Non-Profit Hospitals Posting Lower Cesarean Rates Than Private Counterparts
It’s becoming more common these days for women to schedule cesarean sections early in their pregnancy, as much out of convenience as avoiding a vaginal birth. Unfortunately, many doctors accommodate the request. In fact the rate of cesarean sections in the United States rose 2 percent in 2007 to a record-breaking 31 percent, affecting one in every three women having babies in America that might have been preventable.
But those statistics don’t tell the whole story, as a new independent analysis from California Watch has shown. California Watch is the state’s largest investigative reporting team, part of the nonprofit Center for Investigative Reporting. They don’t shy away from the tough or sensitive subjects, as this report shows. In fact it shines a startling light on for-profit hospitals which have an alarmingly high cesarean rate.
California Watch utilized a state database of birth records to review C-Section rates at 253 hospitals—both public and private. They found that women were 17 percent more likely to undergo a C-section at the private hospitals. One private Southern California hospital boasted a whopping 47 percent Cesarean rate, 38 percent higher than a non-profit counterpart located in Northern California. Not surprising given the revenue earned on a C-section vs. a vaginal birth.
“Half or more of cesareans are avoidable and over-using major surgery on otherwise healthy women and babies is taking a toll,” according to Pam Udy, president of the International Cesarean Awareness Network (ICAN). Risks vary but can include: babies being born premature, having a lower birth weight, lacerations, and respiratory problems. Mothers-to-be incur more risks immediately as well as future risks that a C-section could preempt: infection, hemorrhage, longer hospitalization time, mistakes during surgery, placental abnormalities for a future pregnancy, the possibility of future stillbirths, even death.
Part of the problem is that vaginal birth after cesarean (VBAC) practices have been banned at 821 hospitals across the country, a fact reported as recently as January of 2009, pushing more and more women into surgery-involved cesareans.
“Given the onerous medical liability climate for OB-GYN, interpretation of The College’s earlier guidelines led many hospitals to refuse allowing VBACs altogether,” said Richard N. Waldman, MD, president of the American College of Obstetricians and Gynecologists (ACOG). “Our primary goal is to promote the safest environment for labor and delivery, not to restrict women’s access to VBAC.”
Following forty years of rising cesarean rates, the American College of Obstetricians and Gynecologists released revised guidelines on VBACs in July of this year, stating that “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”
It is clear that both ACOG and hospital administrators need to look very carefully at the results of the California Watch report. Identifying hospitals that have high rates of Cesareans sections and monitoring that behavior could result in lowering rates that never should have gotten this high in the first place. After all, women have been birthing babies far longer than doctors have been in existence and are not that much different than 50, or even 25 years ago. It begs the question that if the women are essentially the same, and the birthing process is essentially the same, then why such a dramatic increase? Caution? Malpractice rates? The bottom line?