Two Similar Hospitals, Two Vastly Different C-Section Rates

new-york-times-staten-island-two-hospitals-two-csection-ratesFive miles apart on Staten Island in New York sit two hospitals serving similar populations. One hospital has the highest c-section rate in New York City, the other boasts the fourth lowest.

In 2008, Richmond University Medical Center had a 48.3 percent c-section rate. At Staten Island University Hospital, the rate was  around 23 percent. The rate was 36 percent overall in NYC between 2000 and 2007.

That’s a huge difference. How is it possible?

For one, Dr. Mitchell A. Maiman at SIUH doesn’t necessarily listen to his patients — or the doctors.

Under Maiman’s leadership, a low c-section rate at his hospital is the goal, since most studies show vaginal births are less complicated overall. So when a patient requests a c-section, the answer is “no.” And no unnecessary inductions for first-time moms before 41 weeks gestation — doctor or mother requested.

Also? VBACs are not only allowed, they’re encouraged. (That’s huge.)

Residents at the university hospital are trained to avoid c-sections, too. They’re encouraged to tell higher-ups whenever a doctor decides to prep for a surgical birth.

Doctors at his hospital either come around to his way of doing things, or they leave the hospital, Maiman told the New York Times.

Maybe such doctors head over to Richmond, where the c-section rate continues to climb. There, Dr. Michael L. Moretti, chairman of the obstetrics and gynecology department at the hospital, and his doctors are meeting with less success at lowering their rates. Still, they’re trying.

Moretti said doctors won’t refuse a c-section based only on maternal choice. However, patients requesting a c-section first have to meet with Moretti to discuss the risks. About half, he said, change their minds and attempt the birth vaginally. (Maiman apparently has a nearly 100 percent success rate in talking women out of going for an optional c-section.)

Doctors at Richmond also submit to peer review of each others’ procedures, which presumably makes them more accountable. It’s also worth noting that Richmond is known for its perinatal unit, which, according to Moretti, means they get more high-risk patients. Still, does that account for just a huge difference in their rate of c-section?

The Times article doesn’t mention VBACs at Richmond or what their policy on inductions are. The article also doesn’t say whether Maiman or Moretti allow for vaginal breech births and vaginal births for multiples. Or what their stance on doulas in the delivery room is.

Still, it looks like a loyalty to the patient (rather than a fear of malpractice), evidence-based medicine (allowing and supporting and teaching VBACs, holding off on inductions) and real information for patients (risks of surgery) might be three ways to make a huge dent in the steadily rising c-section rates in the U.S.

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