Of the roughly 500,000 babies born in California every year, one-third are born via cesarean delivery, or C-section, although individual hospitals rates vary. Nationwide, C-section rates can run as high as 50 percent.
In certain instances, a C-section may be medically necessary — even lifesaving — but there are also serious risks involved. Doctors typically recommend the procedure because there may be a high-risk complication making a vaginal birth unsafe.
However, C-section rates are growing, with little evidence that the increase is resulting in better outcomes for moms and babies. The federal government took note and gave all U.S. hospitals a target to not to exceed a 23.9 percent C-section rate — for first-time mothers with low-risk pregnancies — by 2020.
Sharp Grossmont Hospital was recently recognized for its diligent work to lower its rates, which have decreased from 32.5 percent in 2014 to 20 percent in 2018.
Lisa DeLong, a perinatal educator at Sharp Grossmont Hospital Women's Health Center, explains more about C-section rates and why they matter:
Why have C-section rates increased in recent years?Between 1998 and 2008, C-section births rose from 22 to 33 percent, making it the most commonly performed surgical procedure in the U.S. The increase may partially be due to a growing high-risk population — patients with diabetes, high blood pressure, obesity and advanced maternal age. There is also great variation between regions, hospitals and providers. This variation suggests there are opportunities for improvement in practice.
When should a C-section be considered? And what are the risks?Multiple births, placental complications, fetal distress or when the baby is too big to fit through the birth canal are all possible reasons to have a C-section. Although a C-section can be lifesaving, it carries increased risk for bleeding, infection and potential psychological stress. C-section birth is also associated with increased pain and fatigue, longer hospital stays, longer recovery times, and decreased breastfeeding success.
Subsequent pregnancies may also be affected; once a patient has had their first C-section, the risk of a future C-section increases by 90 percent, and the risk of uterine rupture and placental abnormalities increases as well. That's why it's important to prevent the first C-section to promote quality outcomes for the future.
What steps has Sharp Grossmont taken to lower its C-section rates?The Labor and Delivery team at Sharp Grossmont undertook a multidisciplinary approach with patient safety as a priority. A task force was formed, including obstetricians, nurses and administrative leaders who championed evidence-based strategies to promote vaginal birth.
A labor positioning handbook was created for Labor and Delivery teammembers, which advocates for:
- Frequent position changes during labor
- Patient mobility during labor, including walking
- Use of a peanut ball — a peanut-shaped exercise ball known to help shorten labor
Focus was also placed on education, the creation of guidelines and the development of checklists to help patients, doctors and nurses make informed choices.
Why is it significant that Sharp Grossmont is on the C-section honor roll?Smart Care California is a public-private partnership working to promote safe and affordable health care. The organization issues an annual C-section honor roll recognizing hospitals in California that meet or surpass the federal target aimed at reducing births via C-section in first-time, low-risk pregnancies.
Sharp Grossmont is one of only two hospitals in San Diego County to earn a place on their honor roll for three consecutive years, in recognition of their work to lower C-section rates.
For the news media: To talk with Lisa DeLong about Sharp Grossmont Hospital's work to lower C-section rates for an upcoming story, contact Erica Carlson, senior public relations specialist, at email@example.com.