C-section Rates Climb in Portland Area
Kaiser Sunnyside Hospital is the exception while Curry General Hospital has the lowest rates 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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I never see any mention of the epidemic of obesity in our country in these conversations about excessively high cesarean rates. I think the effect of this phenomenon on the population has an impact on cesarean rate since there is an increased risk for cesarean with obesity. The number of obese and morbidly obese patients has increased and this contributes to cesarean rates.
I am quoted in the article and want to clarify that I am not the President of Oregon Midwifery Council. That is Silke Akerson. I am the Press Officer for Midwives Alliance of North America which is how I was contacted for this article.
"A lot of blame is often put on mothers for "asking for" a C-section. I believe this is inappropriate for several reasons. First, it is doctor's responsibility to provide appropriate care, which includes normalizing and minimizing anxiety, conveying confidence in the mother's ability to deliver, and being very honest about the potential bad outcomes for mothers and babies as a result of unnecessary C-sections"
That is utter and total nonsense. Doctors do indeed educate women, but women want what they want. You sound terribly paranoid. It is this fear of medical professionals and this type of paranoid thinking that makes people not get their children immunized. I was never ever once encouraged in anyway to have a C-section.
"Unfortunately, a large proportion of the fears that are experienced are caused or made worse by the doctors, for instance, by telling moms they are worried the baby is too big, or getting anxious about a baby being "late" who is barely to term. Doctors also often tell the mother their "due date" based on ultrasound, sometimes even contradicting the mother's on calculated due date based on conception! (I've seen a baby considered 4 weeks overdue by ultrasound be delivered in a state that clearly showed it was three weeks early.) "
These are medically sound issues for some women. You say you've seen a baby delivered that was induced that was estimated at 4 weeks overdue, but clearly three weeks early. That can happen, but I am curious, are you a medical professional, or are you using this one experience as the basis for your concerns?
"Many doctors will not allow labor to occur naturally even one day past due, even though it is well known that gestation varies widely."
That is simply an untruth. I have worked with dozens and dozens of RN midwives, OBGYNs, and regular midwives, and this is true of NONE of them. Please be careful with the exaggerations.
"Of course, the most obvious and avoidable cause of unnecessary C-sections is unnecessary inductions."
That is not what the data shows. The data shows the the #1 reason (by a large margin) for unrequired C sections is the mother's request.
Now I hear of people being induced BEFORE their due date even arrives, for no other reason than "the baby seems big" or "we're worried it will go late." Many doctors will not allow labor to occur naturally even one day past due, even though it is well known that gestation varies widely between women, and that some deliever two weeks late every time without incident. "
You are clearly "hearing" about these on blogs. Doctors do NOT induce for these reasons. If a woman is very small, she may be advised a C section is needed, but it would NOT be before the baby was full term. These statements of yours are factless and dangerous to women. You accuse doctors of fear mongering women, which is untrue, but clearly what you are doing, intentional or not.
"Additionally, fears about size are tremendously overblown and add to anxiety and early induction. I know a woman who birthed a 10.5 lb baby vaginally, and know of others who have gone as high as 12 lbs."
Certainly. Size is only an issue for smaller women. If you are 4'11 and have a 12 pound baby, a doctor will allow many many hours for natural delivery and will only C section at the mother's request, or if the mother or the baby or in distress or overly fatigued.
"The human body knows how to give birth. The main reason we have too many C-sections is because of excessive medical intervention and anxiety that interferes with the natural process of birth. "
That is inaccurate. It is not medical intervention, it is that too many women themselves are choosing C sections.
"C-sections can save lives, but the vast majority of births happen just fine with no interventions whatsoever, if the mom is just left alone to start labor when she needs to and is supported through labor by people who care about her. We will lower the C-section rate when we start having confidence in the natural birth process and stop trying to mess with nature's incredible design except when it is absolutely unavoidable. "
Women need to start choosing natural birth and that's all there is to it. All this blaming of hospitals and medical professionals is unfounded.
