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You can follow her on Twitter: \u003ca title=\"https://twitter.com/laliferis\" href=\"https://twitter.com/laliferis\">@laliferis\u003c/a>","avatar":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twitter":"laliferis","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["subscriber"]},{"site":"futureofyou","roles":["subscriber"]},{"site":"stateofhealth","roles":["subscriber"]},{"site":"science","roles":["subscriber"]},{"site":"food","roles":["contributor"]}],"headData":{"title":"Lisa Aliferis | KQED","description":null,"ogImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/86c339d5cdcb0dcd2b6cf5d7c3f5886b?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lisaaliferis"},"state-of-health":{"type":"authors","id":"8344","meta":{"index":"authors_1591205172","id":"8344","found":true},"name":"State of Health","firstName":"State of 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FM","link":"/"}},"stateofhealth_210214":{"type":"posts","id":"stateofhealth_210214","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"210214","score":null,"sort":[1467991607000]},"guestAuthors":[],"slug":"dont-cut-me-episiotomies-now-discouraged-still-too-common","title":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","publishDate":1467991607,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n","blocks":[],"excerpt":"See which California hospitals have the highest and lowest rates of episiotomies. ","status":"publish","parent":0,"modified":1467991607,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":40,"wordCount":1398},"headData":{"title":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common | KQED","description":"See which California hospitals have the highest and lowest rates of episiotomies. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","datePublished":"2016-07-08T15:26:47.000Z","dateModified":"2016-07-08T15:26:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"210214 http://ww2.kqed.org/stateofhealth/?p=210214","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/08/dont-cut-me-episiotomies-now-discouraged-still-too-common/","disqusTitle":"'Don't Cut Me!': Episiotomies, Now Discouraged, Still Too Common","nprByline":"Jocelyn Wiener\u003cbr />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/stateofhealth/210214/dont-cut-me-episiotomies-now-discouraged-still-too-common","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Since it was uploaded to YouTube, \u003ca href=\"https://youtu.be/lCfXxtoAN-I\" target=\"_blank\">the video of Kimberly Turbin’s 2013 episiotomy \u003c/a>has been viewed more than 430,000 times. In the video, Turbin lies on her back in a hospital bed. Her knees are bent, her legs and feet are elevated above her in stirrups. She is trying to push the baby out.\u003c/p>\n\u003cp>“Push, push, push. Go, go, go,” the nurse says.\u003c/p>\n\u003cp>A doctor walks into her room in Providence Tarzana Medical Center in California’s San Fernando Valley. He pulls out a pair of sharp scissors.\u003c/p>\n\u003cp>“What are you doing?” Turbin asks, breathless, between contractions.\u003c/p>\n\u003cp>He tells her he is going to cut her perineum, a procedure known as an episiotomy.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“What? Why? We haven’t even tried,” Turbin cries. “No, don’t cut me!”\u003c/p>\n\u003cp>“What do you mean, ‘Why?’” the doctor responds, sounding increasingly irritated as Turbin continues to protest. “That’s my reason. Listen: I am the expert here.”\u003c/p>\n\u003cp>“You cannot fight with the doctor,” Turbin’s mother tells her daughter. “Just do it, doctor. Don’t worry.”\u003c/p>\n\u003cp>Then comes the audible sound of him snipping Turbin’s flesh.\u003c/p>\n\u003cp>Episiotomy, a once-common childbirth procedure that involves cutting tissue between the vagina and anus to enlarge the vaginal opening, has been officially discouraged in most cases for a decade. Yet it is still being performed at much higher than recommended rates in certain hospitals and by certain doctors.\u003c/p>\n\u003cp>In 2006, the American College of Obstetricians and Gynecologists released a \u003ca href=\"http://www.acog.org/About-ACOG/News-Room/News-Releases/2006/ACOG-Recommends-Restricted-Use-of-Episiotomies\" target=\"_blank\">recommendation against routine use of episiotomy, \u003c/a>finding that it benefited neither mothers nor babies. In 2008, the \u003ca href=\"http://www.qualityforum.org/Home.aspx\">National Quality Forum\u003c/a> also endorsed \u003ca href=\"http://www.npic.org/services/Sample_V093_Incidence_of_Episiotomy_Analysis.pdf\">limiting the routine use\u003c/a> of episiotomies. The procedure is still supported for use in certain emergency situations.\u003c/p>\n\u003cp>Nationally, and throughout California, the use of episiotomies has dropped significantly since the official recommendations came out — from 21 percent of all vaginal births in the state in 2005 to less than 12 percent in 2014.\u003c/p>\n\u003cp>That overall drop masks some giant disparities. A majority of the state’s hospitals now have rates under 10 percent, according to state data. But a few, including Whittier Hospital Medical Center and Beverly Hospital, in Los Angeles, are performing the procedure in more than 60 percent of vaginal births. Neither hospital returned calls for comment.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-full wp-image-210233\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png\" alt=\"Screen Shot 2016-07-08 at 8.12.48 AM\" width=\"1386\" height=\"904\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM.png 1386w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-400x261.png 400w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-800x522.png 800w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-768x501.png 768w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-1180x770.png 1180w, https://ww2.kqed.org/app/uploads/sites/27/2016/07/Screen-Shot-2016-07-08-at-8.12.48-AM-960x626.png 960w\" sizes=\"(max-width: 1386px) 100vw, 1386px\">“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” said Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center.\u003c/p>\n\u003cp>Friedman was the lead author of a 2015 \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=2089343\" target=\"_blank\">JAMA report about the variation in episiotomy rates\u003c/a>among hospitals nationally. While it’s difficult to determine precisely what that rate should be, he said, it should likely be less than 10 percent.\u003c/p>\n\u003cp>As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries because doctors believed a clean incision made it easier to stitch up a woman and prevented overstretching of the muscles surrounding the vagina. In the past few decades, though, research began showing that the cuts were sometimes causing serious pain and injuries, including third and fourth degree lacerations, incontinence and sexual dysfunction. The cuts often proved slower to heal than a natural tear.\u003c/p>\n\u003cp>Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.\u003c/p>\n\u003cp>But some doctors are going against that trend.\u003c/p>\n\u003cp>Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, lists three main reasons why he suspects some providers continue to perform routine episiotomies: They’ve always done them, they lack awareness of best practices or they want to speed up deliveries.\u003c/p>\n\u003cp>“Certain segments of the obstetric community are very slow to modernize the practice,” he said. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”\u003c/p>\n\u003cp>Such variation exists not only among providers, but among hospitals. Case in point: The Los Angeles hospital chain, AHMC Healthcare Inc. Each of its six hospitals have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. Two of them — Garfield Medical Center and Whittier Hospital Medical Center — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals did not return repeated calls and emails requesting comment.\u003c/p>\n\u003cp>By contrast, Kaiser hospitals have seen huge reductions in use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.\u003c/p>\n\u003cp>Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, said her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she said.\u003c/p>\n\u003cp>“When we generated the data, we saw a lot of the variation and got to work on it,” she said.\u003c/p>\n\u003cp>They sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies educated their colleagues about the appropriate use and risks.\u003c/p>\n\u003cp>Physicians tend to respond best if other physicians present them with a compelling argument to change their practices, Flanagan said. Reliable data, transparency and peer-to-peer education is a good recipe for narrowing variation, she said.\u003c/p>\n\u003cp>The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, she said. Zero percent would be too low, she added, since there are some cases where the procedure’s use is indicated — if a baby’s shoulder is stuck, if a baby’s heart rate drops, or if the mother is exhausted and wants an episiotomy, for instance.\u003c/p>\n\u003cp>Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative at Stanford University, says the episiotomy data offers a lesson on how quickly practices can change. It also highlights the hospitals where doctors refuse to alter their ways, he said.\u003c/p>\n\u003cp>In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, he said. But the main reason most doctors still perform episiotomies is because they always have done so, he said.\u003c/p>\n\u003cp>“It is always hard for people to relearn,” Main said.\u003c/p>\n\u003cp>His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices to show them how they compare with their peers around the state. Beginning in 2010, they \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/toolkits/early-elective-deliveries-toolkit\" target=\"_blank\">partnered with the March of Dimes to educate providers\u003c/a> about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he said. They are currently undertaking similar efforts related to C-sections.\u003c/p>\n\u003cp>Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, said he would like to see similar transparency with episiotomies.\u003c/p>\n\u003cp>“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” he said.\u003c/p>\n\u003cp>A lot of women don’t want the procedure, he noted, and doctors are supposed to honor their patients’ wishes.\u003c/p>\n\u003cp>Turbin, a 29-year-old dental assistant who now lives in Stockton, is suing her former doctor, Alex Abassi, for assault and battery. In June, a judge ruled that the case could go to trial this fall. Citing cognitive impairment, Abassi surrendered his medical license last year. The executive director of the attorney’s office representing Abassi declined to comment.\u003c/p>\n\u003cp>Since the episiotomy, Turbin said, “I had major, major, major, major pain.”\u003c/p>\n\u003cp>She’s afraid to go to the doctor now, she said, and she’s terrified of getting pregnant again.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“If I go back to that day, there’s nothing I could have done,” she said. “That doctor was going to cut me no matter what.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/210214/dont-cut-me-episiotomies-now-discouraged-still-too-common","authors":["byline_stateofhealth_210214"],"categories":["stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_169","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_210238","label":"stateofhealth"},"stateofhealth_131680":{"type":"posts","id":"stateofhealth_131680","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"131680","score":null,"sort":[1451929613000]},"guestAuthors":[],"slug":"california-hospital-near-you-fewer-cesarean-sections","title":"Coming Soon to A Hospital Near You: Fewer Cesarean Sections","publishDate":1451929613,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"WPmIYP70LrUKZEjJkcHPyr8TEsXjYxw6\"]Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"Y9SYFgtQLgVTVLaiPzqUNatniraxX0gv\"]Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n","blocks":[],"excerpt":"California's C-section rate is twice as high as recommended. A statewide effort to reduce it could improve health of mothers and babies.","status":"publish","parent":0,"modified":1452791950,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":41,"wordCount":1656},"headData":{"title":"Coming Soon to A Hospital Near You: Fewer Cesarean Sections | KQED","description":"California's C-section rate is twice as high as recommended. A statewide effort to reduce it could improve health of mothers and babies.