The story, Birthrights, in the June 14 edition of The Memphis News examines the complex reasons behind soaring cesarean rates both in Memphis and across the nation.
Data provided by the Tennessee Department of Health showed that the largest Memphis area delivery hospitals had total cesarean rates that hovered around 40 percent in 2011.
||2011 Number of Cesarean Births
||2011 Total Cesarean Rate
||2006 No. of Cesarean Births
||2006 Total Cesarean Rate
|Baptist Memorial Hospital for Women
|Methodist LeBonheur Germantown Hospital
|Regional Medical Center at Memphis
|Saint Francis Hospital in Bartlett
|Saint Francis Hospital in Memphis
From 1998 to 2008, total U.S.cesarean delivery rates climbed by 50 percent, gaining from 22 percent to 33 percent of all births in just a decade, data from the Centers for Disease Control and Prevention and the National Center for Health Statistics show.
As I reported on the story, and interviewed local Memphis physicians, patients, and national experts, I was left with a mountain of data and interviews that pointed to the complex and multifaceted reasons for soaring cesareans.
In Memphis, one clear theme came through: the need to practice defensive medicine to avoid medical liability lawsuits. Despite that pressure and an increasing number of babies delivered by cesarean section, experts overwhelmingly said birth outcomes have not improved for either mothers or their babies.
Most local hospitals said they are working to decrease cesarean deliveries in first time, low-risk mothers with babies in a head down position — especially in situations where physician practice patterns play a role. But local physicians said encouraging vaginal births after a prior cesarean section remains a challenge because most malpractice insurance providers discourage the practice.
Celeste Milton, associated project director in The Center for Performance Measurement in the Division of Healthcare Quality Evaluation at The Joint Commission, the accrediting body for hospitals, recommended a white paper authored by researchers from the California Maternal Quality Care Collaborative. Milton told me The Joint Commission is encouraging hospitals to take a look at the paper.
The CMQCC white paper also was instrumental in the development of a set measures known as the perinatal core. Citing concerns that cesareans do not improve infant or maternal outcomes, The Joint Commission will begin requiring accredited hospitals that deliver at least 1,100 babies or more per year to begin reporting on a set of measures known as the perinatal core:
- Decreasing the early elective birth rate before 39 weeks
- Decreasing the cesarean rate in first-time mothers with a single baby who is head down at term,
- Increasing the use of steroids for babies who are born pre-term
- Reducing acquired bloodstream infections in newborns
- Increasing the exclusive breast-feeding rates during hospitalization.
That data will be used to establish a baseline so that hospitals can compare their rates to that of their peers and encourage physicians to examine practice patterns that may encourage cesarean deliveries in low risk mothers.
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