You make an excellent point. It is important to clarify exactly what practitioners mean when they tell you their cesarean rate. For care providers who do not perform cesareans (all midwives and most family docs), their cesarean rate conventionally means the rate in women still eligible for that practitioner's care at the onset of labor. So a woman who goes into preterm labor would not be eligible for an out-of-hospital midwife's care. And for a home birth midwife who did not have hospital privileges, the woman would have transferred out of her care if she was admitted to the hospital for induction--I specified hospital admission for induction because home birth midwives may use various induction techniques that don't involve hospital admission. But for midwives and family docs with hospital privileges, the woman having labor induced would usually still be cared for by her midwife or family doc, that is, unless the reason for induction was a medical complication outside of their scope of practice.  

-- Henci

This has been on my mind for quite some time.  When a provider (midwife or family practice MD, in particular) claims to have a C-section rate, of say 1%, what does that mean, really?  When it is a provider who does not perform C-sections (not an OB), at what point to they still claim that patient as theirs and include that surgical birth in their statistics?  And at what point is the patient considered transferred out of their care, and into the OB's care?

I suspect that this is a key issue when asking a provider's statistics.  I also have trouble trusting that providers who claim such a low C-section rate are actually talking about 1% of all patients under their care during pregnancy.  Several providers in my area claim this, but I personally know moms who ended up with a surgical birth (often after an induction for dates, not a medical emergency)--either a flukish coincidence or they are skewing their numbers.

Anyone have any thoughts on this??

Thanks!

Cindy