Kaiser Sunnyside Hospital is the exception while Curry General Hospital has the lowest rates in the state
October 20, 2010 -- Oregon’s rate of children born by Caesarean section (C-section) is climbing, which concerns obstetric physicians in the state.
According to data from Oregon’s Center for Health Statistics, the statewide C-section rate from January to June of this year—the latest data available—was 29.8 percent. In 2009, the rate was 29 percent, compared to the nationwide rate of 30.5 percent.
“It’s pretty high,” said Dr. Leonardo Pereira, director of obstetric services at Oregon Health & Science University.
Portland-area hospitals have among the highest rates. Of all births reported, Legacy Health System saw 33 percent of its children born by C-section last year, compared to Providence hospitals at 34 percent and OHSU, which had a 33.6 percent rate. Curry General Hospital in Gold Beach had the state’s lowest rate, 17 percent.
Kaiser Sunnyside Hospital was the exception in the Portland area, having a 20.5 percent rate. Dr. Axel Fuchs, who practices obstetrics, cites the 24-hour presence of a physician and midwife and Kaiser’s policy of not paying physicians more for performing C-sections. Also, he said, “Kaiser’s patients are encouraged to attempt [vaginal delivery].”
No one thinks the C-section rate should be zero. “The high C-section rate is a bad thing,” Pereira said. “Obviously, there are a certain number that are medical necessary, but zero is the wrong goal.”
A rate of 15-20 percent similar to European countries is ideal, according to Pereira and Fuchs. There are several reasons why C-section rates are so high. Nearly half the procedures are planned months ahead because the baby is either too big, the mother has high blood pressure or an abnormal placenta which could put the mother or the child’s life at risk.
“Those are certainly appropriate reasons for C-section,” said Susan Moray, president of the Oregon Midwifery Council and co-owner of NW Community Midwives.
The number of high-risk patients admitted to the hospital also can impact the C-section rate, Fuchs said. And, women may choose to have the procedure because it’s more convenient, easier than vaginal delivery or they fear vaginal delivery. Labor inductions are becoming more common.
Insurance companies also pay physicians twice as much to perform a C-section. “Healthcare isn’t set up to support vaginal delivery,” Pereira said. Having insurers reimburse physicians equally for vaginal births and C-sections would have “a huge impact.”
Data from the Office of Oregon Health Policy and Research shows that the average cost for a C-section at an Oregon hospital is $11,906, while a vaginal delivery costs $6,424.
A C-section is a major surgery that can have major consequences for a mother’s health, Pereira said. The recovery time can take weeks, if not months, and there’s a higher likelihood of the need for blood transfusions or infection.
Also, the procedure can impact the ability of a mother to bond, nurse and care for her baby, Moray said. “I don’t think women’s bodies are faulty or incapable of giving birth vaginally.”
A 2010 study by Dr. Jun Zhang with the National Institutes for Health suggests that the most important factor to reduce the C-section rate is by lowering the number of first-time mothers having a C-section—by selectively offering labor inductions and persuading mothers to vaginally deliver. That study also found that increasing the number of women giving birth vaginally after a C-section (known as V-BAC) is “urgently needed.”
OHSU is participating in a national trial involving a new technology that provides an EKG of a fetus’s heart, which has the potential of lowering the C-section rate by giving doctors more precise information about a baby’s heart rate during labor. That study, being run by the National Institutes of Health, is expected to last two years.
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