07 March 2010

high-touch birth

Lessons at Indian Hospital About Births

...In Tuba City last year, 32 percent of women with prior Caesareans had vaginal births. Its overall Caesarean rate has been low — 13.5 percent, less than half the national rate of 31.8 percent in 2007 (the latest year with figures available). This is despite the fact that more women here have diabetes and high blood pressure, which usually result in higher Caesarean rates...

How do they do it? Check out the entire NY Times article here.

I read this makes-you-shake-your-head-because-it-can-be-so-simple article after coming home from a birth at a hospital five minutes from my home where MANY doctors (whole practices) don't take call on weekends. Period. So there is a very good chance the doctor you stayed at this hospital for will not even be there, won't even know you're in labor. When you get there, get ready to sit in an office not unlike that of a car dealership, where copies will be made of your driver's license and insurance card before you can go to triage. Where you stay in bed if your water is broken. Use a bedpan, 'cause you're not getting out of bed to pee. Be ready to have "concerned" conversations over the birth ball you brought. A hospital where the Friedman Curve is king. Where there isn't even a pantry room because nothing but ice chips is permitted, so why would you need a fridge or microwave or electric tea kettle. Where one can feel truly lucky if not among the 49.3% of birthing women who have a cesarean at this hospital.

There are hospitals within spitting distance where the level of care is as good (better, in my opinion) but people don't have to put up with this way of doing birth. Yet many people still flock to this institution. I don't know why and will continue to offer information on alternatives and then meet them where ever they are, trusting that they know what feels best for them. But in my heart, I'll likely wish we were someplace else...maybe Tuba City.

OK - rant over.


Anonymous said...

Thanks for the link to this article! I've been looking for some ideas on how we could remove incentives for doctors to perform cesareans. For some reason I hadn't thought about salaried income, lol.

Sarah said...

I used a study from a group of Native American hospitals in the SW US as a reference in a paper I did last year for my CCE cert. Study was from 1997 I believe with very similar results. Extremely low overall c/sec rate, I think about 7%, and also very low subsequent c/sec rate. This all in spite of having a higher percent of moms w/type 2 diabetes and BP issues. Ok I just cut n pasted this from the bibio on that paper:

“A Native American Community With a 7% Cesarean Delivery Rate: Does Case Mix, Ethnicity or Labor Management Explain the Low Rate?” by Lawrence Leeman, MD, MPH & Rebecca Leeman CNM, MSN. Originally published in the Annals of Family Medicine, May 2003.

DoulaMomma said...

Thanks Sarah - will check it out!