Published by: Kiran Sreenivas on 8/24/2011 9:34:28 AM
Fashion and television entertainment are not the only industries looking backwards as they move forward. (Have you seen the promos for the new Charlie’s Angels series coming this fall?!) Earlier this month all 17 Portland, OR-area hospitals agreed to stop performing elective induction and caesarian section (C-section) births before 39 weeks. This “hard stop” goes into effect Sept 1 with exceptions only granted in cases of medical necessity. For the people of Portland, the days of women unexpectedly having their water break and rushed to the hospital while an obstetrician is woken from bed to deliver a baby at 3am will no longer be ancient history. And this return to an old practice may soon be coming to a hospital near you.
The rate of C-section deliveries in the United States climbed to an all time high of 34% in 2009. That means more than one in three women undergo surgery to deliver their baby regardless of race or ethnicity. The World Health Organization suggests a country’s Caesarean rate should be around 15%. In the United States, the Joint Commission and the Agency for Healthcare Research and Quality agree that there should be a reduction in C-section rates for certain types of pregnancies.
Inducing labor through cervical widening or ‘breaking’ of the water with medication or other methods is also quite prevalent. One out of every five American births is induced.
Inducing labor and performing C-sections create potential harm. Inducing labor increases the chance a C-section will eventually be performed. C-sections have higher risks of hemorrhaging and infection for the mother than natural delivery. It is also believed infants’ brains develop up till delivery, so inducing delivery may hinder brain development. Lung and respiratory issues are also of concern.
In spite of the risks, women have personal reasons for wanting to schedule their delivery. They may want to ensure it is their obstetrician that attends to them during delivery instead of a random doctor on call. Pregnant women with husbands in the military may want to maximize the small window of time their husbands have to spend with their newborn.
Obstetricians and hospitals have their own reasons for wanting to schedule deliveries. An obstetrician may suggest inducing on a Friday afternoon to prevent being called in on the weekend. Doctors and hospitals may fear a lawsuit if they are not proactive in trying to deliver a healthy baby. With scheduled deliveries, hospitals can efficiently staff and allocate beds in maternity wards.
The most worrisome potential reason for scheduled deliveries is the financial profit. According to one estimate, the average hospital profits $2,240 from an uncomplicated C-section versus only $1,230 for a comparable vaginal birth. While it may be horrifying to think money plays a role, data show it is a possibility. In 2010, California Watch did a report on the number of C-sections performed among 253 hospitals across the state of California. Among the 15 hospitals with the highest rates of C-sections, 10 were for-profit. As for the 15 hospitals with the lowest rates, none were for-profit.
Digging further, California Watch showed not all nonprofit hospitals are equal. Between 2005 and 2007, Hermet Valley Medical Center had one of the highest C-section rates in the state at 28.7% for low-risk pregnancies. Riverside County Regional Medical Center, an NAPH member just 22 miles away, had one of the lowest rates at 9%. Both are not-for-profit, both operate in an area where 15% of the people live below the poverty level, and both serve a population with similar ethnic makeup.
Guillermo Valenzuela, the vice-chairman of obstetrics at Riverside County Regional at the time, attributes their low C-section rates to the hospital’s policy of doctors working in shifts. This means their doctors are paid the same for a shift whether they deliver five babies or just monitor the early stages of labor.
Since each hospital, physician, and woman can have their own policies and preferences regarding deliveries, it was vital all hospitals in the Portland-area agreed to stop inducing labor before 39 weeks to make a true impact.
It will be interesting to see the effects of this new policy. Intermountain Healthcare, a consortium of 23 hospitals in Utah, stopped elective inductions in 1999 and believes it saved patients nearly $50 million for deliveries in 2008 with fewer C-sections performed and fewer newborns put on ventilators. Despite the $3.3 million reduction in their own net revenue over a 5-year period, Intermountain maintains the policy because of the improved patient outcomes. If similar results occur in Portland, the practice of scheduling a delivery may become a thing of the past.
If you or your organization would like to get involved or learn more about this issue, check out the March of Dimes website. They are one of many great resources in this area.