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Coming Soon to A Hospital Near You: Fewer Cesarean Sections","datePublished":"2016-01-04T17:46:53.000Z","dateModified":"2016-01-14T17:19:10.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"131680 http://ww2.kqed.org/stateofhealth/?p=131680","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/01/04/california-hospital-near-you-fewer-cesarean-sections/","disqusTitle":"Coming Soon to A Hospital Near You: Fewer Cesarean Sections","nprByline":"Danielle Venton","path":"/stateofhealth/131680/california-hospital-near-you-fewer-cesarean-sections","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>California is preparing to launch an ambitious plan to reduce C-sections rates. If successful, that reduction will save taxpayer money and keep both mothers and babies healthier.\u003c/p>\n\u003cp>Kicking off in early 2016, \u003ca href=\"http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20R/PDF%20ReducingCSectionsFlier.pdf\" target=\"_blank\">the plan\u003c/a> funded by the Oakland-based California HealthCare Foundation is meant to financially reward hospitals for vaginal births and reduce the pressure on doctors and laboring mothers to deliver quickly.\u003c/p>\n\u003cp>Last year, amid increasing attention to maternal care by health advocates, CHCF released \u003ca href=\"http://www.chcf.org/publications/2014/11/tale-two-births\" target=\"_blank\">an alarming report\u003c/a>. A healthy pregnant woman's chances of giving birth by C-section are uncomfortably dependent upon where she delivers her baby.\u003c/p>\n\u003cp>Overall, just over 27 percent of healthy women in California deliver their babies by C-section. But that's an average. At hospitals across the state, the C-section rate ranges from 10 to a whopping 70 percent.\u003c/p>\n\u003cp>That’s a problem because C-sections are \u003ca href=\"https://www.cmqcc.org/resources-tool-kits/cmqcc-publications/white-paper-cesarean-deliveries\" target=\"_blank\">major surgeries that carry risks\u003c/a> of infection, uncontrolled bleeding, blood transfusions, blood clots, and postpartum depression. They’re also correlated with a lower breastfeeding rate, which is detrimental both to mother and baby.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It doesn't have to be this way. Other developed countries have far lower C-section rates. Only about one in five —or 20 percent—of Finnish, French and Swedish babies are born this way.\u003c/p>\n\u003cp>Earlier this year the World Health Organization \u003ca href=\"http://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/\" target=\"_blank\">released a statement\u003c/a> saying the \"ideal rate\" for C-sections is between 10 and 15 percent, about half the average rate in California. While C-sections can save lives both for mothers and babies, that's only true up to a point. The WHO says globally the number of maternal and newborn deaths go down as C-section rates rise towards 10 percent. After that, there is no improvement.\u003c/p>\n\u003cp>Beyond being risky, C-sections — the \u003ca href=\"http://www.cdc.gov/nchs/fastats/inpatient-surgery.htm\" target=\"_blank\">most commonly performed \u003c/a>surgery in the U.S. — are expensive, about $15,000-$20,000 per birth. Both nationally and in California, Medicaid pays for roughly half of all births.\u003c/p>\n\u003cp>Policymakers see lowering the C-section rates as wins both for patient health and state coffers. The U.S. government has set a national target of 23.9 percent as part of its \u003ca href=\"http://www.healthypeople.gov/2020/topics-objectives/objective/mich-71\" target=\"_blank\">Healthy People 2020 goals\u003c/a>. To meet that benchmark, 60 percent of California hospitals need to reduce their C-section rates.\u003c/p>\n\u003cp>\u003cstrong>One route: Using Nurse Midwives \u003c/strong>\u003c/p>\n\u003cp>If any woman has tried hard to have a vaginal birth, it has been Edwina Brown. Brown moved to California from the U.K. with her husband last year. The couple was expecting their first child, who was born last September.\u003c/p>\n\u003cp>For several months she saw an obstetrician. She chose to switch to nurse midwives. The preference was partially cultural, she says. In her native England midwives attend 80 percent of all births. In the U.S. they are present for just 8 percent.\u003c/p>\n\u003cp>\"At the obstetrician's I felt that there was less room for questions and discussion about the testing they were doing, and how the birth would be,\" says Brown from her home in Petaluma, cradling Lily in her arms.\u003c/p>\n\u003cp>\"With the midwives, I felt it was much more supportive. They wanted to listen and understand what you wanted and---while keeping baby and mum safe---find a way to respect your wishes.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brown delivered at Marin General Hospital, where, several years ago, the hospital changed staffing protocols in an effort to reduce C-sections. (The change was independent of any direction from CHCF.)\u003c/p>\n\u003cp>Years of data had shown two populations of women within in the hospital consistently maintained significantly different C-section rates. Privately insured women averaged 32 percent, while publicly insured women averaged only 16. A similar discrepancy is seen in many other hospitals.\u003c/p>\n\u003cp>Nurse midwives provided most of the care for publicly-insured women. A 24-hour laborist -- a doctor who specializes in delivering babies -- was always on hand to operate or give assistance if needed. Privately insured women followed the more traditional U.S model. Their private physicians would leave busy practices and lives to deliver at the hospital when the baby was expected.\u003c/p>\n\u003cp>In 2011 the hospital revamped its staffing so that all expecting mothers would have access to 24-hour midwives and a 24-hour laborist. The change caught the attention of Melissa Rosenstein with UC, San Francisco's Center for Reproductive Science.\u003c/p>\n\u003cp>\"Laborists are becoming more popular, but there isn’t a ton of data on what the outcomes are,\" she says. \"And it's the same with midwives. There is plenty of data about how safe and effective midwifery is, but not as much as research on what the effect is on cesarean delivery rates, so we thought this would be an excellent natural experiment since this practice change was going to happen.\"\u003c/p>\n\u003cp>In a study published last September in \u003ca href=\"http://journals.lww.com/greenjournal/Fulltext/2015/10000/The_Association_of_Expanded_Access_to_a.5.aspx\" target=\"_blank\">Obstetrics & Gynecology\u003c/a>, Rosenstein and her colleagues reported a significant drop in privately insured women's C-section rates -- from 31.7 to 25 percent -- between 2011 and 2014.\u003c/p>\n\u003cp>\"It was our working hypothesis that we would see a decrease,\" she says, \"but it was more dramatic than we expected.\"\u003c/p>\n\u003cp>Though every C-section seems necessary in the moment, Rosenstein says, \"the truth is there are very few indications that a woman really needs one, there is usually a little wiggle room.\" If physicians work on labor and delivery exclusively, then they can be \"a little bit more patient,\" she added, and wait for a vaginal delivery.\u003c/p>\n\u003cp>Sherri Matteo, one of the certified nurse midwives at Marin General Hospital, says women and doctors don't always know what women are capable of.\u003c/p>\n\u003cp>\"Even when they think, 'Oh! You’re going to have a 12-pound baby? You can’t possibly have this baby vaginally.' I can tell you from experience that some women can. Until you allow a trial of labor, and allow a woman’s body to do what it’s supposed to do, we don’t know for sure.\"\u003c/p>\n\u003cp>There are clear exceptions. When a baby is in a breech position -- when the bottom or feet, rather than the head, will be the first to come out -- is not supported for vaginal delivery by most U.S. doctors and hospitals.\u003c/p>\n\u003cp>That's what happened to Brown's baby and she was desperate for the baby to turn head down.\u003c/p>\n\u003cp>\"I didn’t want a cesarean but I knew it was a possibility from week 32,\" she says. Brown had bad dreams about waking up on an operating table, but says her relationship with hospital staff helped allay her anxiety. In the end she did have a C-section -- efforts to manually turn Lily in the hospital prior to delivery weren't successful -- but she feels the birth was a better experience than it would have been if led by a physician.\u003c/p>\n\u003cp>\"I felt so supported the entire time,\" Brown says.\u003c/p>\n\u003cp>\u003cstrong>Carrots and Sticks\u003c/strong>\u003c/p>\n\u003cp>Hospitals don't have to embrace the nurse midwife model to reduce their C-section rates, however. In fact, with so few midwives and midwife training programs in California, there would not be enough to meet the needs of the state, says Stephanie Teleki, who is overseeing the CHCF effort to reduce c-sections.\u003c/p>\n\u003cp>\"You need to pull a lot of different levers to make these changes,\" she says. \"Nurse midwives could be part of the long-term solution, but in the short-term we'll need to be creative about how to get this done.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Hoag Memorial Hospital Presbyterian in Orange County, under pressure from large employers and groups like the Pacific Business Group on Health, \u003ca href=\"http://pbgh.org/storage/documents/TMC_Case_Study_Oct_2015.pdf\" target=\"_blank\">reduced C-section rates by 20 percent \u003c/a>over 15 months through a suite of measures, some carrots, some sticks. Administrators shared the C-section rates of individual doctors. Large insurance buyers like Disney and Blue Shield altered payments so that hospitals didn't earn more from elective C-sections than from vaginal births. And nurses received end-of-the-year bonuses if they helped the hospital reach its goals. Hoag became\u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/05/10/how-one-hospital-brought-its-c-section-rate-down-in-a-hurry/\" target=\"_blank\"> a test case for measures\u003c/a> that will be taken around the state, under the CHCF's initiative.\u003c/p>\n\u003cp>One key aspect of the CHCF's plan is to fund a \"\u003ca href=\"https://www.cmqcc.org/projects/support-vaginal-birth-and-reduce-primary-cesarean-delivery)\" target=\"_blank\">toolkit\u003c/a>,\" prepared by the California Maternal Quality Care Collaborative, a nonprofit group comprised of several dozen public and private agencies and funded by CHCF and the Centers for Disease Control, among others. It's due out in March 2016. The California HealthCare Foundation is also funding medical professionals to assist about 60 hospitals in implementing the guidelines.\u003c/p>\n\u003cp>Teleki says they're particularly interested in reaching hospitals in Los Angeles, San Diego and Orange counties. \"(T)hat is where the birth rate is the highest and C-section rates are also very high,\" she says. \"If we double down in some of those markets it's a real opportunity to not only impact those areas but to move the needle statewide.\"\u003c/p>\n\u003cp>In what will perhaps be the most impactful step, the foundation plans to work with groups of health care purchasers to make C-sections less profitable.