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Place of Birth as Your #1 Cesarean Risk, with Dr. Neel Shah

The Birthful Podcast: Episode #107

Today we’re taking a look at how the hospital you choose, can be your #1 risk of having a Cesarean. Cesarean rates have increased 500% in one generation, and they are now the most common surgery performed on human beings anywhere in the work. About of them half may be unnecessary. How did we get to this, and what can you do about it? Dr. Neel Shah has answers. Check it out!

To listen here, click the play button on the player above, or click the button below to listen in iTunes.


What we talked about:

  • The medical conundrum of undertreatment vs. overtreatment
  • The 500% increase in Cesarean rates since the late 60’s/early 70’s
  • Why the #1 risk may be what hospital you walk into
  • Labor floors: providing the most intense medical protocols on the healthiest patients
  • Why the problem is not WHERE you deliver (hospital/birth center/home), but HOW the system is set up
  • How it could work: the successful UK system that actually offers choices
  • How you can better your chances
  • Asserting your voice individually and collectively


This episode is brought to you by

Reverie power beds:

winner of the Woman’s Choice Award 6 years straight, and loved by exhausted moms everywhere.

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and also by Megan Othling, of


Additional resources and articles:


Dr. Neel Shah
Courtesy of Dr. Neel Shah

About Dr. Neel Shah

Dr. Neel Shah, MD, MPP is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, and Director of the Delivery Decisions Initiative at the Ariadne Labs for Health Systems Innovation. He is an expert in designing, testing, and spreading system interventions that improve the safety, affordability, and experience of patient care. As an obstetrician-gynecologist at Beth Israel Deaconess Medical Center, Dr. Shah cares for patients during critical life moments that range from surgery to primary care to childbirth.

Prior to joining the faculty, Dr. Shah founded Costs of Care, a global NGO that curates insights from clinicians to help delivery systems provide better care at lower cost. He is listed among the “40 smartest people in health care” by the Becker’s Hospital Review, and has been profiled by the New York Times, CNN, the New England Journal of Medicine, and other outlets for his efforts to demonstrate how over-treatment can harm patients.

In 2015, Dr. Shah co-authored the book Understanding Value-Based Healthcare (McGraw-Hill), which Don Berwick has called “an instant classic” and Atul Gawande called “a masterful primer for all clinicians.” He is an advisor to the Healthcare Financial Management Association, Square Roots, March for Moms, and the National Partnership for Women and Families.



Like the music on the podcast?:

Title music:Vibe Aceby Kevin MacLeod, from the Free Music Archive / CC BY (edited for length).

Sponsorship music:Air Hockey Saloon” by Chris Zabriskie, from the Free Music Archive / CC BY (edited for length).

Adriana Lozada