By Donna Olmstead
Dr. Sharon Phelan, medical director for labor and delivery at the University of New Mexico Hospital, also a professor of obstetrics and gynecology and a fellow in the American College of Obstetricians and Gynecologists, says the cesarean section rate at the hospital, 21 or 22 percent, is slightly less than the state’s average. The rate of c-section for the first pregnancy or primary c-section is about 11 percent, she says.
The rate reflects that more difficult cases are referred to the hospital, a tertiary center with many specialists: “We get a lot of women who are really sick by the time they get here.”
Otherwise the lower rate reflects practices of physicians collaborating with midwives and letting mothers labor longer, before going to a c-section for delivery.
She says even the state’s low rate is more than double the surgical delivery rate of when she was first in obstetrics: “Things have changed dramatically since the 1970s.”
PHELAN: Dramatic Change from the 70s
A litigious society, which causes many physicians to go to cesarean section sooner than later, has increased the rate of the surgeries. Other factors that have boosted the rate include the increasing obesity epidemic. Women who are morbidly obese often have less productive labor. Because it takes longer to get them into surgery, many times they have a c-section when factors first indicate any difficulty for the mom or infant. Obese women can also have higher birth weight babies who are more difficult to deliver vaginally, Phelan says.
DANDADE: Rate doesn’t influence care
Dr. Tuschar P. Dandade, a Presbyterian medical director for women’s services and an obstetrician/gynecologist, says advances in medicine allow more women, whose conditions would have made pregnancy more unlikely in the past, to have babies, boosting the c-section rate across the country. The overall c-section rate for Presbyterian and Rust Hospital, 23.5 percent, is a little above the state average, but likely about the same considering margins of error in the statistics or differences in reporting, he says.
He says physicians and midwives work together at Presbyterian as well, but tend to see more patients with conditions that make them a higher risk for a c-section: “Although we do monitor the c-section rate for trends, we wouldn’t let the rate influence what kind of care a patient receives.”
LICHTMACHER: Many deliveries performed by midwives
Dr. Abraham Lichtmacher, chief of Women’s Services at Lovelace Health System, says for the first part of 2014, the overall c-section rate for Lovelace Women’s Hospital is 17.1 percent: “We have achieved this by following strong, evidence-based medicine and following current guidelines from national organizations. Many of our deliveries are performed by midwives, which also helps in reducing the c-section rate.”
Lichtmacher is an advocate for measuring the NTSV cesarean section rate, which is being promoted by various regulatory and safety organizations. The rate eliminates variations related to high risk situations, such as multiple gestation, abnormal presentation and other factors, he says.
NTSV stands for nulliparous, term, singleton, vertex presentation, he says, which means it’s the mother’s first pregnancy, she is at full-term, she has one baby in her womb, who is coming head first: “The NTSV rate essentially levels the playing field and allows hospitals to look at cesarean sections that can be impacted by clinical practice decisions, patterns that are modifiable and can be improved.”
That rate measured since January at Lovelace Women’s Hospital is 9.1 percent, he says.