\u003c/p>\n\u003cp>This could mean the wider use of \"bundled payments,\" where hospitals are paid a per-birth rate, instead of being paid a higher rate for C-sections, as they are now. At a flat rate, hospitals should preferentially slant toward vaginal births.\u003c/p>\n\u003cp>Ultimately, says Teleki, it will be critical to financially reward providers for promoting vaginal birth.\u003c/p>\n\u003cp>\"There might be some do-gooders right now,\" she says. \"But if hospitals earn more money to do C-sections, it's hard to then say, 'Now please lower your c-sections.'\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>\u003cem>This post was updated to clarify the range of C-section rates at California hospitals. The rates at individual hospitals range from 10 to 70 percent.\u003c/em>\u003c/strong>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/131680/california-hospital-near-you-fewer-cesarean-sections","authors":["byline_stateofhealth_131680"],"categories":["stateofhealth_13"],"tags":["stateofhealth_169","stateofhealth_2519","stateofhealth_397"],"featImg":"stateofhealth_134362","label":"stateofhealth"},"stateofhealth_47281":{"type":"posts","id":"stateofhealth_47281","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"47281","score":null,"sort":[1436811518000]},"guestAuthors":[],"slug":"should-more-women-give-birth-outside-the-hospital","title":"Should More Women Give Birth Outside The Hospital?","publishDate":1436811518,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>A recent recommendation from doctors in the United Kingdom raised eyebrows in the United States: The British National Health Service says healthy women with straightforward pregnancies are better off \u003ca href=\"https://www.nice.org.uk/guidance/cg190\" target=\"_blank\">staying out of the hospital\u003c/a> to deliver their babies.\u003c/p>\n\u003cp>That's heresy, obstetrician Dr. Neel Shah first thought. In the United States, 99 percent of babies are born in hospitals.\u003c/p>\n\u003cp>\"There's really only one way of having a baby in the U.S.,\" says Shah, who works at Harvard Medical School and Beth Israel Deaconess Hospital. Here, he says, delivering at home or at independent birthing centers is still not considered mainstream.\u003c/p>\n\u003cp>Shah was asked by the \u003cem>New England Journal of Medicine\u003c/em> to respond to the British recommendation. He compared birth outcomes here in the U.S. and Britain, especially the cesarean rates, which average 33 percent in the U.S. compared with 26 percent in the U.K. And he started to think the British were on to something.\u003c/p>\n\u003cp>\"We're taking excellent care of high-risk women,\" he says, \"and leaving low-risk, normal women behind. We're the only country on Earth with a rising maternal mortality rate.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There are lots of reasons for the rise — increased obesity, a lack of consistent prenatal care, older women having babies. Shah also blames hospital infections, and the rise in emergency and elective C-section deliveries.\u003c/p>\n\u003cp>Rather than rebut the British, Shah argues in his \u003cem>New England Journal \u003c/em>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1501461\" target=\"_blank\">editorial\u003c/a> that the practice of giving birth outside a hospital with a midwife can be safer.\u003c/p>\n\u003cp>\"Choose the right patients,\" he says. \"And you need to be able to link those birth centers to hospitals, like mine, that have blood banks and three operating suites and everything else.\"\u003c/p>\n\u003cp>The American College of Obstetricians and Gynecologists has been \u003ca href=\"http://www.acog.org/-/media/Statements-of-Policy/Public/sop1102.pdf?dmc=1&ts=20150701T1131257297\" target=\"_blank\">supportive\u003c/a> of midwife-led births. But it draws the line at home birth.\u003c/p>\n\u003cp>\"I don't recommend home birth, and as an organization ACOG suggests that a hospital or birth center is the safest option,\" says Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and chairman of ACOG's committee on obstetrics practice.\u003c/p>\n\u003cp>Women and babies are in real danger, Ecker says, if something goes wrong during a home birth. Compared with births planned for delivery in a hospital or birthing center, planned home births have a significantly higher rate of infant mortality in the U.S., \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth\" target=\"_blank\">studies show\u003c/a>, though the absolute risk of the baby dying is relatively low in both cases.\u003c/p>\n\u003cp>Also, Ecker says, the British and American health systems are simply too different for the British recommendation to make sense for the United States.\u003c/p>\n\u003cp>\"The system that supports home birth in the U.K. is much different than the system that currently exists in the U.S.,\" Ecker says. \"In fact, I would argue that there is no system in the U.S.\"\u003c/p>\n\u003cp>The U.K. has universal health care, and British women are generally referred to a midwife as soon as they know they're pregnant.\u003c/p>\n\u003cp>Though the percentage of American women who choose a midwife-led birth is still only about 9 percent, the total is on the rise, recent statistics suggest. Most midwives work in hospitals or birthing centers.\u003c/p>\n\u003cp>Yinka Sokunbi worked as a midwife in London until her husband's work transferred her to Dallas last year. She was stunned at the different attitudes toward childbirth in the U.S.\u003c/p>\n\u003cp>\"A lot of people do not know what midwives do,\" she says. \"They have this vision of old ladies with potions and herbs.\"\u003c/p>\n\u003cp>From her training and practice, Sokunbi says, she can handle a host of common childbirth scenarios.\u003c/p>\n\u003cp>\"I am suitably trained to recognize when things aren't going as they should be going and what to do about it,\" she says.\u003c/p>\n\u003cp>The bag Sokunbi takes to a home birth has no potions, but does have: a fetal Doppler device for monitoring the baby's heartbeat; certain medications; and oxygen for reviving a blue baby.\u003c/p>\n\u003cp>And at the first sign a delivery could be running into trouble, she sends her laboring patient to the nearest hospital, she says. That handoff to an obstetrician is one of the major differences between the U.S. and the U.K. It's very smooth in the United Kingdom, where doctors and midwives have a close partnership, Sokunbi says.\u003c/p>\n\u003cp>\"In the States, the way I see it so far, it seems there are midwives on one side and obstetricians on the other — and there's this opposition,\" she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Shah warns against \"thinking of midwifery as a silver bullet\" aimed at fixing problems with childbirth in the United States. Rather, he hopes that obstetricians and midwives can work together, as they do in in the U.K., to give many women a cheaper, safer and more pleasant experience of labor and delivery.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Should+More+Women+Give+Birth+Outside+The+Hospital%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"In Britain, women with normal pregnancies are recommended to give birth at home or in a midwife-led center. But 99 percent of babies in the U.S. are born in hospitals.","status":"publish","parent":0,"modified":1436811593,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":817},"headData":{"title":"Should More Women Give Birth Outside The Hospital? | KQED","description":"In Britain, women with normal pregnancies are recommended to give birth at home or in a midwife-led center. But 99 percent of babies in the U.S. are born in hospitals.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Should More Women Give Birth Outside The Hospital?","datePublished":"2015-07-13T18:18:38.000Z","dateModified":"2015-07-13T18:19:53.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"47281 http://ww2.kqed.org/stateofhealth/?p=47281","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/13/should-more-women-give-birth-outside-the-hospital/","disqusTitle":"Should More Women Give Birth Outside The Hospital?","nprByline":"Dianna Douglas","nprStoryId":"419254906","nprApiLink":"http://api.npr.org/query?id=419254906&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/07/13/419254906/should-more-women-give-birth-outside-the-hospital?ft=nprml&f=419254906","nprRetrievedStory":"1","nprPubDate":"Mon, 13 Jul 2015 12:48:00 -0400","nprStoryDate":"Mon, 13 Jul 2015 03:37:00 -0400","nprLastModifiedDate":"Mon, 13 Jul 2015 11:44:22 -0400","nprAudio":"http://pd.npr.org/anon.npr-mp3/npr/me/2015/07/20150713_me_should_more_women_give_birth_outside_the_hospital_.mp3?orgId=1&topicId=1128&d=220&p=3&story=419254906&t=progseg&e=422488331&seg=8&ft=nprml&f=419254906","nprAudioM3u":"http://api.npr.org/m3u/1422490132-06c310.m3u?orgId=1&topicId=1128&d=220&p=3&story=419254906&t=progseg&e=422488331&seg=8&ft=nprml&f=419254906","path":"/stateofhealth/47281/should-more-women-give-birth-outside-the-hospital","audioUrl":"http://pd.npr.org/anon.npr-mp3/npr/me/2015/07/20150713_me_should_more_women_give_birth_outside_the_hospital_.mp3?orgId=1&topicId=1128&d=220&p=3&story=419254906&t=progseg&e=422488331&seg=8&ft=nprml&f=419254906","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A recent recommendation from doctors in the United Kingdom raised eyebrows in the United States: The British National Health Service says healthy women with straightforward pregnancies are better off \u003ca href=\"https://www.nice.org.uk/guidance/cg190\" target=\"_blank\">staying out of the hospital\u003c/a> to deliver their babies.\u003c/p>\n\u003cp>That's heresy, obstetrician Dr. Neel Shah first thought. In the United States, 99 percent of babies are born in hospitals.\u003c/p>\n\u003cp>\"There's really only one way of having a baby in the U.S.,\" says Shah, who works at Harvard Medical School and Beth Israel Deaconess Hospital. Here, he says, delivering at home or at independent birthing centers is still not considered mainstream.\u003c/p>\n\u003cp>Shah was asked by the \u003cem>New England Journal of Medicine\u003c/em> to respond to the British recommendation. He compared birth outcomes here in the U.S. and Britain, especially the cesarean rates, which average 33 percent in the U.S. compared with 26 percent in the U.K. And he started to think the British were on to something.\u003c/p>\n\u003cp>\"We're taking excellent care of high-risk women,\" he says, \"and leaving low-risk, normal women behind. We're the only country on Earth with a rising maternal mortality rate.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There are lots of reasons for the rise — increased obesity, a lack of consistent prenatal care, older women having babies. Shah also blames hospital infections, and the rise in emergency and elective C-section deliveries.\u003c/p>\n\u003cp>Rather than rebut the British, Shah argues in his \u003cem>New England Journal \u003c/em>\u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMp1501461\" target=\"_blank\">editorial\u003c/a> that the practice of giving birth outside a hospital with a midwife can be safer.\u003c/p>\n\u003cp>\"Choose the right patients,\" he says. \"And you need to be able to link those birth centers to hospitals, like mine, that have blood banks and three operating suites and everything else.\"\u003c/p>\n\u003cp>The American College of Obstetricians and Gynecologists has been \u003ca href=\"http://www.acog.org/-/media/Statements-of-Policy/Public/sop1102.pdf?dmc=1&ts=20150701T1131257297\" target=\"_blank\">supportive\u003c/a> of midwife-led births. But it draws the line at home birth.\u003c/p>\n\u003cp>\"I don't recommend home birth, and as an organization ACOG suggests that a hospital or birth center is the safest option,\" says Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and chairman of ACOG's committee on obstetrics practice.