To reduce cesarean section rates, patients must know options

The local rate of births by cesarean section is twice that promoted by the World Health Organization, as noted by Review-Journal health reporter Paul Harasim in Tuesday’s newspaper.

When necessary – and the procedure sometimes is necessary – the major abdominal surgery can save a mother and child from injury or death. But many of the more than 100 women who rallied with their families outside the Pinkpeas Pregnancy and Parenting Care Center at Valley View and Charleston boulevards Monday believe too many doctors are performing C-sections as a matter of convenience and for profit, rather than medical necessity.

"I think it’s great women are becoming more educated about options," says Dr. Steven Harter, one of the few local doctors who encourage women to have a vaginal delivery after previously having a C-section. "They need to feel empowered to ask questions."

Nationally, about one in three deliveries is now done by C-section, with the number slightly higher in Nevada, at 36 percent. Yet as recently as 1965, only 4.5 percent of births nationwide involved cutting a baby out of a mother’s belly.

A Las Vegas Review-Journal series on C-sections, published in April, found decisions can be driven by dollars. In 2010, for instance, moderate C-section deliveries – those with no major challenges – ran up hospital charges at Sunrise Hospital and Medical Center of more than $25,000 each, compared with vaginal deliveries at about $12,000. Dr. Jerry Reeves, an executive with Health Insight, notes that C-sections – now the most common surgical procedure in the nation’s hospitals – have become a major profit center.

C-section rates at Spring Valley, Summerlin, Southern Hills and St. Rose Dominican-Siena – valley hospitals that cater primarily to insured patients – were higher than 41 percent. On the other hand, University Medical Center, which sees more low-income patients, had a rate of 29 percent.

"It seems obvious that the better off a woman is, the better her chance of receiving a C-section," says Dr. Reeves, who notes C-sections can be scheduled well in advance, allowing doctors to see more patients and increase their bottom line.

What can be done? Dr. Harter believes fewer C-sections would be done if doctors didn’t have to worry about lawsuits. He says doctors seldom are sued for doing a C-section when it appears there could be trouble with a pregnancy – but doctors will often be sued if they don’t.

Given the higher complication rates from cesareans, insurance companies could at least attempt to equalize incentives for vaginal births. For the six-year period ending in 2010, Nevada hospital discharge data show that vaginal births resulted in a 4.5 percent complication rate, compared with a 9.5 percent complication rate from cesarean sections.

But the main impetus for change has to come from parents to be. They must be well-informed about all their options – including risks and advantages – and they shouldn’t be afraid to seek a second opinion when suddenly confronting a recommendation for a major, non-emergency surgery.

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