California Watch–a non-profit, independent reporting team — looked at data from 253 California hospitals and found that not only do c-section rates differ strikingly between California hospitals, but for-profit hospitals perform c- sections at higher rates than nonprofit hospitals.
The public advocacy group found that, all things considered, women were at least 17 % more likely to have a c-section at a private hospital than at a non-profit hospital.
Their report also suggests that some hospitals are performing more c-sections for non-medical reasons including, “an individual doctor’s level of patience and the staffing schedules in maternity wards.”
Dr. Jeanne Conry, California district chairwoman of the American Congress of Obstetricians and Gynecologists (ACOG) said, “We take this extremely seriously. The wide variation in C-section rates really is a cause for concern.”
There were some fairly extreme examples of disparity between hospital practices. Chance of c-section is 14% at the nonprofit Kaiser Permanente Redwood City Medical Center, for instance, but 59% at the for-profit Los Angeles Community Hospital. Some hospitals in close proximity to each other, serving essentially the same populations, had dramatically different rates.
“This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate,” said Desirre Andrews, president of the advocacy group International Cesarean Awareness Network (ICAN).
Others don’t see a straight line between a hospital’s profit motive (c-sections bring in almost twice the profit of vaginal births) and these numbers. For one thing, it’s the care-provider not the hospital that makes the call. According to Rick Black, representative of the for-profit Tenet Healthcare hospital chain, to assume hospitals are just coldly out for a buck is “a wrong premise. ” But there may be some subtle incentives that help explain these data– things like the convenience of a scheduled birth over the unpredictable (and often long) nature of spontaneous labor.
In the California Watch story, Guillermo Valenzuela, vice chairman of obstetrics at the non-profit Riverside County Regional, explains that shift work is responsible for the low c-section rate in his hospital. There’s no financial incentive for shift workers to speed up a labor. The doctors get paid the same amount whether they deliver the baby on the clock, or not. Other research has shown that Kaiser Permanente hospitals– which are operated on a shift work model–tend to have lower C-section rates. Kaiser also hires more midwives, who are able to attend births at lower cost than obstetricians and who have lower intervention rates.
Recently we’ve heard compelling evidence that there’s a strong correlation between labor induction rates and increased chance of a c-section. The California report supports this connection: Nurses at Citrus Valley Medical Center, where there is a 29.3 % *low-risk* c-section rate, have complained that doctors are just not patient enough for normal labor. The reason for many of the low-risk C-sections in this hospital is officially due to a “failure to progress.” The nurses say in reality it’s a “failure to wait.” I’ve heard this kind of thing before.
There’s no question that big business has a hand in maternity care (and indeed all healthcare), exactly how, is difficult to explain. But one thing seems to be clear, the rising c-section rates are not due to patient preference alone. Women who opt for scheduled c-sections for non-medical reasons represent a tiny percentage of all births.
California’s maternal death rate has gone up in recent years, now researchers are looking into a possible connection between these numbers and the increased c-section rate. C-sections– though one of the most commonly performed surgeries– bring increased risk of (sometimes serious) infections for mother and/or baby. Surgery should be performed when those risks are outweighed by the benefits. There’s been much debate on about how often the surgery is medically necessary–looking at the research it seems that number should be hovering somewhere around 10-15%, but in the US today about 30% of all births are c-sections. In some hospitals, as this report shows, its much higher.
photo: Kelly Sue/Flickr