\u003c/p>\n\u003cp>Women and babies are in real danger, Ecker says, if something goes wrong during a home birth. Compared with births planned for delivery in a hospital or birthing center, planned home births have a significantly higher rate of infant mortality in the U.S., \u003ca href=\"http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Planned-Home-Birth\" target=\"_blank\">studies show\u003c/a>, though the absolute risk of the baby dying is relatively low in both cases.\u003c/p>\n\u003cp>Also, Ecker says, the British and American health systems are simply too different for the British recommendation to make sense for the United States.\u003c/p>\n\u003cp>\"The system that supports home birth in the U.K. is much different than the system that currently exists in the U.S.,\" Ecker says. \"In fact, I would argue that there is no system in the U.S.\"\u003c/p>\n\u003cp>The U.K. has universal health care, and British women are generally referred to a midwife as soon as they know they're pregnant.\u003c/p>\n\u003cp>Though the percentage of American women who choose a midwife-led birth is still only about 9 percent, the total is on the rise, recent statistics suggest. Most midwives work in hospitals or birthing centers.\u003c/p>\n\u003cp>Yinka Sokunbi worked as a midwife in London until her husband's work transferred her to Dallas last year. She was stunned at the different attitudes toward childbirth in the U.S.\u003c/p>\n\u003cp>\"A lot of people do not know what midwives do,\" she says. \"They have this vision of old ladies with potions and herbs.\"\u003c/p>\n\u003cp>From her training and practice, Sokunbi says, she can handle a host of common childbirth scenarios.\u003c/p>\n\u003cp>\"I am suitably trained to recognize when things aren't going as they should be going and what to do about it,\" she says.\u003c/p>\n\u003cp>The bag Sokunbi takes to a home birth has no potions, but does have: a fetal Doppler device for monitoring the baby's heartbeat; certain medications; and oxygen for reviving a blue baby.\u003c/p>\n\u003cp>And at the first sign a delivery could be running into trouble, she sends her laboring patient to the nearest hospital, she says. That handoff to an obstetrician is one of the major differences between the U.S. and the U.K. It's very smooth in the United Kingdom, where doctors and midwives have a close partnership, Sokunbi says.\u003c/p>\n\u003cp>\"In the States, the way I see it so far, it seems there are midwives on one side and obstetricians on the other — and there's this opposition,\" she says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Shah warns against \"thinking of midwifery as a silver bullet\" aimed at fixing problems with childbirth in the United States. Rather, he hopes that obstetricians and midwives can work together, as they do in in the U.K., to give many women a cheaper, safer and more pleasant experience of labor and delivery.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Should+More+Women+Give+Birth+Outside+The+Hospital%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/47281/should-more-women-give-birth-outside-the-hospital","authors":["byline_stateofhealth_47281"],"categories":["stateofhealth_11","stateofhealth_12"],"tags":["stateofhealth_169","stateofhealth_397"],"featImg":"stateofhealth_47282","label":"stateofhealth"},"stateofhealth_21929":{"type":"posts","id":"stateofhealth_21929","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21929","score":null,"sort":[1412353920000]},"guestAuthors":[],"slug":"early-elective-deliveries-down-in-california-still-more-to-be-done","title":"Early Elective Deliveries Down in California, Still More Work to be Done","publishDate":1412353920,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Doctors, advocates also working to reduce rates of babies born by caesarian-section. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Brittany Patterson\u003c/strong>\u003c/p>\n\u003cp>In California, about 500,000 babies are born every year. Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.\u003c/p>\n\u003cp>One specific bright spot was reduction of early elective deliveries -- where a woman chooses to deliver her baby early, defined as between 36 and 39 weeks. These are scheduled deliveries that are not medically necessary. But \u003ca title=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" href=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" target=\"_blank\">babies born before 39 weeks\u003c/a> are more likely to have feeding and breathing problems, trouble keeping themselves warm, and infections.\u003c/p>\n\u003cp>In 2010, 14.7 percent of births in California were scheduled before 39 weeks. Today, in-part because of intense campaigning, that rate has dropped to less than three percent of total births at about half of the state's hospitals. The effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c!--more-->\u003c/p>\n\u003cp>Citing a 65 percent reduction in early elective deliveries — currently about 5 percent of births in California are early elective deliveries — the effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>By linking hospital discharge records with birth certificates from every California hospital, the center was able to give hospitals timely data on the outcomes of the babies being delivered.\u003c/p>\n\u003cp>Californian’s push seems to be working. For example, in one case, CHHS cites that 25 participating Sutter Health hospitals were able to make an 83 percent reduction in elective early deliveries in a one-year period.\u003c/p>\n\u003cp>The findings were discussed Wednesday at a briefing hosted by the California HealthCare Foundation. Advocates touted the power of harnessing big data, making it transparent, and being collaborative in continuing to make improvements to maternity care for both mothers and children in California.\u003c/p>\n\u003cp>Dr. Elliot Main, director of the California Maternal Quality Care and its California Maternity Data Center, said this major success in maternal care was borne of pressure from multiple points including advice from advocates on the risks of the medically unnecessary scheduled c-sections, buy-in from physicians, hospitals and health care providers, and readily available evidence-based plans to safely change that practice.\u003c/p>\n\u003cp>Better data also played a large role.\u003c/p>\n\u003cp>“We want to turn data into action and quality improvement measurements,” he said. “If hospitals are seeing and using this data they will have stake in improving performance measures.”\u003c/p>\n\u003cp>Over the past 15 years, the state has also seen increases in the number of mothers dying in child birth and the percentage of babies being delivered by c-section, according to the California HealthCare Foundation, but similar collaborate campaigns have started to bring down maternal mortality during childbirth to half the national average — from 16.8 per 100,000 births to 9.2 per 100,000 according to 2010 CHHS data — but experts said there is still work to be done.\u003c/p>\n\u003cp>\u003cstrong>Caesarian-section rates vary widely\u003c/strong>\u003c/p>\n\u003cp>Between 1998 and 2008, births by c-sections in California rose from 22 to 33 percent of all births and now total more than 165,000 per year, according to the CHHS. Across California c-section birth rates vary by hospital, from 10 percent to 75 percent, and some outlier hospitals have rates as high as 80.9 percent. Only 39 percent of hospitals in California meet the national target to have about one in four births by cesarean.\u003c/p>\n\u003cp>“We’ve made some improvements in maternity care, but there are lots to still be made,” Main said. “There’s an important role for physicians to work with midwives, and these collaborations require constant gardening.”\u003c/p>\n\u003cp>To help address lagging maternity health outcomes in the state, CHHS developed a maternity care initiative based on data collected by the California Simulation of Insurance Markets (CalSIM), a model that can be used estimate the impact of various elements of the Affordable Care Act. The\u003ca title=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" href=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" target=\"_blank\"> State Health Innovation Plan\u003c/a>, includes a section addressing maternity health, is currently awaiting federal approval to receive grant funding.\u003c/p>\n\u003cp>The plan calls for the rate of early elective deliveries (c-sections before 39 weeks) to drop below 3 percent, to reduce c-section rates overall by 10 percent, from 33.2 to 30 percent, and to reduce repeat c-sections from 9 percent to 11 percent, increasing instead vaginal births after a mother has previously had a c-section with their first child.\u003c/p>\n\u003cp>To reach those goals the state is calling on CalPERS, Covered California, Medi-Cal and the health plans they contract with to ultimately be required to report data in a timely manner, note in patient directories if they participate in the data reporting, and, effective January 2016, switch to value-based payments to their providers.\u003c/p>\n\u003cp>“Hospitals and doctors would get paid the same regardless of vaginal or c-section,” said Dolores Yanagihara, vice president of performance measurement for the Integrated HealthCare Association. “There would be no incentive to do what brings in more money, but rather to do the right thing.”\u003c/p>\n\u003cp>Currently, although doctors are often paid the same amount for performing a vaginal birth or c-section, hospitals receive a much larger reimbursement for c-sections.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For Dr. David Lagrew, a practicing obstetrician-gynecologist and chief of medical informatics at MemorialCare Health System, a six-hospital group in Southern California, improving maternity care comes with accepting that data and transparency are becoming more available and expected by consumers in today’s medical field landscape.\u003c/p>\n\n","blocks":[],"excerpt":"Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.","status":"publish","parent":0,"modified":1412569662,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":980},"headData":{"title":"Early Elective Deliveries Down in California, Still More Work to be Done | KQED","description":"Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Early Elective Deliveries Down in California, Still More Work to be Done","datePublished":"2014-10-03T16:32:00.000Z","dateModified":"2014-10-06T04:27:42.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"21929 http://blogs.kqed.org/stateofhealth/?p=21929","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/10/03/early-elective-deliveries-down-in-california-still-more-to-be-done/","disqusTitle":"Early Elective Deliveries Down in California, Still More Work to be Done","path":"/stateofhealth/21929/early-elective-deliveries-down-in-california-still-more-to-be-done","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_14679\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-e1377898062785.jpg\">\u003cimg class=\"size-large wp-image-14679\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/106512124-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Doctors, advocates also working to reduce rates of babies born by caesarian-section. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Brittany Patterson\u003c/strong>\u003c/p>\n\u003cp>In California, about 500,000 babies are born every year. Statewide efforts to reduce early deliveries and maternal death have netted improvements, but more work is still to be done, said advocates who gathered this week to share notes on how to improve maternal and child health across the state.\u003c/p>\n\u003cp>One specific bright spot was reduction of early elective deliveries -- where a woman chooses to deliver her baby early, defined as between 36 and 39 weeks. These are scheduled deliveries that are not medically necessary. But \u003ca title=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" href=\"http://www.npr.org/blogs/health/2013/02/21/172589649/hospitals-clamp-down-on-early-elective-births\" target=\"_blank\">babies born before 39 weeks\u003c/a> are more likely to have feeding and breathing problems, trouble keeping themselves warm, and infections.