Wednesday, July 20, 2011

US Cesarean Rate Now 34% ~ Healthgrades

On July 19th, 2011, HealthGrades Obstetrics and Gynecology in American Hospitals (an independent source of physician information and hospital quality outcomes) released a study of U.S. hospital outcomes between 2002 and 2009.  States included in the study where data are publically available: Arizona, California, Colorado, Florida, Iowa, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington and Wisconsin.

In the report, there were several key findings significant to nurses, midwives, physicians, doulas and childbirth educators:

In those states studied, 7% of women undergoing single live born deliveries experience an inhospital complication.  If all hospitals performed at the level of 5-Star rated hospital in maternity care, 32% of these complications (141,869) could have been potentially prevented.

The highest rate of C-section was found in Florida (38.6%) and New Jersey (38.0%).  The lowest rate was found in Utah (22.4%).

As they see it, quoting a 2011 Yale School of Medicine study, the rise in cesarean sections are associated with factors including: 

  • Common labor practices that can lead to cesareans such as inductions or epidurals in early labor.
  • Timing convenience for provider or mother.
  • Increase maternal risk factors such as age, obesity and diabetes.
  • Increased multiple births.
  • Increasing willingness of physicians to perform cesareans.
  • Limited understanding by the mother of the potential complications of cesarean births.
  • Maternal request for cesarean.
  • Physician fear of malpractice claims if they do not perform a cesarean.
  • Established physician practice patterns.

It becomes alarmingly clear after reading the entire report, that 7 of the 9 indications can be eliminated through education....dynamic and evidence-based education of mothers and their partners and simultaneous dynamic and evidence-based education of physicians, midwives and nurses. Yet, providers continue to discourage evidence-based childbirth education either by directly discouraging expectant parents to attend such classes or assert their influence over childbirth education class materials, if the classes are in the hospital setting.

According to "Understanding the Dangers of Cesarean Birth" by Nicette Jukelevics, "women have few standards by which to choose quality coverage for maternity care.  The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization that sets standards for quality of care and service for health plans.  In its 2005 report on the state of health care quality, the NCQA found that 'consumers do not yet have access to the kind of objective information they need to make informed decisions about their care...They need to know which practices, hospitals, and health plans have systems in place to improve quality and safety and which ones make themselves publicly accountable and they need to know how to find their way to high performance providers.'"

The Listening to Mothers II Survey, a survey of over 1600 mothers,  found that US women were poorly informed about the risks of cesareans despite their belief that they should be told about those risks.  The survey went on to point out that support in pregnancy, a healthy life event, for physiologic birth is very limited.  Large proportions of the contributors reported numerous interventions with various degrees of invasiveness and risk. The survey goes on to state that "There were signs of failure to implement standards of informed consent, and many women did not have the childbirth choices or knowledge they wanted.  Most who had experienced specific consequential interventions lacked an accurate understanding of associated side effects.  In open-ended comments, many mothers described indignities and treatment that expressly violated their wishes.  Far too many indicated that they felt overwhelmed, frightened or week during this pivotal event."

The United States of America is not a third world country and our mothers should not be treated with little dignity, little education and little respect.  The invasive procedure, including cesarean sections, not only interfere with a woman's body and healing postpartum but also breastfeeding.  Breastfeeding is interfered with by separation and supplements.  It becomes clear with each passing second, with each new study or press release that United States maternity care is letting down its citizens, mothers and babies.  Families who do want less interventions and more mother-friendly evidence-based care experience policies and trends or "habits" in the health care system that are diametrically opposite of best practice.

This, along with the 20% rise in homebirths (as released by the Center for Disease Control), this is a strong and loud wake-up call for hospitals and providers.  We women, both childbearing and birth professionals, can and will seize this opportunity to shine an even large light on the non-evidence-based practice given to the citizens in the United States.

"The rising cesarean rate is a matter of deep concern for every childbearing woman today and in the future.  Even a mother with previous vaginal births is at risk for a surgical delivery.  The rising cesarean rate is a warning siren that every childbearing woman is at risk for a surgical delivery outcome.  The rising cesarean rate is not a niche issue with over 1.4 million surgical deliveries being performed in 2009.  Every childbearing woman needs to be proactive in her care toward surgical prevention," says ICAN President Desirre Andrews.

I challenge you to print off the HealthGrades 2011 Obstetrics & Gynecology in American Hospitals Report and give to at least five maternity care providers.  If it only changes the practice of one, that is one more than yesterday who will practice evidence-based medicine.

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