Everything Pregnancy

Study Points to New Factors That Impact C-Section Delivery Rate

Hospital procedural issues—and not just patients' medical specifics—impact the frequency of C-section deliveries.

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When I was expecting, I knew all along I was a candidate for a C-section birth, as I was carrying multiples who were in breech position pretty much all along. And I was totally OK with that.

However, I know many women are committed to the idea of a vaginal delivery if medically feasible. And those women in particular may find the results of a new study very illuminating.

The new study by researchers at UC San Francisco and Marin General Hospital in California's Bay Area, published online in Obstetrics & Gynecology, reveals this interesting news: Privately insured pregnant women are less likely to deliver by C-section when midwives and 24-hour obstetrician coverage are included in their regular care.

The study compared C-section rates for women with private insurance before and after a revamp of procedures at the Marin hospital. Before April 2011, private patients at the hospital were managed in a traditional way: Labor and delivery care came from a private doctor or covering partner. The doctor answered calls home or in the office, and typically managed labor from a remote location. On the flip side, expecting mamas who were covered by state public health insurance already had access to around-the-clock in-house obstetricians and midwives—and those women had fewer C-sections.

Then the hospital made two big changes for private patients: First, they offered 24-hour midwives to all patients, and they designated a group of private practice obstetricians for labor, only providing in-house labor and delivery coverage without other duties vying for their time.

Before the changes, about 32 percent of the privately insured women delivered by C-section, and only 25 percent did after the changes. And the trend continued throughout the study time period in 2014.

Why is that?

"There are several ways in which the in-house model of care may have resulted in fewer C-sections," wrote the study's co-author Malini Nijagal, MD, who is now at Boston Medical Center. "Competing surgical and office responsibilities in the former model of private care may impact a provider's decision-making around proceeding with C-section, versus waiting for a vaginal birth when labor begins to deviate from what is expected or hoped for."

Beyond that, the doctor said, the rate of C-section is reduced when a committee is on board to make a decision: "Previously, decisions about C-sections were made independently by one physician. Under the new model, which includes midwives with specific expertise in normal physiologic birth, there is a team approach of care with clinicians discussing each patient twice daily. This often leads to consideration of alternative options for labor management."

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Alesandra Dubin is a mom to one-year-old boy-girl twins. She's also a Los Angeles-based writer and the founder of lifestyle blog Homebody in Motion. Follow her on FacebookInstagramGoogle+ and Twitter.

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