Santa Barbara’s Cottage Hospital

Paul Wellman (file)

Santa Barbara’s Cottage Hospital

Why Are So Many Cesarean Sections Being Performed at Hospitals?

Birthing Trend Has Grown Considerably in the Last 20 Years   

For low-risk, first-time moms, Santa Barbara’s Cottage Hospital had a Cesarean-section rate of 29.5 percent — a number that’s too high, according to Covered California, the state’s marketplace for health insurance. The percentage does not meet Covered California’s recommended rate of 23.9 percent, set for the end of 2019, and it has threatened to remove hospitals from its insurance network that do not meet the mark. The data was culled from 2016 by Cal Hospital Compare, which reports on hospital performance statewide.

Cal Hospital Compare has not yet released data for 2017, but Cottage’s information officer Maria Zate said that the hospital’s C-section rate has dropped to 22.4 percent for 2017, meeting Covered California’s benchmark. “Like many hospitals around the country, we are continuing to make improvements on ways to keep our C-section rates low while keeping the safety of mother and baby our top priority,” Zate said in a statement.

While the World Health Organization considers the ideal percentage to be 10-15 percent, between 1997 and 2015 there was a dramatic increase in C-sections from one in five births to one in three nationwide. In a recent interview on NPR, Dr. Lance Lang, Covered California’s chief medical officer, explained the dangers of what he described as a culture of high C-sections. “When a woman goes to a hospital, it’s the culture of the hospital that really determines whether or not she gets a Cesarean section, not so much her own health,” he said.

Although C-sections can save lives, when performed unnecessarily the procedure can lead to complications for both mother and newborn. Babies born via C-section have higher rates of infection, respiratory complications, and neonatal intensive care stays, and, as the mom recovers, lower breastfeeding rates. The new moms have higher rates of hemorrhage, transfusions, infection, blood clots, and even risk of death. After a mother has a C-section, the likelihood of having a C-section for subsequent births is more than 90 percent. Some hospitals, including Cottage, have banned vaginal birth after cesarean (VBAC).

Among the number of factors that contribute to California’s high Cesarean rates, one major component is efficiency. If a hospital is understaffed or is working around major holidays, it is much faster and more efficient to schedule a 45-minute C-section than wait for vaginal delivery. Laurel Phillips, a licensed midwife and founder and president of Santa Barbara’s Birth Center, suggested that some women may be persuaded into delivering via C-section. “A woman in labor who is told her baby’s life is at risk is in no position to look up what the literature actually says,” Phillips said. “A woman who is told her labor is taking too long and [that she] needs a Cesarean may just need more time.” The C-section rate at the birthing center is 5 percent, Phillips said.

Other critics point to financial incentives as the leading factor for high C-section rates. In California, the cost of a C-section is more than 25 percent higher than that of a vaginal birth, meaning that a hospital can earn more as it bills a patient’s insurance.

One step that can reduce high C-section rates is educating patients and health-care providers. Melinda DeHoyes, the obstetrics director at Lompoc Valley Medical Center, said she keeps her staff well-informed. “The staff, both physicians and nurses, know the potential risks associated with an unnecessary Cesarean section,” she said. “Therefore, we do not schedule Cesarean sections unless medically necessary.” Coming in at 18.7 percent for 2016, Lompoc hospital was recognized for the second year in a row for beating the 23.9 percent mark.

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