According to LeapFrog, show under 23. 6 percent that will show up in their , preferred listing ratings. If you're looking to filter things out, anything below that rate will show up in that filter. They also have ratings for early elective deliveries, which is defined as mothers being scheduled for cesarean sections or, medication inductions prior to 39 weeks gestation without a medical reason.
So again, Early elective deliveries and hospitals should have a rate of early elective deliveries of 5 percent or less according to leapfrog group. They also have ratings for episiotomies, which is defined as mothers having an incision made in the perineum during childbirth.
And hospitals should have a rate of episiotomies of 5 percent or less, according to Leapfrog Group. Um, and then, uh, screening newborns for jaundice, before discharge, which their, um, Their boundaries for that is anything more than 90 percent of babies, basically, should be screened. Preventing blood clots in women undergoing cesarean section.
So, At least 90 percent of, um, birthing people undergoing a cesarean section should receive treatment to prevent blood clots, according to Leapfrog Group. Uh, number of live births, so quantity of live births during the reporting period. Midwives, they'll list whether or not the hospital has certified nurse midwives and or certified midwives deliver newborns.
Doulas, so whether or not the hospital employs or contracts with doulas, and or if the hospital allows patients to bring their own doula, and it will list both of those factors, within that line item, which is nice to know. Lactation services. Whether or not and when or where the hospital provides lactation services, so whether that's in the hospital, in an outpatient setting, and at home after discharge.
Vaginal delivery after cesarean section or a vbac. So whether or not the hospital allows VBACs, uh, tubal ligation, um, which is whether or not the hospital offers tubal ligation during the labor and delivery admission.
, so again, all of those factors can be searched on ratings. leapfroggroup. org and I've got everything linked in the show notes, , for more information on how you can do that.
Alright, question number two is, What is GBS and what does it mean for my care plan? So, GBS, which is also known as Group B Strep or Group B Streptococcus, is a common bacterium naturally present in the body.
And carrier rates differ around the world and from info I pulled off evidence based births website about 18 percent of pregnant people globally are carriers for GBS but it can range anywhere between I think it was 6 or 8 percent to 32%. Um, it's generally harmless to adults but can sometimes cause infections in newborns during labor and delivery which is why it's tracked here in the U. S. and some other countries.
How is it detected? Around 36 to 37 weeks of pregnancy, your care provider will perform a GBS test by swabbing your vagina and rectum. And testing positive means that you are a carrier for GBS at the time of the testing, not that you have an infection. , there are some things, , that can increase the risk of you passing GBS to the baby.
, several factors include preterm labor before 37 weeks, a prolonged rupture of membrane, so if your water is broken for 18 hours or more after delivery. If you have a fever during labor, which can be an indicator for any kind of infection. if you had a previous baby with a GBS infection, and if GBS was detected in your urine during pregnancy, indicating a high bacterial load.
So if you have a positive GBS test, what does that mean for your care plan? Typically, , in the U. S. you'll be offered antibiotics during labor if you're GBS positive. , and that would be just IV antibiotics during labor if you're giving birth in a hospital, and that's to reduce risk of passing the bacteria to your baby.
And the goal is to prevent early onset GBS, which can cause serious, but rare complications in newborns, such as respiratory issues, sepsis, or meningitis. Um, the timing of the antibiotics is most effective when given at least four hours before delivery. , so if you have a fast sleeper or don't receive the antibiotics, your baby may be monitored closely after birth for signs of infection.
, if you're allergic to certain antibiotics, alternative options will be discussed. Those planning out of hospital births may want to discuss antibiotic access and protocols with their provider if that is something that they want to opt into still. And if you're GBS negative, no antibiotics are necessary.
Even if you are GBS positive, they're not necessary. Um, you should always make an informed decision. So part of me going over these facts and giving you the resources is so that you can do that. but just giving you the heads up that if you're positive. This will be part of your discussion with your provider.
Um, in terms of what else you should know, GBS status can change between pregnancies. so testing is done with each pregnancy. And also, just blanket statement here, it's unrelated to personal hygiene. It's just simply part of the body's natural flora. I'll admit, here, I was GBS positive. , my husband and I went over, brains with our provider, and our doula gave us the evidence based signature article on it to read to make an informed decision, and we did decide to proceed with the antibiotics,
okay, so. In terms of what you can do, just be informed of your GBS status if that's something that you want. You can always decline the test as well.