\u003c/p>\n\u003cp>In 2010, 14.7 percent of births in California were scheduled before 39 weeks. Today, in-part because of intense campaigning, that rate has dropped to less than three percent of total births at about half of the state's hospitals. The effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c!--more-->\u003c/p>\n\u003cp>Citing a 65 percent reduction in early elective deliveries — currently about 5 percent of births in California are early elective deliveries — the effort to decrease the practice was spearheaded by the March of Dimes, but strengthened by data collected and synthesized by the California Maternity Data Center.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>By linking hospital discharge records with birth certificates from every California hospital, the center was able to give hospitals timely data on the outcomes of the babies being delivered.\u003c/p>\n\u003cp>Californian’s push seems to be working. For example, in one case, CHHS cites that 25 participating Sutter Health hospitals were able to make an 83 percent reduction in elective early deliveries in a one-year period.\u003c/p>\n\u003cp>The findings were discussed Wednesday at a briefing hosted by the California HealthCare Foundation. Advocates touted the power of harnessing big data, making it transparent, and being collaborative in continuing to make improvements to maternity care for both mothers and children in California.\u003c/p>\n\u003cp>Dr. Elliot Main, director of the California Maternal Quality Care and its California Maternity Data Center, said this major success in maternal care was borne of pressure from multiple points including advice from advocates on the risks of the medically unnecessary scheduled c-sections, buy-in from physicians, hospitals and health care providers, and readily available evidence-based plans to safely change that practice.\u003c/p>\n\u003cp>Better data also played a large role.\u003c/p>\n\u003cp>“We want to turn data into action and quality improvement measurements,” he said. “If hospitals are seeing and using this data they will have stake in improving performance measures.”\u003c/p>\n\u003cp>Over the past 15 years, the state has also seen increases in the number of mothers dying in child birth and the percentage of babies being delivered by c-section, according to the California HealthCare Foundation, but similar collaborate campaigns have started to bring down maternal mortality during childbirth to half the national average — from 16.8 per 100,000 births to 9.2 per 100,000 according to 2010 CHHS data — but experts said there is still work to be done.\u003c/p>\n\u003cp>\u003cstrong>Caesarian-section rates vary widely\u003c/strong>\u003c/p>\n\u003cp>Between 1998 and 2008, births by c-sections in California rose from 22 to 33 percent of all births and now total more than 165,000 per year, according to the CHHS. Across California c-section birth rates vary by hospital, from 10 percent to 75 percent, and some outlier hospitals have rates as high as 80.9 percent. Only 39 percent of hospitals in California meet the national target to have about one in four births by cesarean.\u003c/p>\n\u003cp>“We’ve made some improvements in maternity care, but there are lots to still be made,” Main said. “There’s an important role for physicians to work with midwives, and these collaborations require constant gardening.”\u003c/p>\n\u003cp>To help address lagging maternity health outcomes in the state, CHHS developed a maternity care initiative based on data collected by the California Simulation of Insurance Markets (CalSIM), a model that can be used estimate the impact of various elements of the Affordable Care Act. The\u003ca title=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" href=\"http://www.chhs.ca.gov/PRI/CalSIM%20State%20Health%20Care%20Innovation%20Plan_Final.pdf\" target=\"_blank\"> State Health Innovation Plan\u003c/a>, includes a section addressing maternity health, is currently awaiting federal approval to receive grant funding.\u003c/p>\n\u003cp>The plan calls for the rate of early elective deliveries (c-sections before 39 weeks) to drop below 3 percent, to reduce c-section rates overall by 10 percent, from 33.2 to 30 percent, and to reduce repeat c-sections from 9 percent to 11 percent, increasing instead vaginal births after a mother has previously had a c-section with their first child.\u003c/p>\n\u003cp>To reach those goals the state is calling on CalPERS, Covered California, Medi-Cal and the health plans they contract with to ultimately be required to report data in a timely manner, note in patient directories if they participate in the data reporting, and, effective January 2016, switch to value-based payments to their providers.\u003c/p>\n\u003cp>“Hospitals and doctors would get paid the same regardless of vaginal or c-section,” said Dolores Yanagihara, vice president of performance measurement for the Integrated HealthCare Association. “There would be no incentive to do what brings in more money, but rather to do the right thing.”\u003c/p>\n\u003cp>Currently, although doctors are often paid the same amount for performing a vaginal birth or c-section, hospitals receive a much larger reimbursement for c-sections.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For Dr. David Lagrew, a practicing obstetrician-gynecologist and chief of medical informatics at MemorialCare Health System, a six-hospital group in Southern California, improving maternity care comes with accepting that data and transparency are becoming more available and expected by consumers in today’s medical field landscape.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21929/early-elective-deliveries-down-in-california-still-more-to-be-done","authors":["8344"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_169"],"featImg":"stateofhealth_14679","label":"stateofhealth"},"stateofhealth_19805":{"type":"posts","id":"stateofhealth_19805","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19805","score":null,"sort":[1403970646000]},"guestAuthors":[],"slug":"surprising-advantage-for-older-moms-more-likely-to-live-longer","title":"Surprising Advantage for Older Moms: More Likely to Live Longer","publishDate":1403970646,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19806\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/178753234.jpg\">\u003cimg class=\"size-large wp-image-19806\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/178753234-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As a woman who had not just her last child, but also her first child after age 33, I enthusiastically clicked on the NPR story in my Facebook feed this morning.\u003c/p>\n\u003cp>NPR reports that older moms -- women who had their last child after age 33 -- have twice the odds of \"exceptional longevity\" as women who had their last child before age 29. This \"exceptional longevity\" is defined as living to age 95. The research is according to a study published this week in the journal Menopause.\u003c/p>\n\u003cp>I got over the fact that \"older moms\" are women who had their last child after 33, which seems kind of young to me.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/blogs/health/2014/06/28/326163561/older-moms-take-heart-you-may-be-more-likely-to-live-longer\" target=\"_blank\">NPR explains\u003c/a> why there may be a connection between bearing children later and longevity:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>\"We think that a woman's ability to have children at a later age is evidence that her reproductive system is aging more slowly, and that the rest of her system is also aging more slowly,\" says Thomas Perls, a geriatrician at Boston Medical Center. He's an author of the paper and a principal investigator of the\u003ca href=\"https://dsgweb.wustl.edu/llfs/\" target=\"_blank\"> Long Life Family Study\u003c/a>, an international effort to figure out the secrets of a long and healthy life.\u003c/p>\n\u003cp>That might bring some comfort to older moms who have been told that they won't be able to keep up with their teenagers.\u003c/p>\n\u003cp>Other research also has shown that women who \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19414513\" target=\"_blank\">give birth later in life\u003c/a> are more likely to make it to 95 or 100 years. The theory is that certain genetic variations that allow women to bear children later are also related to longevity.\u003c/p>\n\u003cp>\"Variants allowing a woman to have children over a longer period of time would increase the chances she can pass the genes on to children and subsequent generations,\" says Perls. \"It's essentially winning the evolutionary game.\"\u003c/p>\u003c/blockquote>\n\u003cp>NPR correctly points out that this \"age of last child\" is not perfect marker for how old a woman's reproductive system is. A woman might reasonably have decided not to have more children, even though her body was capable of going on.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So the next step is to see if there's an association between longevity and the age of menopause, which would be a better marker of the longevity of a woman's reproductive ability.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The researchers corrected for several variables, they say, including education and tobacco use. In addition, none of the women in the study used fertility treatments. Researchers said having children at an older age after using those treatments is not likely to be associated with longer life.\u003c/p>\n\n","blocks":[],"excerpt":"If a woman's reproductive system is aging more slowly, it could mean the rest of her is aging more slowly, too.","status":"publish","parent":0,"modified":1403970890,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":13,"wordCount":432},"headData":{"title":"Surprising Advantage for Older Moms: More Likely to Live Longer | KQED","description":"If a woman's reproductive system is aging more slowly, it could mean the rest of her is aging more slowly, too.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Surprising Advantage for Older Moms: More Likely to Live Longer","datePublished":"2014-06-28T15:50:46.000Z","dateModified":"2014-06-28T15:54:50.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19805 http://blogs.kqed.org/stateofhealth/?p=19805","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/06/28/surprising-advantage-for-older-moms-more-likely-to-live-longer/","disqusTitle":"Surprising Advantage for Older Moms: More Likely to Live Longer","path":"/stateofhealth/19805/surprising-advantage-for-older-moms-more-likely-to-live-longer","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19806\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/178753234.jpg\">\u003cimg class=\"size-large wp-image-19806\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/178753234-640x426.jpg\" alt=\"(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>As a woman who had not just her last child, but also her first child after age 33, I enthusiastically clicked on the NPR story in my Facebook feed this morning.\u003c/p>\n\u003cp>NPR reports that older moms -- women who had their last child after age 33 -- have twice the odds of \"exceptional longevity\" as women who had their last child before age 29. This \"exceptional longevity\" is defined as living to age 95. The research is according to a study published this week in the journal Menopause.\u003c/p>\n\u003cp>I got over the fact that \"older moms\" are women who had their last child after 33, which seems kind of young to me.