Cesarean sections: How providers are decreasing them

By: Sanford Health News .

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While a cesarean section is a valuable tool for delivery in certain circumstances, the rate of C-sections in the U.S. is significantly higher than the Centers for Disease Control and Prevention, World Health Organization and American Congress of Obstetricians and Gynecologists prefer.

WHO considers the ideal rate for C-sections to be 10 to 15 percent. However, the CDC estimates 1 in 3 women in the U.S. give birth by C-section. Between 1996-2011, ACOG reported a 60 percent increase in C-section rates, with the highest rate in 2009 at 32.9 percent. Additionally, rates only decreased 0.9 percent between 2009 and 2015.

Sanford Health receives referrals and significantly more high-risk pregnancies, and it has taken significant steps that helped minimize C-sections. From the moment a woman walks in the door all the way until delivery, Sanford Health obstetrician providers are doing everything to achieve a vaginal birth, including patient education, developing a labor plan and following set protocols.

“Our primary C-section rate at Sanford Health is 13.5 to 14.5 percent, and our overall C-section rate is 28 percent. So when you compare that to national numbers, which have a primary C-section rate of 22 percent and an overall C-section rate of 32 percent, we are doing really well,” said Jeanne Hassebroek-Johnson, M.D., an OB/GYN at Sanford Health.

Fewer inductions

“We do fewer inductions with moms having their first baby. That first one is often more difficult, so avoiding induction lowers the C-section rate,” Dr. Hassebroek-Johnson said. “We do not perform elective inductions before 39 weeks. That is actually a national mandate, so we only perform them early when they are medically necessary.”

Prolonged labor

ACOG’s current guidelines around patient management of labor encourage longer observation times before deciding a woman’s labor is in need of assistance.

“Often times, when you think someone is not making progress, if you are patient and wait long enough, they do,” said Dr. Hassebroek-Johnson. “We have protocols in place used by physicians and midwives regarding the appropriate augmentation of labor. So if someone is slowing down in her progress of labor, we use medications to give her every opportunity to dilate before resorting to a C-section.”

Sometimes the best option

There are times when a C-section cannot be prevented and is the best option. And while having a C-section may increase a woman’s risk of requiring the procedure in the future, many women still can have a vaginal delivery after caesarean, or VBAC.

“A woman who had her first baby vaginally but her second had a heart rate dip leading to a C-section would be a perfect candidate,” Dr. Hassebroek-Johnson said. “She has what we call a ‘proven pelvis,’ so we would really encourage her to try VBAC. But it depends on the situation. Some women will need a C-section based on risk factors. The decision is based on what is best for mom and baby.”