There are countries, I'll list the link in the show notes too for the evidence based birth. Articles and website that go over the different protocols for various countries around the world and how they approach group B strep during pregnancy and other risk factors that some countries determine whether or not it's worth administering antibiotics or not.
Um, and then obviously discuss any questions with your provider, such as options for monitoring your baby or alternative care preferences if antibiotics aren't your choice. Um. I'll go over this in the next question, too, but brains is a common thing that I recommend to clients and students of mine. Um, so we'll run through brains, which stands for B is for benefits.
What are the benefits of this procedure or intervention? R is for risks. What are the risks of this procedure or intervention? A is alternatives. Are there any alternatives that we should be considering or discussing right now? I is intuition. What is my intuition telling me about this information that I'm receiving now?
And N is what if we do nothing or just not now? And S is holding space to process the information that you've just been given and to make an informed decision to give informed consent for yourself. So anyway, I would recommend running through all of those things, , to determine if you want to consent to the GBS test to begin with.
And if you do, take the test and discover that you are positive for GBS, how you want to proceed with that. Okay.
And question number three, the last one for today, is my provider has scheduled a 39 week induction for me. Without really discussing it, what should I do?
So first, for any induction, this should be a shared decision.
Not your provider scheduling something and then just telling you to show up. , so no matter what their initial reasoning was, it should always be a discussion and not just somebody from the office calling to tell you or, you know, as you're walking out, checking out for your prenatal appointment that they're like, oh, let's get you on the schedule for this.
It should be,, a true two way conversation and informed decision for you to make. , so in order to have that two way conversation, I would clarify with your provider by asking directly, is this induction medically necessary? If so, why? If not, why are you suggesting it? And based on their answer, run through brains, which again I just , discussed with question number two.
But what are the benefits, risks, alternatives? What is your intuition telling you? , what if we do nothing or just not yet? And then space to process all the info and make an informed decision.
Generally speaking, non medically indicated reasonings include that you're 39 weeks without any other contraindications.
, if they reference the ARRIVE trial, I highly recommend reading or listening to evidence based birth summary of everything that has come out about the ARRIVE trial. And since the ARRIVE trial, to be, , fully informed on why that trial may or may not be a good reference to use for you. , if your provider is quoting a big baby or if they're suggesting an ultrasound just to measure baby and then come back in and start fear mongering around a big baby, um, again, EBB has some great resources on that too I'll link in the show notes.
, if it's around the holidays. So we, um, at the time of this recording, it's now January. So we're past the peak holiday season, um, for peak inductions and scheduled cesareans. Um, but yeah, the holidays are not a medically indicated reason to induce. Um, likewise, throughout the year, your provider's vacation schedule and convenience with their schedule is not a medically indicated reason to induce. ,
one high blood pressure reading with no other symptoms of preeclampsia, um, or hypertension, those are also non medically indicated reasons. , you'd want to, you know, have several high blood pressure readings, over a certain length of time. You know, more, more than just the one.
, and I guess another question here too that is good to, to kind of explain further is why might you want to avoid an early induction? Um, so the American College of Obstetricians and Gynecologists, also known as ACOG, and other leading health organizations stress that induction should ideally be reserved for medical indications, unless very specific criteria are met.
And this is because, um, and there's an increased risk of unnecessary interventions when you schedule an early elective induction. There's increased risk for cesarean, because the body simply isn't ready at this point if it hasn't gone into spontaneous labor.
And if the cervix is not ripe, it significantly increases the likelihood of cesarean delivery, especially for first time parents. . And ACOG notes that the first time parents with an unfavorable cervix have higher rates of cesarean when labor is induced compared to those who labor spontaneously.
So that is evidence based. and all of this too is part of a cas what's known as the cascade of interventions. an induction often leads to epidural use because of the second reason, which I'll go into as well, um, but then with epidural use, you've got IV fluids, you've got continuous monitoring, so you're not able to get up and move around, to help get in optimal positions to shift baby down and in and through the pelvis, and also potential need for assisted delivery, which is vacuum or forceps during the pushing phase.
And these interventions increase recovery time and reduce birth satisfaction.
, and partly like I mentioned, why induction does lead to higher epidural use is inductions are long. First time spontaneous births are long too, but inductions are really long, like one to three days long. So just prepare yourself for that mentally and emotionally. Um, I think as, as a birth doula, I've attended several inductions and.
