Hospitals in the state, however, are starting to band together to implement practices that have been shown to benefit birth outcomes. The majority of the state’s birth centers recently moved to ban elective C-sections and inductions before 39 weeks except when there is a clear medical need. The move was based on a spate of studies that found that such policies led to reductions in admissions to neonatal intensive care units at several hospitals across the country without an increase in stillbirths.
Brigham and Women’s Hospital in January began encouraging more women to have vaginal deliveries after C-sections to nudge down its C-section rate, which is slightly below the state average. “To my great happiness,” said Dr. David Acker, chief of obstetrics at Brigham and Women’s, “about 26 to 27 percent of women who’ve had previous cesareans now deliver vaginally compared to 21 or 22 percent a year ago.”
While certain birth centers like Tufts Medical Center argue that their C-section rates, which are well above the state average, can be attributed to serving more pregnant women who have complications, many community hospitals including Newton-Wellesley Hospital also have higher-than-average rates.
“I don’t think anyone’s arguing that Newton-Wellesley serves as high a risk population as Boston Medical Center, which has a large low-income population,” said Eugene R. Declercq, a professor of community health sciences at Boston University School of Public Health. Yet Newton-Wellesley’s C-section rate was nearly 38 percent in 2009 compared with 30 percent at Boston Medical Center, according to the latest state data.
What’s more, a Department of Public Health report released last year showed that the cesarean rates for first-time mothers with low-risk pregnancies ranged from 10 percent to 35 percent among the various state birth centers, which suggests that some hospitals are clearly performing too many surgeries.
“We track our C-section rate and are always making efforts to keep a handle on it,” said Dr. Sabrina Craigo, chief of maternal-fetal medicine at Tufts Medical Center. The rate declined from a peak of nearly 39 percent in 2009 to 35 percent in 2011, which Craigo attributed to the hospital’s recent addition of two nurse midwives who handle lower-risk pregnancies and favor fewer medical interventions.
Thomas Beatty, chair of obstetrics-gynecology at Newton-Wellesley, said his hospital’s C-section rate is now in the 33 to 34 percent range after the hospital’s midwives and physicians adopted new policies.
But, Beatty said, it’s been difficult for staff to pinpoint why their C-section rates were higher than average in the first place. “There are so many factors that play into it.”