Hard To Tell If Kansas Is Lowering C-Section Rates

Jun 4, 2018
Originally published on June 5, 2018 8:21 am

Physicians, researchers and hospitals broadly agree that cesarean sections have become too common. That’s powered efforts to limit them to ever fewer cases.

Still, it can be hard to gauge the track record of most Kansas hospitals. When a national group came asking for numbers that reveal how regularly C-sections are performed, many hospitals in the state didn’t reply.

Among those that did respond to the health advocacy Leapfrog Group, about half had reached or exceeded a federal goal to scale back C-sections. Yet some that didn’t report their numbers, such as Via Christi St. Joseph in Wichita and the University of Kansas Hospital, told the Kansas News Service their rates are also in line.

Hospitals report cesarean data to other organizations — for example, for accreditation — but Leapfrog argues those figures should be readily accessible to the public in a single place for comparison across facilities.

Leapfrog asked hospitals — with some exceptions, such as critical access and Veterans Administration hospitals — to reveal how often moms with lower-risk conditions end up having C-sections.

Among the eleven that answered in Kansas, Mercy Hospital Fort Scott had the lowest rate -- under 9 percent.

“We’re taking our time,” said Brenda Stokes, executive director of quality assurance, “and not ... jumping right to a C-section if it’s not warranted.”

That idea of taking time was a theme among the Kansas hospitals on track or getting close. Professional medical groups have suggested doctors sometimes expect labor to progress faster than it often does, contributing to a national rate of C-sections that experts largely agree is too high.

“We know that women can be successful having a vaginal delivery if we give them just that extra little bit of time,” said physician Sara Blake, of the University of Kansas Health System’s St. Francis Campus in Topeka. “As long as mom and baby are looking good, then that extra bit of time is sometimes warranted.”

Leapfrog lists St. Francis’ cesarean rate at 20 percent, though the hospital says it has fallen farther since then.

Nearly one-third of babies in the U.S. are born by cesarean — up from about a fifth in the mid-1990s.

That jump is cause for “significant concern that cesarean delivery is overused,” according to the The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine.

The rate of cesareans among mothers with low-risk deliveries, in particular, varies greatly by hospital, they say. Studies haven’t revealed any medical rhyme or reason for it.

The lower-risk conditions are specific to first-time mothers giving birth to a single baby positioned head down at full term.

Leapfrog says the hospital-by-hospital variation in that scenario seems related to practices such as how long a woman is allowed to labor before doctors raise the option of a C-section. Sometimes the facilities play a role.

That includes how women are monitored, whether they’re allowed to walk around or must stay in their beds, how far their rooms are from nurses’ stations, and what aids for labor a hospital has on hand — such as balance bars or inflatable balls that help women position themselves better.

“There’s a lot of things hospitals can do,” said Erica Mobley, the group’s director of operations.

Experts agree C-sections are sometimes the best option for the safety of mother and child. It can be a lifesaving measure in cases where there are problems with placenta positioning, for example.

But unnecessary C-sections mean mom gets stuck with a longer recovery time, bigger medical bills, and all the risks of major surgery.

And since a woman who has her first child by C-section is likely to have any kids after that by cesarean, too, those costs to health or pocketbook may repeat in the future.

Mobley says some health care providers are reluctant to change.

“There’s also a very big fear of malpractice and things going wrong,” she said. “Some providers may be more likely to skip to doing a C-section maybe sooner than is necessary because of that fear.”

Nationally, about 20 percent of hospitals that disclosed their data to Leapfrog already reached the Department of Health and Human Services target of achieving 23.9 percent or lower by 2020. Leapfrog’s numbers — limited to those hospitals that responded — show rates at Kansas hospitals ranging from 8.8 to 38.5 percent.

Kansas’ state health agency doesn’t keep hospital-by-hospital C-section tallies. Although hospitals that handle at least 300 births a year do report data to a national accreditation firm, that commission doesn’t release it.

“We are in the process of carefully considering it in the future,” a spokeswoman for the accreditation organization said by email.

Leapfrog argues public disclosure helped press hospitals to stop scheduling induced deliveries before the 39th week of a pregnancy unless there’s a medical reason. The rate of such deliveries, which aren’t recommended by obstetrician and maternal health groups because of health risks to the baby, has dropped significantly in less than a decade.

Several hospitals in Kansas said they’ve sharply reduced or eliminated early scheduled deliveries, which helps them avoid C-sections, too.

“Unless we have a medical indication for delivering,” said Blake, at St. Francis in Topeka, “that’s just a flatout no-go here.”

Darryl Nelson is chief medical officer for the Midwest division of HCA Healthcare, which says it is the country’s biggest provider of obstetrical services.

HCA says data gathered across its network showed babies delivered earlier than 39 weeks were more likely to experience illness and other complications and end up in neonatal intensive care units. That prompted the network to shift away from early scheduling across its system.

But not all hospitals that have had success scaling back early scheduling have met the federal government’s target for cesarean sections. That includes HCA’s Overland Park Regional Medical Center, with a 26 percent C-section rate according to Leapfrog.

Nelson said the facility handles a lot of deliveries with more complicated factors, but agrees it can and should lower the cesarean rate among mothers who don’t face those factors.

“We absolutely are aspiring to perform at benchmarks” promoted by the federal government, Leapfrog and medical groups, he said. “There’s clearly still opportunity.”

Celia Llopis-Jepsen is a reporter for the Kansas News Service, a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio covering health, education and politics. You can reach her on Twitter @Celia_LJ. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to the original post.

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