With a focus on new moms, some hospitals dramatically reduced unneeded C-sections

With a focus on new moms, some hospitals dramatically reduced unneeded C-sections

5/9/2021 12:12:00 PM

With a focus on new moms, some hospitals dramatically reduced unneeded C-sections

C-section rates in low-risk first deliveries vary widely across the nation, with some hospitals having rates as high as 50 percent or more.

, in addition to longer recovery that can make it hard to care for a newborn.California’s efforts focused on first births because they generally involve more difficult labor and often determine the course of subsequent deliveries, he said. “We know that if you had a C-section on your first birth, 90 percent plus of all your future births are going to be a cesarean,” he said.

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Nobody ever says that they did an unnecessary cesarean.C-section rates in low-risk first deliveries vary widely across the nation, depending on the state, hospital and provider, with some hospitals having rates as high as 50 percent or more, according to Main.

“C-section rates shouldn’t be dependent on which door the woman walks through,” he said. “If she walks through one door, it’s very low, with another door it’s very high, even with the same level of risk factors, and that’s just not right.”Why such a wide variation? headtopics.com

It’s not because so many women want to schedule their deliveries, Main said.“There are always a few patients who want it, but it’s less than 1 percent in most studies,” he said. “Most of it has been driven by physician attitudes and nursing culture.”He said he thinks there has been increasing sentiment that having a C-section is no different that having a vaginal delivery.

“There’s a sort of loss of the value of having a normal birth,” he said.Study co-author Dr. Melissa Rosenstein, an assistant professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said it’s not that doctors have bad intentions “or that they are trying to do it just for convenience” but that challenging to try to determine if a patient who had a C-section would have been able to go on to delivery vaginally.

“Nobody ever says that they did an unnecessary cesarean,” she said. “All the providers think that there’s a reason. But I think that we were able to show that these reasons are fluid, and there are ways you can be more patient with labor and end up with a vaginal birth.”

Melissa Petrus had her five babies delivered at Providence St. Jude Medical Center in Fullerton, California.Courtesy Melissa PetrusProvidence St. Jude Medical Center, where Petrus gave birth, started ramping up efforts to reduce first-time C-sections in January 2015, initially focusing on teaching nurses how to better support women in labor and encourage them to walk around more and change positions during labor, said Dawn Price, a nurse and the hospital’s executive director of women’s and children’s services, who helps oversee the program. headtopics.com

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Then the hospital started providing educational sessions to physicians, with a doctor from the California Maternal Quality Care Collaborative coming out to talk about each physician’s C-section rates and how everyone could get to the goal.“It’s that balance of monitoring the baby and observing the baby’s tolerance of the labor, as well as giving mom more support to have that labor, and not rush to interventions,” she said. The hospital also works to educate expectant women about why it’s best to avoid a first-time cesarean.

Like many other hospitals, its first-time C-section rate had climbed over the years.“We got efficient at doing C-sections,” Price said. “So it almost got normalized that that was OK.”But all that’s changed significantly. The hospital’s C-section rate in low-risk first births dropped from 34 percent when the program began to 19.9 percent in 2020, she said.

Dr. David Nelson, an assistant professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center and chief of obstetrics at Parkland Health and Hospital System in Dallas, said the new study supports educating providers, standardizing labor management practices to promote consistency, and tracking C-section rates among physicians, all with the goal of helping other hospitals reduce rates.

It’s difficult for doctors to lower their cesarean rate without knowing what that rate is and how it compares to the target goal, Nelson, who co-authored aneditorial that accompanied the study, said. “For us to effect change on the cesarean rate, it’s really important to measure and report the rate,” he told NBC News. headtopics.com

Before the success of the California program could be adopted in other states, it would be helpful to know which aspects of the big statewide effort had the greatest impact, Nelson said. That could allow other states to direct resources to the most effective and cost-efficient strategies.

“The findings from the California program offer hope for improvement,” Nelson said.Experts also encourage women to talk with their doctors about any delivery concerns and ask about their C-section rates. In 2018, California launched the patient website

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that includes a video and other materials to educate women. “It’s very important that women feel empowered and supported in labor,” Main said.Jacqueline Stenson Read more: NBC News Health »

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Too many women dies in America in childbirth. We need to focus on mom and baby. Used to be in hospital for 3 days. Rushed out in 24 now and stats are not good. Things are being missed. We deserve the very best modern medicine has to offer. We have kids to raise. Is this the only positive thing Commifornia has going for them, reducing the amount of Cesarean section births? Guess you gotta search down pretty deep to find something positive huh

Still should listen to women. They know their bodies better than any. Hospitals don’t encourage, they pressure women in these situations.

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