"That is utter and total nonsense. Doctors do indeed educate women, but women want what they want...fear of medical professionals and this type of paranoid thinking that makes people not get their children immunized. I was never ever once encouraged in anyway to have a C-section."
::It didn't sound to me like the previous writer suggested that Cesarean sections (or C/S) were encouraged, but, just because you were not encouraged in your pregnancy does not mean that others have not been. As as CNM/NP (having worked both in- and out-of-hospital), I have seen it happen many times. And it is anything but "nonsense" to suggest a doctors role/responsibility in educating and empowering women throughout the childbearing year. And don't get me started on immunizations.
"These are medically sound issues for some women. You say you've seen a baby delivered that was induced that was estimated at 4 weeks overdue, but clearly three weeks early. That can happen, but I am curious, are you a medical professional, or are you using this one experience as the basis for your concerns?"
::Does it really matter if that person is a health care professional? And those are not necessarily "medically sound" reasons and usually these concerns can't be substantiated. I believe that birth is a mysterious process, but that there is something innately perfect about it - a woman will grow the size baby that is meant to pass through her pelvis and a baby will gestate as long as it needs to. Our bodies possess so much wisdom. I have attended births of babies born from 35-43 weeks and from 5-12lbs, I have seen quite petite women bear large babies and just the opposite (which, anecdotally appears to be more arduous) - so there is no way in knowing which difficulties we will have to overcome during birth, but we have to trust that women can do it.
""Many doctors will not allow labor to occur naturally even one day past due, even though it is well known that gestation varies widely."
That is simply an untruth. I have worked with dozens and dozens of RN midwives, OBGYNs, and regular midwives, and this is true of NONE of them. Please be careful with the exaggerations."
::Maybe where you work this is not true, but, again, I have seen this happen first-hand. "Dozens and dozens" does not constitute an accurate national view on how pregnancy is perceived at varying gestational ages by different practitioners, so your statement is as much of an exaggeration as the previous writer's.
""Of course, the most obvious and avoidable cause of unnecessary C-sections is unnecessary inductions."
That is not what the data shows. The data shows the the #1 reason (by a large margin) for unrequired C sections is the mother's request."
::This is a myth. There are many, many reasons why the rate of C/S has risen so drastically over the last 50 years and maternal choice is not #1. Instead of questioning someone else's sources, why don't you tell us yours? Please, read this: http://www.childbirthconnection.org/article.asp?ck=10456
"Now I hear of people being induced BEFORE their due date even arrives, for no other reason than "the baby seems big" or "we're worried it will go late..."
...Doctors do NOT induce for these reasons. If a woman is very small, she may be advised a C section is needed, but it would NOT be before the baby was full term. These statements of yours are factless and dangerous to women. You accuse doctors of fear mongering women, which is untrue, but clearly what you are doing, intentional or not."
::Again, doctors indeed DO induce for these reasons and thinking a woman is "too small" is not a good reason to even suggest, let alone ADVISE a C/S. You are painting the medical standard of birth to be the ONLY standard of birth. To say these statements are "factless and dangerous to women" is as naive as believing that medical politics are not fear-based. I would argue that doctor fear of litigation is the main cause for the spike in C/S... "they won't sue you for a C/S!" [but they probably should for misinformation... and scare-tactics] At least we agree on the "not before full-term" part.
"Size is only an issue for smaller women. If you are 4'11 and have a 12 pound baby, a doctor will allow many many hours for natural delivery and will only C section at the mother's request, or if the mother or the baby or in distress or overly fatigued."
::Again, untrue - although I would love to believe it as such. Probably 40% of the time that woman (in my estimation, not really based on anything but experience - and of course the hospitals I have worked in could be quite different from yours) will be strongly urged to have or scared into having a C/S. As for the last 60%... let's say they all are given a trial of labor/refuse the C/S: half have a completely natural, beautiful, empowering birth, 1/3 go on to have a C/S for unrelated problems or interventions, and the rest grow exhausted or scared, or I suppose could truly have a malformed or inadequate pelvis (though true cephalopelvic disproportion is EXTREMELY rare) and opt for the C/S after all.
