In this first of a two part series, KRCB examines what’s behind the long-term rise in cesarean sections and what can be done to reduce them.
In 2011 Marin General Hospital decided to overhaul their staffing practices. Privately insured pregnant mothers would now receive the same staffing care as publicly insured mothers: Around-the-clock nurse midwives and "laborists" -- obstetricians focused solely on delivering babies rather than maintaining a clinical practice.
When researchers at Marin General and the University of California, San Francisco examined C-section delivery rates they found rates had dropped. "There is plenty of data internationally and in the U.S. about how safe and effective midwifery is," says Melissa Rosenstein, MD, MAS, of the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences and primary author on a paper analyzing the effects of the staffing change. "There hasn't been as much research on what the effect is on caesarian delivery rates, so we thought this would be an excellent natural experiment."
Prior to the switch nearly 32 percent of privately insured women underwent C-sections. In the years after the switch the average was 25 percent. Rosenstein says she was surprised at the magnitude of the change.
"No one is saying that doctors are on purpose performing unnecessary C-sections," she says. "Every one seems necessary in the moment." She adds that while there are some clear cut indications that a laboring mother needs one, for many, "there is a little wiggle room. The thought is that by having physicians work on labor and delivery and have no other competing demands on their time they’re able to be a little bit more patient and await a vaginal delivery with the confidence of a collaborative team effort." Read more about her research here.