\u003c/p>\n\u003cp>\u003ca href=\"http://www.npr.org/blogs/health/2014/06/28/326163561/older-moms-take-heart-you-may-be-more-likely-to-live-longer\" target=\"_blank\">NPR explains\u003c/a> why there may be a connection between bearing children later and longevity:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>\"We think that a woman's ability to have children at a later age is evidence that her reproductive system is aging more slowly, and that the rest of her system is also aging more slowly,\" says Thomas Perls, a geriatrician at Boston Medical Center. He's an author of the paper and a principal investigator of the\u003ca href=\"https://dsgweb.wustl.edu/llfs/\" target=\"_blank\"> Long Life Family Study\u003c/a>, an international effort to figure out the secrets of a long and healthy life.\u003c/p>\n\u003cp>That might bring some comfort to older moms who have been told that they won't be able to keep up with their teenagers.\u003c/p>\n\u003cp>Other research also has shown that women who \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/19414513\" target=\"_blank\">give birth later in life\u003c/a> are more likely to make it to 95 or 100 years. The theory is that certain genetic variations that allow women to bear children later are also related to longevity.\u003c/p>\n\u003cp>\"Variants allowing a woman to have children over a longer period of time would increase the chances she can pass the genes on to children and subsequent generations,\" says Perls. \"It's essentially winning the evolutionary game.\"\u003c/p>\u003c/blockquote>\n\u003cp>NPR correctly points out that this \"age of last child\" is not perfect marker for how old a woman's reproductive system is. A woman might reasonably have decided not to have more children, even though her body was capable of going on.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So the next step is to see if there's an association between longevity and the age of menopause, which would be a better marker of the longevity of a woman's reproductive ability.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The researchers corrected for several variables, they say, including education and tobacco use. In addition, none of the women in the study used fertility treatments. Researchers said having children at an older age after using those treatments is not likely to be associated with longer life.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19805/surprising-advantage-for-older-moms-more-likely-to-live-longer","authors":["240"],"categories":["stateofhealth_12"],"tags":["stateofhealth_169","stateofhealth_349","stateofhealth_461","stateofhealth_397"],"featImg":"stateofhealth_19806","label":"stateofhealth"},"stateofhealth_19560":{"type":"posts","id":"stateofhealth_19560","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19560","score":null,"sort":[1403096127000]},"guestAuthors":[],"slug":"in-san-francisco-centering-pregnancy-outside-the-box-prenatal-care","title":"Low-Income Latinas Turn to Group Visits for Prenatal Care","publishDate":1403096127,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_19562\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10646_016-hpf.jpg\">\u003cimg class=\"size-full wp-image-19562\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10646_016-hpf.jpg\" alt=\"Araceli eats fruit during a break following an exercise on healthy eating during a Centering Pregnancy group in San Francisco. (Deborah Svoboda/The World)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During a Centering Pregnancy group prenatal appointment in San Francisco, Araceli (left) eats fruit following an exercise on healthy eating. (Deborah Svoboda/The World)\u003c/figcaption>\u003c/figure>\n\u003cp>Once a month, Irma Vásquez goes for prenatal check-ups at a clinic in San Francisco’s Mission District. But her appointment looks nothing like a doctor's appointment. Instead of getting one-on-one care, she meets with 12 other Latina immigrants for a group visit.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Studies show group prenatal care leads to better birth outcomes.\u003c/aside>\n\u003cp>The women meet at a community clinic and first take their own blood pressure, weigh themselves, and write down the results. Then they take turns seeing a midwife in a makeshift exam area in the corner of the room. The midwife checks each baby’s heart rate and talks privately with each woman.\u003c/p>\n\u003cp>Afterward they all sit in a circle and talk -- in Spanish -- about everything from eating healthy to dealing with domestic problems at home. Finally, there’s group meditation. Vásquez says this is her favorite part.\u003c/p>\n\u003cp>“It clears your mind of all the things that are going on around you, going on outside,” she says in Spanish. “It makes you more relaxed.”\u003c!--more-->\u003c/p>\n\u003cp>Vásquez, who is from Mexico, says she’s under a lot stress. She lives in a cramped apartment with her husband and his entire family. The group appointments help.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Vásquez and the other women are a part of a prenatal care program known as \u003ca href=\"http://www.centeringhealthcare.org/pages/centering-model/pregnancy-overview.php\" target=\"_blank\">Centering Pregnancy\u003c/a>. Women with similar gestational ages meet, learn about self-care, and have facilitated group discussions.\u003c/p>\n\u003cp>\u003cstrong>Better Outcomes -- for Mom and Baby\u003c/strong>\u003c/p>\n\u003cp>Studies show group prenatal care leads to better birth outcomes when compared against standard care. Women who do Centering Pregnancy are more likely to \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23855366\" target=\"_blank\">breastfeed\u003c/a>, at least initially, and attend prenatal care appointments. They’re less likely to have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23445830\" target=\"_blank\">postpartum depression\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276878/\" target=\"_blank\">preterm births\u003c/a>.\u003c/p>\n\u003cp>And there’s another benefit -- Centering Pregnancy is linked to fewer caesarean sections -- and that saves taxpayer Medicaid dollars. For California births without complications, it cost nearly \u003ca href=\"http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby-Executive-Summary.pdf\" target=\"_blank\">twice as much for c-sections than it does for vaginal births.\u003c/a>\u003c/p>\n\u003cp>Midwife Margy Hutchison started Centering Pregnancy at\u003ca href=\"http://obgyn.medschool.ucsf.edu/sfgh/clinics/our_clinics/ob/_centering.aspx\" target=\"_blank\"> San Francisco General Hospital \u003c/a>15 years ago -- for people like Irma Vásquez. Hutchison noticed that many of her Latina immigrant patients suffered from chronic stress or depression.\u003c/p>\n\u003cp>“It was really clear to me that many of them were really struggling,” Hutchison says. “And patients I continue to see are struggling with the impact of social isolation.”\u003c/p>\n\u003cp>Hutchison says she would see these Latina immigrants sitting alone and silent in the hospital’s waiting rooms. She wanted to connect them.\u003c/p>\n\u003cp>“Experience has shown me certainly that this group of people benefit tremendously from being in group prenatal care,” Hutchison says.\u003c/p>\n\u003cp>Hutchison says many of these women were suffering from stress, social isolation or depression -- which are all linked to \u003ca href=\"http://www.google.com/url?q=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F21890014&sa=D&sntz=1&usg=AFQjCNHt2_6HbogfWvS07gsYcmq2kDyI_Q\" target=\"_blank\">preterm births\u003c/a>, \u003ca href=\"http://www.ajog.org/article/0002-9378(93)90016-C/abstract\" target=\"_blank\">low birth weight\u003c/a>, and damage to children’s \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18049295\" target=\"_blank\">cognitive skills\u003c/a>. But it was hard to convince the women to do group prenatal care at first.\u003c/p>\n\u003cp>“If a woman’s depressed that may be the last thing she wants to do,” Hutchison says. “She wants to curl up in a ball and stay home.”\u003c/p>\n\u003cp>That was the case for Karent Novela, a Mexican immigrant who moved to San Francisco a year before she became pregnant. Novela didn’t speak English, and her only family here --her husband -- works 12 hours a day. She was depressed and not in the mood to hang out with other women.\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"https://www.youtube.com/watch?v=3Mf3Oe45Uuk\">Centering Pregnancy: Outside-the-box prenatal care\u003c/a>\u003c/div>\n\u003cp>In addition, S.F. General’s Centering Pregnancy program is run by midwives, and that scared Novela. She had seen a midwife, one without medical credentials, back in Mexico a year earlier, and she had had a miscarriage. Now in the U.S., she wanted to see a doctor.\u003c/p>\n\u003cp>“When they told me about midwifes, my first thought was, ‘Midwives, that’s what we call in Mexico, parteras,’” says Novela. “Parteras are like the same in Mexico, but without any degrees or studies, just by their basic knowledge they deliver babies. So I just said, ‘No!’”\u003c/p>\n\u003cp>But the nurses at S.F. General were persistent. They assured her that their midwives are trained professionals.\u003c/p>\n\u003cp>“The nurse that was with me, she told me, ‘You might try it. If you like it, you can stay. If you don’t like it you can just keep coming to your appointments with your doctor. But you decide. It’s your decision.”\u003c/p>\n\u003cp>Novela signed up. She loved it.\u003c/p>\n\u003cp>“Having people who speak my language, and having people who are from my same background -- like, they don’t have family -- that changed me. It changed my life.”\u003c/p>\n\u003cp>\u003cstrong>Choosing Centering Pregnancy over Traditional Care\u003c/strong>\u003c/p>\n\u003cp>Novela isn’t alone. Most Latina midwifery patients at S.F. General are now choosing Centering Pregnancy over one-on-one care -- and 95 percent of these women say they would do it again with future pregnancies. Internal hospital data show that Centering Pregnancy patients are more like to attend prenatal care appointments than midwifery patients who get traditional care.\u003c/p>\n\u003cp>Laurie Jurkiewicz is a midwife at S.F. General who runs Centering Pregnancy groups in Spanish. She says some U.S. hospitals hesitated at first to launch Centering Pregnancy programs -- mostly because, like S.F. General, they weren’t set up for group prenatal care.\u003c/p>\n\u003cp>“It’s out-of-the box thinking, right?” says Jurkiewicz. “And so our struggle was we’d get a room, and we’d get kicked out of a room at the last minute, and the rooms weren’t very nice.”\u003c/p>\n\u003cp>S.F. General got the program off the ground by partnering with community clinics and using their space for these group appointments. Other hospitals are now doing the same or partnering with churches for meeting space.\u003c/p>\n\u003cfigure id=\"attachment_19572\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10640_010-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19572\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10640_010-hpf-300x200.jpg\" alt=\"Laurie Jurkiewicz, a midwife from San Francisco General Hospital, monitors the baby's heartbeat during a Centering Pregnancy group appointment. (Deb Svoboda/The World)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Laurie Jurkiewicz, a midwife from San Francisco General Hospital, monitors the baby's heartbeat during a Centering Pregnancy group appointment. (Deb Svoboda/The World)\u003c/figcaption>\u003c/figure>\n\u003cp>Jurkiewicz says the partnerships have allowed Centering Pregnancy to flourish at S.F. General. When they first created the program in 1999, it was the only one like it on the West Coast. Today, there are 21 Centering Pregnancy programs in California alone -- mostly in California public hospitals where \u003ca href=\"http://caph.org/caphmemberhospitals/fastfacts/\" target=\"_blank\">nearly half the patients are Latino\u003c/a>. It’s also \u003ca href=\"https://centeringhealthcare.secure.force.com/WebPortal/LocateCenteringSitePage\" target=\"_blank\">growing nationwide\u003c/a>, especially among high-risk, low-income populations.