""The human body knows how to give birth. The main reason we have too many C-sections is because of excessive medical intervention and anxiety that interferes with the natural process of birth. "
That is inaccurate. It is not medical intervention, it is that too many women themselves are choosing C sections."
::I don't think I have to say again that this is false. So I'll just let you infer it from my previous responses/criticisms and add that anxiety is strongly tied to unfavorable labor patterns and many interventions (especially if used when not absolutely necessary) cause more harm than help.
"Women need to start choosing natural birth and that's all there is to it. All this blaming of hospitals and medical professionals is unfounded."
::Wow, it is truly like beating a dead horse with you on this "women choose C/S for themselves and that's why rates are so high and boohoo for the hospitals and medical professionals and why are you bullying them?" As a health care professional I am not at all offended by this person's obviously very enlightened take on birth in America. And I whole-heartedly agree with them that it's important to have "confidence in the natural birth process" and to "stop trying to mess with nature's incredible design" in fact, I couldn't have said it better myself. Trusting women and their bodies and supporting them physically, emotionally, and spiritually are the hallmarks of a healthy birth system.
This is exactly why I choose to birth my baby at home recently. I wanted to avoid being cut a 3rd time by a local Portland hospital.
It's not like hospitals are encouraging or forcing C-sections. It is up to the mother, unless there is a medical need. You word it like the hospitals just do it and they are to blame. Home birth is fine of course, but don't pretend hospitals have anything to do with this high percentage.
Wow, that was a really uneducated statement. Hospitals (most, anyway), or more specifically the current national medical perspective on birth ABSOLUTELY, 100% is responsible for this percentage.
C-sections are not presented to women in hospitals as an option in many cases. So to say it is up to the mother is almost completely false. I've seen many women urged, scared, or bullied into the procedure. And more often than not - in fact I've never seen this happen - the woman is not offered any information on true risks of the operation itself, healing, and the impact on bonding; so rarely (if ever) is a truly informed choice being made.
I recommend everyone read this article as well if you're really curious what is the cause of our exorbitantly high C-section rate: http://www.childbirthconnection.org/article.asp?ck=10456
A lot of blame is often put on mothers for "asking for" a C-section. I believe this is inappropriate for several reasons. First, it is doctor's responsibility to provide appropriate care, which includes normalizing and minimizing anxiety, conveying confidence in the mother's ability to deliver, and being very honest about the potential bad outcomes for mothers and babies as a result of unnecessary C-sections. If doctors were more honest and more reassuring, fewer mothers would want or ask for C-sections. Unfortunately, a large proportion of the fears that are experienced are caused or made worse by the doctors, for instance, by telling moms they are worried the baby is too big, or getting anxious about a baby being "late" who is barely to term. Doctors also often tell the mother their "due date" based on ultrasound, sometimes even contradicting the mother's on calculated due date based on conception! (I've seen a baby considered 4 weeks overdue by ultrasound be delivered in a state that clearly showed it was three weeks early.)
Of course, the most obvious and avoidable cause of unnecessary C-sections is unnecessary inductions. It stands to reason that if you induce early, it is more likely labor will not progress. When we gave birth to our first baby in 1983, most all doctors were very comfortable with a baby going two weeks overdue, assuming all other factors checked out OK. Now I hear of people being induced BEFORE their due date even arrives, for no other reason than "the baby seems big" or "we're worried it will go late." Many doctors will not allow labor to occur naturally even one day past due, even though it is well known that gestation varies widely between women, and that some deliever two weeks late every time without incident. Additionally, fears about size are tremendously overblown and add to anxiety and early induction. I know a woman who birthed a 10.5 lb baby vaginally, and know of others who have gone as high as 12 lbs.
The human body knows how to give birth. The main reason we have too many C-sections is because of excessive medical intervention and anxiety that interferes with the natural process of birth. C-sections can save lives, but the vast majority of births happen just fine with no interventions whatsoever, if the mom is just left alone to start labor when she needs to and is supported through labor by people who care about her. We will lower the C-section rate when we start having confidence in the natural birth process and stop trying to mess with nature's incredible design except when it is absolutely unavoidable.