If you’ve ever given birth, you probably were advised to ask your hospital about their cesarean section rate before delivering.
That’s because, due to longer-term health issues such as scarring and infection, C-sections should be used only when a vaginal delivery would put the mother’s or baby’s health at risk. Despite those concerns, as many as 30 percent of all births are delivered via C-section at some Northern California hospitals, which could hint at underlying issues at the facility resulting in women getting unneeded cesareans, said Christa Sakowski, clinical lead for the California Maternal Quality Care Collaborative.
Among hospitals in the Sacramento region, Sutter Davis has the lowest uncomplicated C-section rate by far. In fact, it has the lowest average in the state with a rate of 13.7 cesareans out of 100 deliveries, according to 2015 state data. The hospital with the next lowest rate is the Kaiser Permanente in south Sacramento, with 19 C-sections out of 100 deliveries, and Kaiser Permanente Roseville Medical Center, with 20.1 C-sections of 100 deliveries.
Those rates do not include births where a C-section may have been necessary, such as in the cases of twins, abnormal position of the baby and other situations risky to the health of the mother or baby, according to the state figures.
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Part of Sutter Davis’ low rate may stem from proactive attempts by obstetricians and other maternal care specialists there to encourage natural births, said William Gilbert, the Sutter Health director for women’s services in the Sacramento Valley. The hospital’s reputation for expertise with vaginal births may also attract pregnant mothers across the region who know they want to deliver vaginally.
“The doctors, nurses and midwives, for 20 years, really tried to have natural labor for their patients,” Gilbert said. “It’s a combination of everyone being on the same page with trying to avoid C-sections.”
Specialists at the hospital also stress educating patients about prenatal care, normalizing vaginal birth as a natural physiological process and not intervening with a C-section if there isn’t a need, said Annette Fineberg, an OB-GYN at Sutter Davis.
Sutter Davis promotes a variety of techniques to support the mother during vaginal birth, Fineberg said. They include using showers in labor, bringing in a doula and encouraging active birthing, which involves moving around and being in an upright position during labor. Volunteer doulas at Sutter Davis provide psychological support to mothers during the birthing process.
The highest C-section rate of any Sacramento area hospital was at the Methodist Hospital of Sacramento, where 31.3 out of 100 deliveries involved a C-section, according to the state data. Dignity Health, which operates Methodist Hospital, said in a statement: “There are a variety of factors that contribute to C-section rates at hospitals. … Dignity Health is committed to providing quality obstetric services in the communities we serve. Perinatal safety and the health of mother and baby are our top priorities.”
Nearly all hospitals in the Sacramento area – 12 of 13 – had a lower C-section rate than the 2015 statewide average of 29 C-sections per 100 deliveries. Memorial Hospital of Gardena, in Los Angeles County, performed 53.7 C-sections per 100 births, the highest in the state excluding hospitals with fewer than 50 C-sections a year.
While some mothers may opt for a C-section again to have an experience consistent with their first birth, a second C-section is often the direct result of a first one. For some mothers, scarring in the uterus prevents the placenta from implanting correctly in the womb. Consequently, the placenta may grow into the muscle wall or over the cervix, blocking the baby from leaving the womb. Contractions during birth may also rupture the scar, causing the mother to lose blood and the baby to lose access to oxygen.
About 200 hospitals in California are members of the California Maternal Quality Care Collaborative, and nearly 70 hospitals across California, including Methodist Hospital, participate in the organization’s initiative to reduce C-section rates, Sakowski said. The initiative helps each hospital identify areas of improvement and suggests ways they could change current practices.
Other hospitals, such as Sutter Medical Center in Sacramento, are working internally to provide better care. From 2010 to 2012, the hospital participated in a project led by Gilbert to improve “recording accuracy, transparency and performance for obstetric quality measures,” according to a published paper on the project.
A hospital’s C-section rate is often unusually high because of organization culture, Sakowski said. Maternity care teams across hospitals may have different opinions about acceptable reasons for getting a C-section or how much control a patient has over their care. Other issues may involve problems with scheduling or coding problems.
Sutter Davis’ low rates can be replicated at other hospitals, Fineberg said. Not intervening unless a C-section is medically necessary or trying to determine which women will be successful with a vaginal birth is a large part of the hospital’s success, she said. C-sections introduce a range of health risks, including hemorrhaging, blood clots, scarring and pain or numbness in the abdominal area.
“A lot of it is just having trust in what a woman can do,” Fineberg said.