It becomes a mental game at a certain point of the birther feeling super defeated because they've been at it for so long. They are mentally, physically, emotionally exhausted by day two, thinking that they were going to meet their baby on day one. Um, And it just again leads to lower birth satisfaction and feeling defeated like your body is not doing what it's supposed to when in reality, um, your body just wasn't ready and you're trying to flip a switch on that it just doesn't work that way, you know?
Um, and so just know going into it and prepare yourself mentally that if you do have a medically indicated, Induction or if you are choosing an elective early induction, um, be prepared for it to take a while., and along with that comes the official diagnosis of quote unquote a failed induction or a failure to progress.
And this is where your body. makes technically no progress, in dilation, basically, um, or cervical effacement, , after hours, of labor. And a provider can slap that label on it and , Typically, if they approach you with a failed induction or a failure to progress, it leads to a cesarean section.
, so yeah, so those are reasons that typically you'd want to avoid unnecessary interventions such as an early elective induction. ,
and there's also risks to babies. So aside from you and what you're putting your body through, um, Babies often have respiratory issues. If they are induced before 39 weeks without medical necessity, um, they have increased, breathing difficulties due to immature lungs, even if the due date seems accurate.
, And I've got some studies, too, that I can link in the show notes about this, and then also the NICU admissions, there's higher rates after early elective inductions,, just due to, feeding difficulties, temperature regulation issues, and hypoglycemia. , So, yeah, all in all, spontaneous labor when possible is associated with the best outcome for both parent and baby, so induction should really be considered only when medically indicated or after informed decision making.
Again, so this should not be your provider or the front desk admin saying, let's get you on the schedule for your, for your induction or for a scheduled C section, um, unless there's been a full conversation and informed consent given,, always advocate for evidence based care. , so if your provider is referencing a certain study or trial, ask for that information so that you can read it and study it for yourself as well.
, And trust your intuition. Again, that I portion of brains. If something doesn't feel right for you, take time to sit on it and do the research and really, um, honor that intuition, in your decision making process. These are difficult conversations to have, and they can feel like really big decisions in the moment, but just try to remember that you do have time, typically speaking, when it's not a medical emergency to, Do the research, read the studies and trials if you see fit, , but don't always, , just take that, "Hey, we've got you on the schedule for an induction",, at face value and really, make sure that you're making an informed decision and go into it, with knowledge and evidence.
If you're pregnant for the first time and or asking yourself any of these questions, I highly recommend seeking out a childbirth education course. While your local hospital probably offers courses, I'm going to be honest, they tend to teach you how to be a good patient. Those hosted outside of the hospital setting tend to be much more comprehensive And hopefully you'll be able to find a specific method or teacher that you truly resonate with.
I offer an online self paced course called Metamorphosis, so I'll plug that one now. Metamorphosis is a transformational, self paced, comprehensive online childbirth education course. It's almost 8 hours of video content spread across 50 lessons. in four modules and comes with over 200 pages of guides and worksheets and affirmations at every step.
In the foundation module, you'll determine your why and learn what a physiological birth looks and feels like and how baby station can mean more than your cervical dilation.
In the Connection module, you'll ensure your care provider is aligned with the birth you envision, and how to build out your village in a way that sets you up for best success all the way through postpartum.
Then, there's the Confidence module, where you'll learn all of your options and be equipped with evidence based resources to make an informed decision each step of the way, culminating in your very own birth priorities plan.
And last, but certainly not least, in the calm module, you'll release fears that are holding you back from the birth you envision and infuse peaceful meditations into your daily routine. Then practice proven pain coping methods to prepare you for labor.
Knowledge is power, and I'm so grateful that you're here listening to this episode. And if you're interested in childbirth education, but self paced online learning is not your cup of tea, or you may have a specific method that you're looking for, there's no gatekeeping here.
In that case, I have a referrals page on my site I'll link in the show notes for various other Columbus, Ohio, local and live online options in case any of those would be a better fit for you. Again, I just want to encourage and empower you to have the information you need to advocate for the birth you desire.
Vanessa: Thank you so much for spending time with me today. I hope you found this episode helpful and encouraging on your journey. Don't forget to hit subscribe so you never miss a future episode. And if you enjoyed today's conversation, I'd be so grateful if you left a quick review. It helps others find the show.
For more information, Resources and links mentioned in this episode. Be sure to check out the show notes. You can also connect with me on Instagram at breath and birth. co for more support and inspiration until next time, remember you've got this and you're never alone in this journey.