If you're currently preggers and wondering whether or not you'll end up having a C-section, you should probably take a good, hard look at the place you plan to deliver. Because according to a new study out of Harvard, the No. 1 thing that currently determines if a woman will give birth via C-section is not her medical risks or preference, but the hospital she gets rolled into. And the reason apparently lies in the management culture of labor and delivery units.
"It is hard to predict when women will go into labor, how long labor will take, and which women may require critical resources like the operating room or blood bank," explained senior author Neel Shah, an obstetrician and Harvard Chan School researcher. "The way managers address this uncertainty appears to be an independent risk factor for a woman getting a C-section."
In order to get a handle on the divergent practices at play, researchers interviewed 118 nurse and physician managers at 53 hospitals about things like unit culture management (including practices that facilitate communication and collaboration among staff), nursing management (including practices that ensure appropriate nurse staffing levels), and patient flow management (including practices that adjust resources to accommodate surges in patient arrival). The hospitals were then categorized as having either "reactive" management practices that address management problems as they occur, or "proactive" management practices that preemptively mitigate challenges before they arise.
Bottom line? The women who received care at hospitals with the most proactive unit culture management were not only more likely to have a C-section, they were also at higher risk for postpartum hemorrhage, blood transfusion, and prolonged hospital length of stay. Why? The researchers speculate that the managers at these hospitals may be focused on achieving different goals—like neonatal outcomes or financial performance—that are not necessarily aligned with maternal well being.
Of course, C-sections aren't necessarily bad, but it may be helpful for hospitals to know that it's not just the doctors who influence whether or not moms-to-be are having them, but also the management culture in their own labor and delivery units.