Monday, March 29, 2010

Tuba City does it right!

Recently, The New York Times covered the low c-section rate at Tuba City Hospital, a hospital run by the Navajo Nation.  While the rest of the US has a c-section rate of 31.8%, the Tuba City Hospital's rate is only 13.5% despite higher levels of high blood pressure, diabetes, and obesity, factors associated with c-sections (the World Health Organization suggests a 15% c-section rate as a goal for all countries). Tuba City Hospital also has a higher than average rate of VBACs, with 32% of women delivering vaginally after a previous c-section.

How can this hospital have so few c-sections?
1. Midwives attend most of the births, with OBs only interfering when necessary.
2. Doctors are salaried, not paid by procedure.
3. The hospital and doctors are federally, not privately, insured against malpractice, so no higher rates are placed on VBACs or VBAC attending OBs.
4. Births are culturally viewed as a celebration, not a source of fear.

The c-section rate in the US does not need to be 1 in 3 births.  American women need access to midwifery services and doctors who will put the patient's best interests first.  C-sections result in higher rates of maternal and infant death than vaginal births.  The first three reasons listed above could be made realities in the rest of the US, but even if only the first change was made- having nurse midwives attend most births, with doctors available if needed- c-section rates would drop drastically.  Just having a doula at an OB-attended birth lowers the risk of c-section.  

What do you think it will take to lower the c-section rate in the US?

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