South Florida C-section rates too high

 

Too many South Florida babies are being delivered by cesarean section (C-section), according to new state figures. While the national average is 31.8 percent of births done by C-section, in the year ended June 30, 2008, 43 percent of births in Broward county, 42 percent in Palm Beach county and over 50 percent of births in Miami Dade county were C-section deliveries. Statewide the number is 39 percent, the second highest rate behind New Jersey.

 Across Florida, C-section rates vary sharply with a few South Florida doctors delivering as many as three-fourths of their patients’ babies this way and a few doing almost none. According to state figures, half the births at Holy Cross Hospital in Fort Lauderdale and Palms West Hospital in Loxahatchee were by C-section, while in other facilities two-thirds of the births are natural births.

According to researchers, the idea that most C-sections are done as a convenience measure is much less a factor than fear of malpractice lawsuits. South Florida is a very litigious area relative to the rest of the country and doctors and hospitals claim that they feel compelled to do C-sections the moment any irregularity arises before or during labor.

Consequently. few doctors allow women to try natural birth after a prior C-section. About 95 percent of Florida women who have caesareans will deliver subsequent babies that way. Most doctors and hospitals refuse to perform "vaginal birth after cesarean," or VBAC, claiming that the stress can produce uterine rupture, a complication actually reported in less than 1 percent of births. Virtually no doctors do natural delivery for breech or multiple births.

In a recent Sun Sentinel article, Lorie McCoy, co-owner of Amazing Births midwife practice in Boca Raton. said that doctors often push mothers to C-sections if the labor drags on for 12 hours, if drugs fail to induce the baby or if the baby is big.

Dr. Bruce Zafran, an OB-GYN practicing in Coral Springs, explains this by saying that "If there's any untoward event, the first thing [patients] ask is, 'why wasn't there a C-section? If there's any doubt, there's no incentive to take a chance."

“Most doctors avoid an immediate risk by doing a C-section, even though it may raise the risk of problems in future births”, Lake Worth obstetrician Sam Lederman, chief of OB-GYN at Good Samaritan Medical Center said. "The philosophy is, you will never be sorry you did a C-section, but the reverse is not always true."

According to Eugene Declercq,  a researcher at Boston University School of Public Health, doctors who have a 50 percent C-section delivery rate can not justify them all medically. Contrary to popular belief, cesareans cause slightly more complications and side effects for the mother and the baby than do natural births. Babies born by caesarean are more likely to develop lung infections from excess fluids not squeezed out by natural birth and require intensive care, a National Institutes of Health advisory panel  said in 2006. Because C-sections are major surgeries, there is an increased risk of infections, blood clots, and anesthesia reactions among other potential complications. Women who have repeat C-sections are more prone to have abnormal placenta growth that causes bleeding and complications. and they pose increasing risks with every subsequent pregnancy.

In addition to higher risks for mothers, C-sections also drive up the price of health care for everyone. Data from the Florida Agency for Health Care Administration  show cesareans in South Florida hospitals range from $11,000 and $30,000 which is  about twice the $5,000 to $16,000 range for natural births. Higher costs reflect surgical fees and longer hospital stays. Pregnancy in general is the most expensive condition for both private insurers and Medicaid, according to a 2008 report by the Childbirth Connection, a New York think tank."The financial toll of maternity care on private [insurers]/employers and Medicaid/taxpayers is especially large," the report said. "Maternity care thus plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets."

The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade.

That is why officials in the American College of Obstetricians and Gynecologists  are joining insurers like United Healthcare in urging a reduction in the rate of C-sections in Florida.

 For more information: Table of South Florida birth rates