C-section rates in Hungary

According to the Hungarian Health Insurance Supervisory Authority, the rate of C-sections in Hungary in 2006 was 28.9% across the country, though the rate varied widely between individual hospitals. The highest C-section rate of nearly 47% was recorded in the little town of Csorna, while the lowest C-section rate of a bit less than 16% was recorded in Tapolca.

Generally speaking, surgical births were more common in university teaching hospitals and lowest in small town hospitals.

However, a straight comparison between these institutions is not fair, since complicated cases tend to be transferred out of small town hospitals to the large tertiary hospitals that specialize in perinatal pathology. Unfortunately, no research is available that controls for this difference, and only looks at the outcomes of low-risk pregnancies in different hospitals.

What the WHO recommends and why

The WHO (World Health Organization) recently updated its recommendations regarding the rate of surgical deliveries. These recommendations unequivocally state that C-section rates below 5% and over 15% put women’s lives at risk. Why? Because apparently when the number of C-sections rise above 10-15%, the rise in the number of maternal deaths is not balanced by a corresponding decrease in fetal death. What that means is that when C-section rates go above 15%, women start dying unnecessarily due to a procedure that was meant to save their babies’ lives, but didn’t.

C-section rates are on the rise all over the world, so Hungary is not unique in this. Nonetheless, our current C-section rate of about 30% means that at least half of them were performed unnecessarily.

What you can do

It has long been known that the hospital and caregiver you choose play a large role in the outcome of your birth. Yes, apparently, if you have a low-risk pregnancy, the biggest factor determining whether you will receive a cesarean section or an episiotomy is where you choose to give birth, not necessarily whether you need one.

With that in mind, you can do the following things to decrease your chances of receiving an unnecessary C-section:

• Look through the list of various Hungarian hospitals’ C-section rates, and see where your doctor’s institution ranks. Don’t be afraid to change institutions.
• Ask your doctor about his or her C-section rate (though do keep in mind that if your doctor specializes in high risk pregnancies, this number can be higher than average). Hungarian doctors are not used to being questioned this way, and some may actually be offended. However, unless women participate in their own care and ask these questions, maternity care will never reflect women’s real needs and desires. Don’t be afraid to change caregivers.
• Get educated about labor and birth. Attend childbirth classes or read books.
• Let labor begin on its own. Inductions automatically increase your chances of a C-section by 30%.
• Move around in labor. This helps the baby achieve optimal positioning and helps avoid stalled labor, which is often diagnosed as “failure to progress” and is indication for a C-section.
• Bring support. Research has shown that having a continuous support person with you decreases the chances of receiving a C-section. This can be your partner, a family member, a friend or a professional doula.
• Use medications and interventions wisely in order to avoid the so-called cascade of interventions where one step leads to another down a slippery slope towards a surgical birth that could have been avoided.

The current Hungarian C-section rate means that a pregnant woman (that means YOU) has a 1 in 3 chance of having a surgical birth in an average Hungarian hospital. If you want to improve your chances, it is time to do something about it.