\u003c/p>\n\u003cp>Karent Novela, the Mexican immigrant, says she's built a community with the other Latina immigrants from her Centering Pregnancy group. They now call each other for support.\u003c/p>\n\u003cp>“They didn’t have family, they didn’t have friends, and most of them had their first baby like me,” says Novela. “So I just feel like, OK, I’m not the only one who is having these difficulties. I’m not the only one who is suffering for this. My way of seeing my situation changed. So I start to change.”\u003c/p>\n\u003cp>Novela says Centering Pregnancy shook things up in her life and pulled her out of her out of her depression. And that, she says, empowered her to be a better mom.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/154978849&color=ff5500&auto_play=false&hide_related=false&show_artwork=true&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Clarification: The open in the radio piece above suggests that Centering Pregnancy was founded at S.F. General Hospital. But S.F. General was the first hospital on the west coast to offer the program.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The core of the Centering Pregnancy model is medical care, education and support -- in a group setting.","status":"publish","parent":0,"modified":1403216287,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":true,"iframeSrcs":["https://w.soundcloud.com/player/"],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":35,"wordCount":1289},"headData":{"title":"Low-Income Latinas Turn to Group Visits for Prenatal Care | KQED","description":"The core of the Centering Pregnancy model is medical care, education and support -- in a group setting.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Low-Income Latinas Turn to Group Visits for Prenatal Care","datePublished":"2014-06-18T12:55:27.000Z","dateModified":"2014-06-19T22:18:07.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"19560 http://blogs.kqed.org/stateofhealth/?p=19560","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/06/18/in-san-francisco-centering-pregnancy-outside-the-box-prenatal-care/","disqusTitle":"Low-Income Latinas Turn to Group Visits for Prenatal Care","path":"/stateofhealth/19560/in-san-francisco-centering-pregnancy-outside-the-box-prenatal-care","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_19562\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10646_016-hpf.jpg\">\u003cimg class=\"size-full wp-image-19562\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10646_016-hpf.jpg\" alt=\"Araceli eats fruit during a break following an exercise on healthy eating during a Centering Pregnancy group in San Francisco. (Deborah Svoboda/The World)\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2014/06/RS10646_016-hpf-320x214.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">During a Centering Pregnancy group prenatal appointment in San Francisco, Araceli (left) eats fruit following an exercise on healthy eating. (Deborah Svoboda/The World)\u003c/figcaption>\u003c/figure>\n\u003cp>Once a month, Irma Vásquez goes for prenatal check-ups at a clinic in San Francisco’s Mission District. But her appointment looks nothing like a doctor's appointment. Instead of getting one-on-one care, she meets with 12 other Latina immigrants for a group visit.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Studies show group prenatal care leads to better birth outcomes.\u003c/aside>\n\u003cp>The women meet at a community clinic and first take their own blood pressure, weigh themselves, and write down the results. Then they take turns seeing a midwife in a makeshift exam area in the corner of the room. The midwife checks each baby’s heart rate and talks privately with each woman.\u003c/p>\n\u003cp>Afterward they all sit in a circle and talk -- in Spanish -- about everything from eating healthy to dealing with domestic problems at home. Finally, there’s group meditation. Vásquez says this is her favorite part.\u003c/p>\n\u003cp>“It clears your mind of all the things that are going on around you, going on outside,” she says in Spanish. “It makes you more relaxed.”\u003c!--more-->\u003c/p>\n\u003cp>Vásquez, who is from Mexico, says she’s under a lot stress. She lives in a cramped apartment with her husband and his entire family. The group appointments help.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Vásquez and the other women are a part of a prenatal care program known as \u003ca href=\"http://www.centeringhealthcare.org/pages/centering-model/pregnancy-overview.php\" target=\"_blank\">Centering Pregnancy\u003c/a>. Women with similar gestational ages meet, learn about self-care, and have facilitated group discussions.\u003c/p>\n\u003cp>\u003cstrong>Better Outcomes -- for Mom and Baby\u003c/strong>\u003c/p>\n\u003cp>Studies show group prenatal care leads to better birth outcomes when compared against standard care. Women who do Centering Pregnancy are more likely to \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23855366\" target=\"_blank\">breastfeed\u003c/a>, at least initially, and attend prenatal care appointments. They’re less likely to have \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/23445830\" target=\"_blank\">postpartum depression\u003c/a> and \u003ca href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276878/\" target=\"_blank\">preterm births\u003c/a>.\u003c/p>\n\u003cp>And there’s another benefit -- Centering Pregnancy is linked to fewer caesarean sections -- and that saves taxpayer Medicaid dollars. For California births without complications, it cost nearly \u003ca href=\"http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby-Executive-Summary.pdf\" target=\"_blank\">twice as much for c-sections than it does for vaginal births.\u003c/a>\u003c/p>\n\u003cp>Midwife Margy Hutchison started Centering Pregnancy at\u003ca href=\"http://obgyn.medschool.ucsf.edu/sfgh/clinics/our_clinics/ob/_centering.aspx\" target=\"_blank\"> San Francisco General Hospital \u003c/a>15 years ago -- for people like Irma Vásquez. Hutchison noticed that many of her Latina immigrant patients suffered from chronic stress or depression.\u003c/p>\n\u003cp>“It was really clear to me that many of them were really struggling,” Hutchison says. “And patients I continue to see are struggling with the impact of social isolation.”\u003c/p>\n\u003cp>Hutchison says she would see these Latina immigrants sitting alone and silent in the hospital’s waiting rooms. She wanted to connect them.\u003c/p>\n\u003cp>“Experience has shown me certainly that this group of people benefit tremendously from being in group prenatal care,” Hutchison says.\u003c/p>\n\u003cp>Hutchison says many of these women were suffering from stress, social isolation or depression -- which are all linked to \u003ca href=\"http://www.google.com/url?q=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F21890014&sa=D&sntz=1&usg=AFQjCNHt2_6HbogfWvS07gsYcmq2kDyI_Q\" target=\"_blank\">preterm births\u003c/a>, \u003ca href=\"http://www.ajog.org/article/0002-9378(93)90016-C/abstract\" target=\"_blank\">low birth weight\u003c/a>, and damage to children’s \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18049295\" target=\"_blank\">cognitive skills\u003c/a>. But it was hard to convince the women to do group prenatal care at first.\u003c/p>\n\u003cp>“If a woman’s depressed that may be the last thing she wants to do,” Hutchison says. “She wants to curl up in a ball and stay home.”\u003c/p>\n\u003cp>That was the case for Karent Novela, a Mexican immigrant who moved to San Francisco a year before she became pregnant. Novela didn’t speak English, and her only family here --her husband -- works 12 hours a day. She was depressed and not in the mood to hang out with other women.\u003c/p>\n\u003cdiv>\u003ca class=\"embedly-card\" href=\"https://www.youtube.com/watch?v=3Mf3Oe45Uuk\">Centering Pregnancy: Outside-the-box prenatal care\u003c/a>\u003c/div>\n\u003cp>In addition, S.F. General’s Centering Pregnancy program is run by midwives, and that scared Novela. She had seen a midwife, one without medical credentials, back in Mexico a year earlier, and she had had a miscarriage. Now in the U.S., she wanted to see a doctor.\u003c/p>\n\u003cp>“When they told me about midwifes, my first thought was, ‘Midwives, that’s what we call in Mexico, parteras,’” says Novela. “Parteras are like the same in Mexico, but without any degrees or studies, just by their basic knowledge they deliver babies. So I just said, ‘No!’”\u003c/p>\n\u003cp>But the nurses at S.F. General were persistent. They assured her that their midwives are trained professionals.\u003c/p>\n\u003cp>“The nurse that was with me, she told me, ‘You might try it. If you like it, you can stay. If you don’t like it you can just keep coming to your appointments with your doctor. But you decide. It’s your decision.”\u003c/p>\n\u003cp>Novela signed up. She loved it.\u003c/p>\n\u003cp>“Having people who speak my language, and having people who are from my same background -- like, they don’t have family -- that changed me. It changed my life.”\u003c/p>\n\u003cp>\u003cstrong>Choosing Centering Pregnancy over Traditional Care\u003c/strong>\u003c/p>\n\u003cp>Novela isn’t alone. Most Latina midwifery patients at S.F. General are now choosing Centering Pregnancy over one-on-one care -- and 95 percent of these women say they would do it again with future pregnancies. Internal hospital data show that Centering Pregnancy patients are more like to attend prenatal care appointments than midwifery patients who get traditional care.\u003c/p>\n\u003cp>Laurie Jurkiewicz is a midwife at S.F. General who runs Centering Pregnancy groups in Spanish. She says some U.S. hospitals hesitated at first to launch Centering Pregnancy programs -- mostly because, like S.F. General, they weren’t set up for group prenatal care.\u003c/p>\n\u003cp>“It’s out-of-the box thinking, right?” says Jurkiewicz. “And so our struggle was we’d get a room, and we’d get kicked out of a room at the last minute, and the rooms weren’t very nice.”\u003c/p>\n\u003cp>S.F. General got the program off the ground by partnering with community clinics and using their space for these group appointments. Other hospitals are now doing the same or partnering with churches for meeting space.\u003c/p>\n\u003cfigure id=\"attachment_19572\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10640_010-hpf.jpg\">\u003cimg class=\"size-medium wp-image-19572\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/06/RS10640_010-hpf-300x200.jpg\" alt=\"Laurie Jurkiewicz, a midwife from San Francisco General Hospital, monitors the baby's heartbeat during a Centering Pregnancy group appointment. (Deb Svoboda/The World)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Laurie Jurkiewicz, a midwife from San Francisco General Hospital, monitors the baby's heartbeat during a Centering Pregnancy group appointment. (Deb Svoboda/The World)\u003c/figcaption>\u003c/figure>\n\u003cp>Jurkiewicz says the partnerships have allowed Centering Pregnancy to flourish at S.F. General. When they first created the program in 1999, it was the only one like it on the West Coast. Today, there are 21 Centering Pregnancy programs in California alone -- mostly in California public hospitals where \u003ca href=\"http://caph.org/caphmemberhospitals/fastfacts/\" target=\"_blank\">nearly half the patients are Latino\u003c/a>. It’s also \u003ca href=\"https://centeringhealthcare.secure.force.com/WebPortal/LocateCenteringSitePage\" target=\"_blank\">growing nationwide\u003c/a>, especially among high-risk, low-income populations.\u003c/p>\n\u003cp>Karent Novela, the Mexican immigrant, says she's built a community with the other Latina immigrants from her Centering Pregnancy group. They now call each other for support.\u003c/p>\n\u003cp>“They didn’t have family, they didn’t have friends, and most of them had their first baby like me,” says Novela. “So I just feel like, OK, I’m not the only one who is having these difficulties. I’m not the only one who is suffering for this. My way of seeing my situation changed. So I start to change.”