North Bay midwives reduce C-section rates
Despite the cost, and risk to mother and baby, the number of women giving birth by cesarean delivery, or C-section, increased by 60 percent in the U.S. between 1996 and 2009, and by 2011 it was the nation's most common operating room procedure.
With a resurgence of midwives, however, studies show that C-section rates at hospitals where they are employed are much lower.
At 26 percent, California is below the national average of 32 percent, and at hospitals in the North Bay the rate is even lower.
Around the North Bay, most hospitals now engage midwives for their patients including Sutter Santa Rosa Regional Hospital, Kaiser Permanente, NorthBay Healthcare, and Ukiah Valley Medical Center, which has the lowest C-section rate, at 16 percent.
As the only hospital in the county with a labor and delivery ward, Marin General Hospital handles an average of 1,400 births a year. After adopting an expanded midwifery program in 2011, the hospital dropped its C-section rate by 10 percent in three years.
That year, the hospital took over the county-run birth center, which had been providing midwives to its mostly publicly insured patients. Hospital officials decided to continue offering the service to privately insured women as well.
Initially, 16 percent of those women opted for the midwife service, which includes around-the-clock nurse midwives.
Almost immediately, the C-section rate dropped from 32 percent to 27 percent. The rate continued to fall to where it now fluctuates between 18 percent–22 percent.
'With a midwife, there's more leeway in decision-making, taking a wait and see approach versus making a decision on the fly,' said Sheri Matteo, a nurse midwife, and director of midwives at Prima Medical Group in Novato that serves the hospital with 13 midwives.
Marin's program became the subject of a study at University of California San Francisco, which also examined rates for successful vaginal birth after a C-section. The study found that with midwife assistance, the rate increased significantly from 13 percent to 22 percent.
'Obstetrics is a team sport. It can't be done just by doctors or just by midwives. It works for us as an integrated team,' Matteo said. 'I think that the doctors have embraced the outcome of the study and see us as a positive influence on lowering the C-section rate. Overall, we have been very accepted into the practice and the labor floor culture.'
C-sections carry serious risks for both women and their babies. Women are at an increased risk for hemorrhage, hysterectomy, infection, blood clots, longer recoveries, chronic pelvic pain, and difficulty with future pregnancies.
Problems for babies, can include breathing difficulties that need treatment in a newborn intensive care unit.
In the long-term, babies born by C-section are at increased risk of developing chronic childhood diseases like asthma and diabetes.
The procedure is also more costly than a vaginal delivery. Statistics vary, but all cite the price tag of a C-section as $10,000 - $20,000 more.
While there are clear cut indications when a C-section should be performed, such as when a baby is breach, or in the wrong position, other factors are more subjective, such as fetal heart rate, and the amount of time the labor is taking are also determining factors,
Matteo likened giving birth to running a marathon, where there is help and encouragement along the way.
'Being in labor absolutely takes time and you need people to support you. Hospitals and medical institutions are not designed to do that. C-sections can absolutely be a lifesaver, but not at a rate of over 30 percent,' she said.
Midwives in California must complete three-years of study in an approved program before applying for a license. They are trained for the full scope of women's health issues with a specialty in obstetrics, although mostly what they practice is pre-natal care.
By being part of a midwife team, physicians can be available for labor and delivery, with no other competing demands on their time, so they're able to be more patient and await a vaginal delivery.
Ukiah Valley Medical Center (UVMC) has been employing midwives for more than 20 years. At nearly 16 percent, it also has the lowest rate of C-section births in the North Bay area. Out of a total of 866 births last year, 61 percent were delivered with a midwife.
At UVMC, midwives are on-call 24 hours a day, and assist with all stages of labor, while doctors are set up with remote-viewing to check in on the patient's heart rate and labor pattern. Out of bed positions are also available and women can walk down the hall.
'Women aren't stuck in their room on a monitor,' said Casey Ford, director of the Family Birth Center at UVMC. 'The majority of women want a very natural child birth, and support and encouragement is a really big part of that.'