May 13, 2009

Cesarean Rates in Some Counties Soar

An article appearing in last week’s Miami Herald provides the somewhat stunning news that last year, more babies in Miami-Dade county in Florida were born by c-section than were born vaginally. While the c-section rate for the U.S. hit a record high in 2007 at 31.8% – a level and trend of increases that alarms many advocates – the rates were over 50% for Miami-Dade county, and nearly 44% in nearby Broward county.

A table of c-section rates by institution in South Florida accompanies the article and shows most hospitals with a rate greater than 40%, with many greater than 50%. In Kendall Regional in Miami-Dade county, the percentage of cesarean births was 70.3%.

The article notes that costs are also higher in south Florida than elsewhere, saying that: “Data from the Florida Agency for Health Care Administration shows cesareans in South Florida hospitals range from $11,000 and $30,000 — about twice the $5,000 to $16,000 range for natural births.”

While some of those interviewed for the piece note the risks of c-section, particularly for women planning to have multiple children, one physician described the outcomes for women who had cesarean sections thusly: “They’re happy and pain-free and walking around the first day.”

I’d be really interested in hearing from women – with any type of birth – who describe themselves on the day they gave birth as “pain free.”

Several considerations are raised in the piece in an attempt to explain the high c-section rate in south Florida, including risk, malpractice concerns, a local culture of “aggressive” practice of medicine, maternal demand (which is thought to be a fairly small factor), and lack of options for VBAC once a woman has had an initial cesarean. The reader comments on the article raise a different set of issues, such as being pressured by providers to have a cesarean section and being held to strict “due” dates.

Relatedly, Lynn Paltrow of the National Advocates for Pregnant Women recently wrote a piece for the Huffington Post, “Concerned About Coerced Abortions? Try Saying No to Cesarean Surgery.”  She notes that while anti-choice activists put much energy and attention into so called abortion coercion laws (measures that create barriers to women obtaining abortions, ostensibly to prevent them from feeling “coerced” into abortions), they don’t pay the same attention to women who are coerced into c-sections.

Paltrow argues that:

…if protecting pregnant women and the “unborn” were really the goal, the legislation would not focus on abortion exclusively, but rather would make it illegal to pressure or coerce a pregnant woman to have any medical intervention. This would include policies that force pregnant women who have had previous cesarean surgery to have repeat surgery whether they need it or not.

For more on this and related topics, see our online content, Pregnancy & Birth.


8 Responses to “Cesarean Rates in Some Counties Soar”

  1. Labor Nurse Says:

    I don’t know what to say other than this is a travesty and I am sure glad I do not live the Dade county!!!!

  2. mrs spock Says:

    70%!? I had a very necessary c-section- and it sure as hell wasn’t pain free. My scar is still sensitive one year later.

  3. Judith Lienhard Says:

    When will be held accountable?

  4. MomTFH Says:

    Yeah, I wrote about this, too. Miami Dade County is my stomping grounds. I delivered both of my kids in Miami Dade, and the cesarean rate was what made me choose midwives for the deliveries instead of an ob/gyn. I am dreading the irony that I will most likely be trying to get a residency to train as an ob/gyn in Miami.

  5. Rachel Says:

    Thanks for your comment and the link to your post. Would love to hear more from your unique perspective about why the rate is so high around there!

  6. MomTFH Says:

    I am not sure. That’s a really good question. I could make some bad guesses.

    Some people think it has something to do with Hispanic ethnicity. Other than Brazil, I am not sure if other Latin American countries have high rates of cesareans. And, this kind of complaint implies that it is maternal demand that is driving the cesarean rate, and I think most literature in general contradicts that maternal demand is that high. But, many practitioners are of Latin descent, also. What that has to do with cesareans, I have no idea.

    I think the ob/gyn population here tends to be rather incestuous, with many practitioners coming from the same training program, which has a higher than 50% cesarean rate and a rather overmedicalized reputation. Also, medical standards of care vary from region to region, and trends may seem to feed off of the medicolegal climate.

    With the malpractice rates being so high (and the cost of living and standard of living for the ob/gyns who go bare) doctors may need to cram in more office visits and more procedures and may have little time for unscheduled labors.

    Miami in general is not an overly progressive or deep city. There isn’t a strong counter culture movement. Not a lot of networking between groups. I didn’t know anyone else who had used a midwife personally when I sought one out.

  7. FormerlyKnownAsMDCMidwife Says:

    South Florida and Miami in particular has a large community of non-nurse midwives. The medical establishment continues to reject them and their supporters even though OBGYN providers have been decreasing in numbers.

    Interestingly, nearly one year ago, Miami Dade College shut down the only non-nurse direct entry midwifery program at the college level in the United States. (Miami Dade College is also the largest school of higher ed in the country.) The students in the program were allowed to continue, but those that were accepted for that fall, were left out to dry.

    Those prospective students, midwives, and friends rallied and wrote letters to legislators, media, and organizations, garnering international support, however Miami Dade College President Eduardo Padron, and the 8 Board Members only had excuses and weren’t interested in any of the solutions that were offered. Even the fact about the C-section and infant mortality rates being abysmal and the fact that Gov. Charlie Crist had signed onto measures to combat this–nothing was offered to the students or to support the program. Not one single glimmer of hope.

    And now look.

    More interestingly is that Jennie Joseph, owner of the Birth Place in the Winter Garden area of Orlando, FL, has been successfully attending pregnant women for quite some time. And NOW, drum-roll please…–a Certfied Nurse-Midwive pilot practice in the area has been implemented to copy her results–giving CPMs like Jennie, no credit.

    The CNM-CPM-and medical establishment debate continues….while women and babies are dying.

    They know what to do in Florida, they just aren’t doing it. It’s really that simple.

  8. Adrienne Shulman Says:

    These stats leave me just about speechless. I’m sure individual doctors believe they are performing necessary surgery each time, but the medical community should step back and look at the numbers and commit to making Miami a safer place to give birth.

    Unnecessary c-sections dis-empower the mother, often times making mothers feel victimized. They also get in the way to a successful start to breastfeeding since mother and baby cannot spend time together right away, and a painful incision site makes it difficult to hold baby while feeding.

    My only advice to mothers in Miami (and elsewhere) looking to avoid an unnecessary c-section is to do your research on your care provider – if you are delivering in a hospital with a 70% c-section rate, then chances are good you will deliver via c-section. If a natural delivery is important to you, look for a midwife or an OB that practices the midwifery model of care with fewer medical interventions. I’ve also seen a study that showed having a doula attend your birth lowers your risk of a c-section by half.

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