I hear your anger, and it is justified. An ongoing problem with the HealthGrades reports is the cavalier assumption that cesarean surgeries for which there is no medical indication all represent "patient choice" surgeries. The only data we have from asking women themselves comes from Listening to Mothers II, a survey carried out by Childbirth Connection of a nationally representative sample of 1600 women giving birth in 2005. In that population, 1 woman of the 252 who would have been eligible for an elective cesarean said she had a "patient request" surgery. That amounts to 0.4% of the eligible population or 4 per 1000. On the other hand, 9% of the women surveyed or 90 per 1000 reported feeling pressured by their obstetrician to agree to cesarean surgery. I have another study in which 13% of cesarean surgeries performed during labor or 130 per 1000 were by self-report "obstetrician choice" elective surgeries. Another 3% or 30 per 1000 were a joint decision between the laboring woman and the ob, but considering the unequal power relationship, those could reasonably be called "obstetrician choice" cesareans as well, bringing the total to 160 per 1000 or 40 times the number of patient request surgeries.
Kalish RB, McCullough L, Gupta M, et al. Intrapartum elective cesarean delivery: a previously unrecognized clinical entity. Obstet Gynecol 2004;103(6):1137-41.
So which do you think is the bigger problem: elective surgery at patient request or obstetrician request?
-- Henci