Lowering C-section rates at one hospital: why it’s good for moms

When one hospital in California was found to be performing a higher-than-average number of C-sections, an insurance company stepped in and led to some big changes. They said that unless this hospital could lower their number of surgical births, they’d stop covering deliveries at this hospital.

Since this hospital didn’t want to lose the business of so many patients, they listened. What resulted was a drop in the number of C-sections from 38 percent to just over a third (the national average is 33 percent), including the number of C-sections in first-time moms. They also managed to increase their vaginal birth after cesarean (or VBAC) rates.

Overall this is a big win for moms: fewer C-sections (which are known to be riskier and lead to longer recoveries) and higher vaginal delivery rates, including the option to attempt a VBAC. So how did they do this?

The hospital went about this in a few pretty smart ways. They made public the C-section rates of each doctor who delivered there. This allowed OB/GYNs to see where they compared to their colleagues when it came to the amount of C-sections they routinely do. While some doctors didn’t like this, others found it helpful in seeing where they fell in the pack. The hospital also asked nurses to help foster practices that we know can encourage a vaginal birth. Scheduling a C-section took more effort too, to ensure that it was really needed.

One more big change included hiring OB/GYN hospitalists, who are obstetricians who only work on labor and delivery and guarantee that there is a doctor covering the unit 24 hours a day, seven days a week. As someone who currently works in this capacity, I can say with confidence that I bet this change helped many women avoid an unnecessary C-section at this particular hospital. Here’s why.

You may be thinking, “But having an OB/GYN around all the time will only lead to more C-sections, right? Don’t they just love to do surgery?!” Not for the most part. Think about when a doctor, who wants to be home in time for dinner, might recommend a C-section in a borderline case to ensure he can do that. Or maybe he’s got a full day in clinic and by doing the C-section over his lunch break—rather than letting labor continue for a few more hours—he can make sure he’ll make it back to clinic in time.

When there’s a hospitalist around who is going to be on labor and delivery (L&D) the entire time and will leave at 8 p.m. no matter what, that rush to get patients delivered in order to be home or be in clinic doesn’t exist. Also, hospitalists tend to work shorter shifts rather than cover an extended 36-hour labor of a patient, for example. This means less sleep-deprived doctors whose judgment can’t be clouded and who might recommend a C-section so they can finally go home and get some rest.

Lastly, having hospitalists on L&D means women can be allowed to attempt a VBAC. Not being physically present in the hospital is a major reason many OB/GYNs don’t offer them (because if a woman’s previous C-section scar ruptures it is a surgical emergency), which is one reason the repeat C-section rate is so high in this country.

If you are worried about how high the C-section rate is in this country (and really, it’s a legitimate concern), you may want to ask some focused questions at your next prenatal appointment. “What are your and the hospital’s C-section rates? Do you allow for VBACs? Is there a doctor always physically present on L&D? If my labor stalls out, how willing are you to give me time to see if it progresses before recommending a C-section?” Opening up this conversation can help you gauge just how supportive of a vaginal delivery your OB/GYN might be.

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About Dr. Jennifer Lincoln, Medical Director, Pregnancy

Dr. Jennifer Lincoln is a board-certified generalist obstetrician/gynecologist and attending physician in Portland, Oregon. She primarily works on labor and delivery has recently been certified as an International Board Certified Lactation Consultant.


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