\u003c/p>\n\u003cp>Novela says Centering Pregnancy shook things up in her life and pulled her out of her out of her depression. And that, she says, empowered her to be a better mom.\u003c/p>\n\u003cp>\u003ciframe src=\"https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/154978849&color=ff5500&auto_play=false&hide_related=false&show_artwork=true&show_comments=true&show_user=true&show_reposts=false\" width=\"100%\" height=\"166\" frameborder=\"no\" scrolling=\"no\">\u003c/iframe>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Clarification: The open in the radio piece above suggests that Centering Pregnancy was founded at S.F. General Hospital. But S.F. General was the first hospital on the west coast to offer the program.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19560/in-san-francisco-centering-pregnancy-outside-the-box-prenatal-care","authors":["46"],"categories":["stateofhealth_11","stateofhealth_14"],"tags":["stateofhealth_169","stateofhealth_349","stateofhealth_461"],"featImg":"stateofhealth_19562","label":"stateofhealth"},"stateofhealth_2876":{"type":"posts","id":"stateofhealth_2876","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"2876","score":null,"sort":[1328728585000]},"guestAuthors":[],"slug":"new-federal-plan-to-reduce-early-elective-births","title":"New Federal Plan to Reduce Early Elective Births","publishDate":1328728585,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cstrong>Delivering early--for no medical cause--can harm babies.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>By Emily Bazar, \u003ca title=\"http://centerforhealthreporting.org/blog/feds-announce-plan-reduce-early-elective-births781\" href=\"http://centerforhealthreporting.org/blog/feds-announce-plan-reduce-early-elective-births781\" target=\"_blank\">Center for Health Reporting\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_2882\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Birth_Baby_NathanLeClair_Flickr_02082012.jpg\">\u003cimg class=\"size-medium wp-image-2882\" title=\"(Nathan LeClair: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Birth_Baby_NathanLeClair_Flickr_02082012-300x199.jpg\" alt=\"(Nathan LeClair: Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Nathan LeClair: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Now the feds are jumping in.\u003c/p>\n\u003cp>This morning, \u003ca href=\"http://www.hhs.gov/\" target=\"_blank\">the U.S. Department of Health and Human Services\u003c/a> announced a national campaign to reduce elective deliveries of babies before 39 weeks of pregnancy, saying the effort will improve care and save millions.\u003c/p>\n\u003cp>Under the “Strong Start” initiative, the government will work with hospitals across the country that have joined the \u003ca href=\"http://www.healthcare.gov/compare/partnership-for-patients/\" target=\"_blank\">Partnership for Patients\u003c/a>, a voluntary effort to reduce preventable injuries and complications.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It also will partner with organizations such as the \u003ca href=\"http://www.marchofdimes.com/\" target=\"_blank\">March of Dimes\u003c/a> and the \u003ca href=\"http://www.acog.org/\" target=\"_blank\">American Congress of Obstetricians and Gynecologists\u003c/a>, which have taken strong stands against early elective births.\u003c/p>\n\u003caside class=\"pullquote alignright\"> ... up to 10 percent of all deliveries are scheduled during weeks 37 and 38 without a medical reason. \u003c/aside>\n\u003cp>The federal government now joins a fast-growing movement to cut early elective births. \u003ca href=\"http://centerforhealthreporting.org/article/dramatic-gains-california-hospitals-reducing-early-deliveries759\" target=\"_blank\">As I wrote last week\u003c/a>, nearly 100 hospitals across California have adopted policies to discourage or prohibit doctors from scheduling deliveries – either by inducing labor or performing cesarean sections – between weeks 37 and 39 of pregnancy without a medical reason.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003ca href=\"http://www.leapfroggroup.org/media/file/FactSheet_ElectiveDeliveries.pdf\" target=\"_blank\">Data show\u003c/a> that delivering early without a valid medical reason increases the risk of complications to babies, including breathing and feeding problems and blood infections.\u003c/p>\n\u003cp>According to HHS, up to 10 percent of all deliveries are scheduled during weeks 37 and 38 without a medical reason.\u003c/p>\n\u003cp>“Preterm births are a growing public health problem that has significant consequences for families well into a child’s life,” HHS Secretary Kathleen Sebelius said.\u003c/p>\n\u003cp>The cost-savings for reducing early elective births could be significant. \u003ca href=\"http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/\" target=\"_blank\">Medicaid\u003c/a>, the publicly funded health program for low-income people, pays for just less than half of the nation’s births each year. A 10 percent drop in deliveries before 39 weeks would lead to more than $75 million in annual Medicaid savings, HHS said.\u003c/p>\n\u003cp>HHS also announced a plan to distribute more than $40 million in grants to reduce preterm births before 37 weeks of gestation.\u003c/p>\n\u003cp>More than half a million preemies are born each year, HHS said, a number that has grown by 36 percent over the past two decades.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The grants will be awarded to providers and coalitions to improve prenatal care for women covered by Medicaid.\u003c/p>\n\u003cdiv>\u003c/div>\n\n","blocks":[],"excerpt":"Now the feds are jumping in.\r\n\r\nThis morning, the U.S. Department of Health and Human Services announced a national campaign to reduce elective deliveries of babies before 39 weeks of pregnancy, saying the effort will improve care and save millions.\r\n\r\nUnder the “Strong Start” initiative, the government will work with hospitals across the country that have joined the Partnership for Patients, a voluntary effort to reduce preventable injuries and complications.\r\n","status":"publish","parent":0,"modified":1328833159,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":404},"headData":{"title":"New Federal Plan to Reduce Early Elective Births | KQED","description":"Now the feds are jumping in.\r\n\r\nThis morning, the U.S. Department of Health and Human Services announced a national campaign to reduce elective deliveries of babies before 39 weeks of pregnancy, saying the effort will improve care and save millions.\r\n\r\nUnder the “Strong Start” initiative, the government will work with hospitals across the country that have joined the Partnership for Patients, a voluntary effort to reduce preventable injuries and complications.\r\n","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"New Federal Plan to Reduce Early Elective Births","datePublished":"2012-02-08T19:16:25.000Z","dateModified":"2012-02-10T00:19:19.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"2876 http://blogs.kqed.org/stateofhealth/?p=2876","disqusUrl":"https://ww2.kqed.org/stateofhealth/2012/02/08/new-federal-plan-to-reduce-early-elective-births/","disqusTitle":"New Federal Plan to Reduce Early Elective Births","path":"/stateofhealth/2876/new-federal-plan-to-reduce-early-elective-births","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>Delivering early--for no medical cause--can harm babies.\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>By Emily Bazar, \u003ca title=\"http://centerforhealthreporting.org/blog/feds-announce-plan-reduce-early-elective-births781\" href=\"http://centerforhealthreporting.org/blog/feds-announce-plan-reduce-early-elective-births781\" target=\"_blank\">Center for Health Reporting\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_2882\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Birth_Baby_NathanLeClair_Flickr_02082012.jpg\">\u003cimg class=\"size-medium wp-image-2882\" title=\"(Nathan LeClair: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Birth_Baby_NathanLeClair_Flickr_02082012-300x199.jpg\" alt=\"(Nathan LeClair: Flickr)\" width=\"300\" height=\"199\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Nathan LeClair: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Now the feds are jumping in.\u003c/p>\n\u003cp>This morning, \u003ca href=\"http://www.hhs.gov/\" target=\"_blank\">the U.S. Department of Health and Human Services\u003c/a> announced a national campaign to reduce elective deliveries of babies before 39 weeks of pregnancy, saying the effort will improve care and save millions.\u003c/p>\n\u003cp>Under the “Strong Start” initiative, the government will work with hospitals across the country that have joined the \u003ca href=\"http://www.healthcare.gov/compare/partnership-for-patients/\" target=\"_blank\">Partnership for Patients\u003c/a>, a voluntary effort to reduce preventable injuries and complications.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It also will partner with organizations such as the \u003ca href=\"http://www.marchofdimes.com/\" target=\"_blank\">March of Dimes\u003c/a> and the \u003ca href=\"http://www.acog.org/\" target=\"_blank\">American Congress of Obstetricians and Gynecologists\u003c/a>, which have taken strong stands against early elective births.\u003c/p>\n\u003caside class=\"pullquote alignright\"> ... up to 10 percent of all deliveries are scheduled during weeks 37 and 38 without a medical reason. \u003c/aside>\n\u003cp>The federal government now joins a fast-growing movement to cut early elective births. \u003ca href=\"http://centerforhealthreporting.org/article/dramatic-gains-california-hospitals-reducing-early-deliveries759\" target=\"_blank\">As I wrote last week\u003c/a>, nearly 100 hospitals across California have adopted policies to discourage or prohibit doctors from scheduling deliveries – either by inducing labor or performing cesarean sections – between weeks 37 and 39 of pregnancy without a medical reason.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>\u003ca href=\"http://www.leapfroggroup.org/media/file/FactSheet_ElectiveDeliveries.pdf\" target=\"_blank\">Data show\u003c/a> that delivering early without a valid medical reason increases the risk of complications to babies, including breathing and feeding problems and blood infections.\u003c/p>\n\u003cp>According to HHS, up to 10 percent of all deliveries are scheduled during weeks 37 and 38 without a medical reason.\u003c/p>\n\u003cp>“Preterm births are a growing public health problem that has significant consequences for families well into a child’s life,” HHS Secretary Kathleen Sebelius said.\u003c/p>\n\u003cp>The cost-savings for reducing early elective births could be significant. \u003ca href=\"http://www.healthcare.gov/using-insurance/low-cost-care/medicaid/\" target=\"_blank\">Medicaid\u003c/a>, the publicly funded health program for low-income people, pays for just less than half of the nation’s births each year. A 10 percent drop in deliveries before 39 weeks would lead to more than $75 million in annual Medicaid savings, HHS said.\u003c/p>\n\u003cp>HHS also announced a plan to distribute more than $40 million in grants to reduce preterm births before 37 weeks of gestation.\u003c/p>\n\u003cp>More than half a million preemies are born each year, HHS said, a number that has grown by 36 percent over the past two decades.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The grants will be awarded to providers and coalitions to improve prenatal care for women covered by Medicaid.\u003c/p>\n\u003cdiv>\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/2876/new-federal-plan-to-reduce-early-elective-births","authors":["240"],"categories":["stateofhealth_14","stateofhealth_13"],"tags":["stateofhealth_169"],"featImg":"stateofhealth_2882","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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