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.

Sunday, July 17, 2011

Prescription Milk

You may have seen this trailer before.  But you may want to see it again!
(if you are looking at this on Facebook, please go to to see the complete video.)

Saturday, July 16, 2011

Guest Blogger: Jodi Hitchcock MSW

Perinatal Mood Disorders:  Who Should Screen?

By Jodi K. Hitchcock, MSW

I am often asked whose responsibility it is to screen a pregnant or postpartum woman for a mood disorder (or a PMD).  This seemingly simple question has a complex answer.  I can reply with whom should be screening, or with whom is actually screening, or there is even whom I think needs to be doing it.  Unfortunately, these three are rarely one and the same and that leaves many women at risk for never receiving a proper diagnosis or treatment. 

Lets begin with whom should be screening.  In an ideal world, all obstetricians and midwives would include a standard PMD assessment during all perinatal visits.  Unfortunately, this rarely happens and when it is addressed, a clinical diagnostic tool is often not used.  The doctors and midwives that I have discussed this with have explained a variety of reasons why they do not routinely screen their patients.  The most common reason that has been given is that they do not know what to do with a patient whose scores indicate a high probability for a PMD.  In the area that I live, there are very few resources readily available for doctors and midwives to refer patients should they be experiencing a PMD.  Women who are on Medicaid have the most difficulty finding specialized treatment, which leaves these women particularly vulnerable to more significant problems.

Through my experience researching and working with the perinatal population, I have discovered that there is an “underground society” of professionals providing these services, but they are not well known and are rarely publicized.  I have many theories behind why I believe this is the case, but I will save those for a future post!   The bottom line is that physicians are often times at a loss for what the next treatment step should be so they skip the clinical diagnostic assessment entirely.  I am not placing blame on obstetricians or midwives, this is a much broader concern where changes need to be made at every level.

Although most hospitals now include some form of PMD education or screening as part of the discharge process, this is only a minor first step in accurate diagnosis and treatment.  The majority of women will experience some form of postpartum blues in the first 2 weeks postpartum.  If the symptoms become worse or are not getting any better at 3 weeks postpartum, it is likely that she may be experiencing a PMD and this could not be determined at discharge from the hospital.  Although a 6-week postpartum visit with a doctor is generally a standard practice, for women going through depression, anxiety, panic, etc., this can feel like a very long time to wait.  This is one of the main reasons that I feel the optimum place for a new mother to be screened is at the pediatrician office.  New babies are often seen a couple of times in the first month after birth to do weight checks (especially if they are breastfed).  A standard diagnostic test (such as the Edinburgh Postnatal Depression Scale) could be administered to the mother at each of these visits and referrals made to see a specialist or even see their own doctor (sooner than the usual 6-week visit).  In addition to diagnosis occurring sooner, having multiple assessments done in one location allows the medical professional the ability to monitor the symptoms to see if the woman is improving with time or getting worse.  The sooner a mom receives treatment for a PMD, the least amount will be needed for a shorter amount of time.  Therefore, early detection is beneficial to mom, baby and the family unit and pediatricians play a key role in this success!

About the Author: 

Jodi K. Hitchcock, MSW is a mother of 4 amazing children (ages 10, 9, 6 and 21 months) and the stepmother to a wonderful 14 year old.  She currently works 24 hours a day as a stay-at-home mom to those lovely children.  In addition, Jodi works as an independent consultant providing perinatal support, education and outreach to mothers, couples and families experiencing PMD’s.  In addition, she conducts training seminars and provides outreach education to other perinatal professionals.  After experiencing a variety of PMD’s during and after her pregnancies, Jodi is able to provide a unique combination of personal and professional knowledge to the people she works with.  Jodi especially loves to work with pregnant women who are experiencing or are at risk to experience a PMD so that she may empower them through education and prevention techniques so that they may have the best possible birth experience!  To read more about Jodi and her personal experiences, visit her website @