Orange County’s rate of cesarean sections is on the rise, which increases medical costs as well as health risks for mother and baby.
Obesity-related complications are one factor, leading obstetric experts to recommend pre-conception efforts to improve the health of all women of childbearing age.
In some other states, the approach has been different: cutting Medicaid payments to hospitals for C-sections in an attempt to discourage unnecessary surgeries.
The snapshot of maternal health comes from the county’s Health Care Agency analysis of hospital data in a new report called “Complications of Pregnancy and Childbirth in Orange County.” The report covers 144,584 local births from 2006 to 2008.
For those three years, the county’s C-section rate hit 33 percent, on par with the national rate of 32 percent, which is at an all-time high. The World Health Organization recommends that a nation’s C-section rate not exceed 15 percent. In 1999, the county’s C-section rate was 22.5 percent.
C-section rates also vary considerably locally based on where a woman lives and where she delivers her baby.
Cesarean births require major surgery, resulting in a longer recovery for mothers, as well as a greater chance of respiratory problems for the newborn.
Women who had C-sections stayed in the hospital nearly four days – almost twice as long as women who gave birth vaginally. An average C-section delivery cost $20,228, while a vaginal birth cost $11,114, the report says.
“Our health care costs will continue to be exponentially greater if we continue with the path that we’re on as far as maternity care,” said B.J. Snell, director of Beach Cities Midwifery and Women’s Healthcare in Laguna Hills. “One way to lower the costs is to not provide high-risk care to the most normal thing in the world.”
Coastal Communities Hospital in Santa Ana had the county’s highest C-section rate at 43 percent. Chief Executive Craig Myers did not return a phone call seeking comment.
The hospital with the lowest rate was La Palma Intercommunity at 26.6 percent.
Women living along the coast, and inland to the Irvine and Tustin area, had the highest percentage of C-sections. But medical necessity doesn’t appear to be the driving force.
Coastal residents had lower rates of prenatal conditions that increase the likelihood of a C-section. Mothers who weigh too much are at greater risk for certain complications including gestational diabetes and pregnancy-induced hypertension.
“The lack of medical indicators identified in this study suggests that other non-medical factors may be responsible for the higher incidence of cesarean deliveries in these cities,” the report says.
It’s unknown what percentage of local C-sections are elective, but the national figure is estimated at 28 percent, according to a study published in the journal Obstetrics and Gynecology.
Experts say C-section rates not only depend on patient demand but also on doctors’ decisions, including inducing labor or opting for a C-section if labor is progressing slowly. Additionally, in Orange County, roughly half of C-sections were repeats, with a first C-section almost automatically leading to a second.
AFTER C-SECTIONS
The report also noted that vaginal births after C-sections, known as VBACs, accounted for only 1 percent of deliveries. Some hospitals and malpractice insurers forbid the practice because of the small risk of uterine rupture.
“Once you’ve had a cesarean section, then you’re always going to have a cesarean,” said Snell, the midwife. “Shouldn’t happen, but that’s basically what has played out.”
Jenny Thomas, 35, is due with her second child next month. Three years ago, her first son was in breech position and had to be delivered by C-section. Thomas found the surgery and recovery difficult and this time she plans to try for a vaginal birth at Hoag Hospital.
Thomas, who lives in Orange, is doing what she can to help the process. She’s loading up on vegetables and skipping the cookies she indulged in during her first pregnancy, hoping a small baby will help her deliver vaginally.
“I haven’t gained much weight and I feel so much better,” she said. “I’ve definitely tried to eat healthier this time around. I’ve been exercising. I’m hoping that makes a difference.”
EFFECTS OF OBESITY
Maternal weight before pregnancy is another concern highlighted in the report, which says 18.5 percent of adult women in Orange County are obese. In 2009, national experts addressed the obesity epidemic by revising the amount of weight pregnant women should gain.
A new recommended weight range was created for obese women, advising them to gain only 11 to 20 pounds during pregnancy. Women who start at a healthy weight should gain 25 to 35 pounds.
Locally, 16 percent of women developed a pregnancy-related health condition, most commonly gestational diabetes.
Dr. Manuel Porto, chairman of obstetrics at UC Irvine, said mothers with gestational diabetes often have very large babies that can’t be delivered vaginally. He said there’s a greater need for primary care doctors to focus on preconception health for women of childbearing age.
“Once the pregnancy is ongoing, you’re not going to have an obese person go on a diet and achieve her ideal body weight,” Porto said. “Getting patients on an exercise program and diet program and addressing all that before even trying to get pregnant can improve the outcome of the pregnancy.”
To read the full report, visit ochealthinfo.com/pubs
Efforts to improve the health of mothers and newborns in Orange County are the focus of many medical professionals, including Barbara Johnson, R.N., who teaches a breastfeeding class at UC Irvine Medical Center in Orange.
Maternal health is the subject of the county Health Care Agency’s new report, “Complications of Pregnancy and Childbirth in Orange County,” which documents problems caused by obesity during pregnancy and increasing rates of C-sections.
Pre-birth education such as what Johnson provides is just one method for addressing such problems.
Another solution, says Dr. Manuel Porto, chairman of obstetrics at UC Irvine, is to focus even earlier on the mother’s health. He wants primary care doctors to address health issues, such as obesity, that affect women of childbearing age before a baby is conceived.
Contact the writer: 714-796-3686 or cperkes@ocregister.com
