Primary and repeat cesarean delivery rates are now high in the U.S., with nearly one-third of women delivering by cesarean compared to 21 percent in 1995. Cesarean delivery has also associated with a higher risk of maternal complications, longer length of stay and longer postpartum recovery, but there are non-medical reasons why it is difficult to lower the rates.
In a paper to be presented Thursday, researchers looked at all singleton term deliveries at a community hospital between January 2005 and April 2014. Demographic, clinical and outcome data were collected at the time of delivery. In this community hospital with a diverse patient population, there were two changes made in April 2011 that were associated with lower cesarean delivery rates: Midwives became available to all laboring women and obstetrician staffing practices were changed to allow doctors to focus solely on their laboring patients instead of having to juggle their surgical and office responsibilities.
Before the change was instituted, women cared for under the traditional, private practice obstetrician model had high cesarean delivery rates that had been increasing every year, which was the same trend taking place nationally. After the changes were made, cesarean delivery rates not only dropped but they continued to decrease more each year.
There are arguments against the midwife aspect of this: Abortion was legalized because we want all aspects of pregnancy to be done my medical personnel. People who take a training course and pay a fee are not going to be equipped to deal with an emergency. In the modern 'defensive medicine' world of government health care control, no responsible doctor is going to sign off that a delivery by a midwife is absolutely safe. Taking a step backward and advocating that pregnant women don't need hospitals or doctors looks bad, because hospitals and doctors will still get sued. Former Senator and Vice-Presidential candidate John Edwards made his fortune suing hospitals for not doing cesarean deliveries enough and the legal implications for using more midwives rather than doctors are astounding.
The increase in cesarean deliveries is the result of trial judgments against hospitals and doctors who did not do enough of them, according to attorneys, it is the precautionary principle in action.
Having doctors who specialize in labor obviously makes more sense, they are then more familiar with the labor of their patients.
"Both primary and repeat cesarean delivery rates have been at an all time high in recent years and it has been difficult to identify what can be done to reverse the trend," stated Melissa Rosenstein, M.D., one of the researchers on the study who is with the University of California, San Francisco, Division of Maternal-Fetal Medicine in their statement. "This research demonstrates that changing from the traditional model of obstetric care to one that expands access to midwives and to OB/GYN doctors whose schedule is structured to allow them dedicated time spent delivering babies, without having to come in from the office or from home, is an intervention that can successfully lower cesarean delivery rates and make childbirth safer."
Title: The Effect of Expanded Midwifery and Hospitalist Services on Primary Cesarean Delivery Rates, upcoming plenary session February 5th 8 AM PST at the Society for Maternal-Fetal Medicine's annual meeting
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