Excessive C-sections: Hospitals respond to Consumer Reports study

Researchers at Consumer Reports say their analysis of hospital data finds too many hospitals are delivering babies by C-section when it's not medically necessary. Local hospitals say it's good to shed the light on the issue but Consumer Reports' hospital ratings for C-section frequency are misleading, because they don't take into account all the factors involved in many C-section decisions.

Consumer Reports says it has analyzed data from more than 1,500 hospitals in the 22 states where data is available and found several where more than half the women who expect a low-risk delivery undergo a C-section.

For low-risk deliveries, Consumer Reports found that C-section rates ranged from less than five percent to more than 50 percent. Low-risk deliveries are defined as: women who haven't had a C-section before, don't deliver prematurely, and are pregnant with a single baby who is properly positioned.

There are situations when a C-section is the safest option. But Consumer Reports says the vast majority of women who anticipate a low-risk delivery should expect to have a natural birth. Unnecessary C-sections drive up medical costs and increase risks for mothers and babies.

A state-by-state break down rates most smaller hospitals in Washington as better than average for doing fewer C-sections. Larger hospitals tend to get lower ratings and perform more C-sections. In it's report, Consumer Reports rates Overlake, Providence Centralia and UW Medical Center among the worst.

To avoid unnecessary C-sections, Consumer Reports encourages expectant parents to ask the person who will deliver your baby about the hospital's C-section rates. In general, Consumer Reports says the lower the C-section rate, the better. Women are encouraged to definitely look for rates lower than the national average, which for low-risk deliveries is close to 18 percent.

Overlake Medical Center, Providence Centralia Hospital, and UWMC say they are aware of the C-section analysis and they continue to reduce their C-section rates. But doctors stress the Consumer Reports analysis omits critical factors. People involved in the baby delivery process say the study does not adjust for all the things known to influence C-section rate.

The hospitals submitted the following responses they say should be considered when reviewing the Consumer Reports information:

Providence Centralia response:

"Providence Centralia Hospital has been aware of the C-Section data, and started working last fall on this issue. We have decreased our overall C-Section rate by 13 percent in the first quarter of 2014 and expect that trend to continue."

Overlake Medical Center response:

"Overlake Medical Center is actively engaged in multiple efforts to reduce our elective cesarean section rate. The most impactful changes are being achieved by changing our policies and procedures around elective C-sections, working directly with the OB-GYN physicians who practice here and actively participating in the Leading Edge Advanced Practice Topics (LEAPT) program through the Washington State Hospital Association which is working statewide to ensure safe deliveries. Additionally, we are developing an active patient education effort to explain all childbirth options.

Overlake has been top ranked in patient safety six years in a row by Healthgrades and continually receives the highest measure of patient safety from The Leapfrog Group-- an "A" grade. Patient safety and high quality care is our foremost goal and we are aggressively pursuing every effort possible to improve our elective cesarean rates."

University of Washington Medical Center response:

"Cesarean section rates are determined by many factors. One of the most important is the severity or illness present in the mother or the baby either before pregnancy or developing during the pregnancy. The Consumer Reports paper acknowledges that their analysis cannot account for these factors. Thus the population of patients it describes corrects for some high risk factors (for example prematurity, twins, breech presentation) it does not correct for hypertension, diabetes, obesity or fetal growth problems). At the UW Medical Center publicly available data shows our population of patients has the highest severity of illness of any hospital in the state. In fact our hospital has the fifth highest severity of illness calculation for any hospital in the United States in an analysis done with University Hospital Consortium data from 125 academic medical centers. We would therefore expect our cesarean section rates to be higher than most hospitals in Washington State.

In addition as part of the response to Affordable Care Act we are developing systematic approaches to providing pregnancy care. One of those decisions resulted in the transfer of our low risk midwifery service of 400 patients to Northwest hospital. This made room at UWMC for more high-risk patients but resulted in shrinking our population of low risk women expected to have a high chance of vaginal birth. One of those groups is women having failed an attempted home birth. For the last 2 years this population has accounted for nearly 10 percent of our entire birth population. As a result of this system decision we have seen a significant and expected rise in our cesarean section rate.

Another significant factor in determining cesarean section rates is hospital culture. This can be indirectly measured in many ways. One way is the elective induction of labor, that is labor induced for non- medical reasons. At UWMC we have a 0 rate of elective induction of labor at term. Another way is analyzing the rate of elective delivery prior to 39 weeks. Our rate for that indicator is also 0. Elective cesarean section on maternal request at UWMC is also near 0. Our culture is not to do non-medically indicted labor inductions or cesarean sections.

Nonetheless we feel we still have work to do in optimizing our cesarean section rate. We have recently analyzed our reasons for cesarean section in a similar group of patients described by Consumer Reports. While the national average for premature labor related cesarean section (not reaching 6 cm) is 40% the rate at UWMC is 10%. We have developed and are testing new method of graphically plotting the progress of labor to make sure we give every woman the optimal chance of having a safe vaginal birth.

Our goal for pregnancy is to have every family go home with the healthiest mother and baby that is possible given the unique circumstances present in each family. "