A woman's chances of having a cesarean birth may depend on the hospital where she delivers, a new study suggests.
Patients with low-risk births have a nearly 30% increased risk of cesarean birth if they go from a hospital with a low cesarean birth rate to one with a higher rate in Michigan, according to an analysis by a team from the Obstetric Initiative, a statewide quality improvement project whose coordinating center is at Michigan Medicine.
The study specifically evaluated cesarean deliveries among low-risk births involving first time mothers who were at 37 weeks or more of pregnancy and were delivering one baby in the head down position.
The findings appear in an abstract in the American Journal of Obstetrics and Gynecology to be presented at the Society of Maternal-Fetal Medicine's annual Pregnancy Meeting.
"The hospital where birth happens does seem to matter," says senior author Elizabeth Langen, M.D., a high-risk maternal fetal medicine physician at Michigan Medicine's Von Voigtlander Women's Hospital. "The culture of the birthing center and its practices for supporting vaginal birth do appear to influence chances of a cesarean birth."
Researchers analyzed 185,693 births between 2012-2017 using birth certificate files from the Michigan Department of Health and Human Services. Nearly 29%, or 53,347, were cesarean deliveries. Twenty-five hospitals had cesarean birth rates that were above the average. These findings are consistent with similar study results for hospitals nationally.
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The study reinforced that higher maternal BMI and larger baby size also increased chances of cesarean deliveries, but even accounting for such factors, researchers identified a 30% difference in risk between hospitals.
"We want to make sure every mom delivers in a way that's safest and healthiest for her and her baby," Langen says. "For some women, a cesarean birth is the safest way to deliver. But we want to make sure cesarean birth isn't overused because it is a major surgery."
In the U.S., nearly a third of birthing moms now deliver babies via cesarean section, which is associated with increased risk of serious complications, such as hemorrhage and uterine rupture in future pregnancies, in addition to longer recovery periods and higher economic costs.
The study's lead author, Jasmine Ebott, M.D., an ob-gyn resident at Michigan Medicine, initiated the study to dig deeper into characteristics that influenced cesarean delivery rates.
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The Obstetrics Initiative aims to facilitate hospital efforts to support vaginal delivery and safely reduce cesarean delivery among low-risk births in Michigan. The initiative is funded by Blue Cross Blue Shield of Michigan/Blue Care Network.
OBI promotes several evidence based best practices to support vaginal deliveries, including delaying labor admission so women don't get hospitalized too early, supporting the use of continuous labor support for women in labor, and emphasizing the importance of shared decision making with patients.
One of the most basic strategies is encouraging labor support to help moms cope with contractions. Michigan Medicine's Dial-A-Doula program, for example, connects women coming to Von Voigtlander Women's Hospital for labor and delivery with trained volunteer birth doulas who are on-call 24 hours a day. This free service is led by the study's co-author Lisa Kane Low, Ph.D., C.N.M.
But the wide variances in cesarean delivery rates among centers highlights that hospitals must also do their part in ensuring protocols support vaginal delivery.
"There are public policy steps we can take to support maternal care to make sure moms are as healthy as possibly before and during pregnancy," Langen says. "Hospitals also have to work to improve their systems to better support vaginal birth. It's not one or the other but a combination of these efforts, on multiple fronts, that will lead to improving care for this population.
"Our goal is to set both delivering women and hospitals up for success in safely reducing cesarean births."