Calif. private hospitals performing more C-sections

September 13, 2010 7:27:28 PM PDT
It turns out that you are more likely to have a C-section at a private hospital than a public one according to an analysis by our media partner California Watch. It's a non-profit, bi-partisan project of the center for investigative journalism.

For expectant mothers, whether or not they'll have a Cesarean section is frequently on their minds.

"When they told me that I might have a C-section, if they induced me, you know I was a little bit nervous. Typically the recovery time is a lot longer and being a first time mom and parent, you know, I didn't know what to expect," new Mom Loren Coleman said.

Loren ended up not having that C-section, but increasingly more babies are being delivered that way. From 1996 to 2007, the rate of C-sections rose 56 percent in California and it turns out the odds of having a Cesarean may have something to do with where you deliver your baby.

"When we looked at whether hospitals are for profit or non-profit there we saw a significant difference," California Watch reporter Nathanael Johnson said.

Johnson poured over records compiled by the state and found significant differences among 253 hospitals. In general, C-sections rates have been climbing for years, partly because of older mothers and an increase in obesity.

Johnson took out the highest risk candidates for his analysis and then compared hospitals with similar demographics.

"We found that a healthy woman walking into a hospital, if it's a for profit hospital, she has a greater chance of having a C-section than if it's a non-profit hospital," he said.

In fact, 15 percent more likely. Higher C-section rates were found at hospitals catering to all ethnic groups and economic classes and California Watch found no correlation between C-section rates and the percentage of a hospital's business from low-income or indigent patients receiving Medi-Cal.

"There were lots of examples of hospitals in the same area, serving the same population, with radically different rates," Johnson said.

"Some of that may be patient characteristics, but probably some of that are hospital and physician characteristics. It's not a big surprise," Pacific Medical Center Chairman of Obstetrics and Gynecology Dr. Elliott Main said.

San Francisco's Pacific Medical Center is a private hospital.

"It's a difficult business though. We can be damned for doing too few C-sections, damned for doing too many," Main said.

According the California Watch analysis, California Pacific's C-section rate was lower than the statewide average for similar hospitals.

"Many of the public hospitals are teaching hospitals that have more of a standardized approach to care in a private hospital there is a there's a lot more independence of the physician," Main said.

But, it's major abdominal surgery with a higher risk of complications.

"The first C-section leads to the second and third, and that's where most of the complications arise; less so with the first birth much more with the second, third or fourth Cesarean birth. And we we've seen a increase in major complications in those births," Main said.

California Watch previously reported a dramatic increase in the state's maternal death rate and researchers are now exploring the possible connection to the rise in C-sections.

Comparing hospitals with similar demographics, the California Watch analysis revealed that rising C-section rates cannot be completely attributed to changes in patient health, but Johnson says one significant conclusion can be drawn.

"It looks like people are doing a lot of unnecessary C-sections out there," he said.

Written and produced by Ken Miguel.


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