Article on c-sections & profit motive

[CI Mama]

Posted on NPR today:
http://www.npr.org/blogs/health/2010...cc=nh-20100913

Here's a link to the investigative study by California Watch:
http://www.californiawatch.org/healt...-sections-4069

None of this is probably a big "news flash" to anyone who frequents MDC. But I thought it was interesting to see it looked at from the perspective of for-profit vs. non-profit hospitals. And it is also good to see it reported in a fairly mainstream news source.

[MegBoz]

Thanks for sharing.
Quote from the California Watch site:

Another analysis of C-section rates noted that the variation among hospitals seems to defy a rational pattern. That 2007 study, in the American Journal of Obstetrics & Gynecology, concluded that the “rates of operative delivery in the United States are highly variable and suggest a pattern of almost random decision making.

Really? they seem random? Hm... how about you look for associations with things like:

• induction (there's already been recent press on how higher induction rates really raise CS rate)
• Epidural rate
• AROM rate
• CS for FTP
• rate of use of pit to augment/ speed up labor
• cEFM (Slowing labor since women can't be upright & "ambulatory")
• nothing-by-mouth (Exhausting women, & possibly slowing labor)
• VBAC rate
• Rate of births attended by midwives

I mean, really! It's not random! These things impact the CS rate & are indicative of a more medically-managed approach to birth on the whole, & the medically-managed approach leads to a higher CS rate. Look at the way they practice - look at protocols & procedures & I imagine it wouldn't be hard to see what's going on.

[CI Mama]

Not random at all. I think the report makes it very clear that there are clear patterns in place. Here's an excerpt from the CW report that I found particularly interesting:

Valenzuela attributes his hospital’s low rate to doctors working in shifts. Shift workers have no financial incentive to hurry a delivery along: The doctor is paid the same and can end a shift regardless of whether he or she delivers 10 babies or simply monitors the early stages of labor. The system increases accountability, he said.

By contrast, most doctors, who must be there when the baby arrives to make their fee, face a dilemma unknown to shift workers: either wait hours for a vaginal delivery or perform a C-section.

“If I come in in the morning, look over the charts and see that one of the patients just had a C-section without medical indication,” Valenzuela said, “you can bet that I’m going to start asking questions.”

Other hospitals rely on a similar system. Kaiser Permanente hospitals use this shift-work model and generally have lower C-section rates. Dr. Tracy Flanagan, who regularly delivers babies and is director of women’s health at Kaiser Permanente Northern California, has worked under both systems and understands how the forces of time can affect a physician in private practice.

“You are sitting in labor and delivery for 12 hours and she’s barely making progress, and your family is yelling at you wondering when you are going to come home,” Flanagan said. “There’s tremendous pressure. In addition, you know that you will get paid the same or more for doing a C-section. Our medical system makes it hard to do the right thing. That’s a big reason I moved over to Kaiser.”

Kaiser also addresses this issue by hiring midwives, who are able to conduct births more cheaply than doctors. Midwives participate in the majority of Kaiser births.

Last spring, The Joint Commission, the principal body that evaluates hospitals in the United States, instituted a standard designed to prevent frivolous C-sections. The Joint Commission wrote that hospitals with low C-section rates “have infant outcomes that are just as good, and better maternal outcomes. … Many authors have shown that physician factors, rather than patient characteristics or obstetric diagnoses, are the major driver for the difference in rates within a hospital.”

Revealing these patterns gives me hope that something might actually change.