babble » blogs » Strollerderby
Strollerderby
Two Similar Hospitals, Two Vastly Different C-Section Rates
Five miles apart on Staten Island in New York sit two hospitals serving similar populations. One hospital has the highest c-section rate in New York City, the other boasts the fourth lowest.
In 2008, Richmond University Medical Center had a 48.3 percent c-section rate. At Staten Island University Hospital, the rate was around 23 percent. The rate was 36 percent overall in NYC between 2000 and 2007.
That’s a huge difference. How is it possible?
For one, Dr. Mitchell A. Maiman at SIUH doesn’t necessarily listen to his patients — or the doctors.
Under Maiman’s leadership, a low c-section rate at his hospital is the goal, since most studies show vaginal births are less complicated overall. So when a patient requests a c-section, the answer is “no.” And no unnecessary inductions for first-time moms before 41 weeks gestation — doctor or mother requested.
Also? VBACs are not only allowed, they’re encouraged. (That’s huge.)
Residents at the university hospital are trained to avoid c-sections, too. They’re encouraged to tell higher-ups whenever a doctor decides to prep for a surgical birth.
Doctors at his hospital either come around to his way of doing things, or they leave the hospital, Maiman told the New York Times.
Maybe such doctors head over to Richmond, where the c-section rate continues to climb. There, Dr. Michael L. Moretti, chairman of the obstetrics and gynecology department at the hospital, and his doctors are meeting with less success at lowering their rates. Still, they’re trying.
Moretti said doctors won’t refuse a c-section based only on maternal choice. However, patients requesting a c-section first have to meet with Moretti to discuss the risks. About half, he said, change their minds and attempt the birth vaginally. (Maiman apparently has a nearly 100 percent success rate in talking women out of going for an optional c-section.)
Doctors at Richmond also submit to peer review of each others’ procedures, which presumably makes them more accountable. It’s also worth noting that Richmond is known for its perinatal unit, which, according to Moretti, means they get more high-risk patients. Still, does that account for just a huge difference in their rate of c-section?
The Times article doesn’t mention VBACs at Richmond or what their policy on inductions are. The article also doesn’t say whether Maiman or Moretti allow for vaginal breech births and vaginal births for multiples. Or what their stance on doulas in the delivery room is.
Still, it looks like a loyalty to the patient (rather than a fear of malpractice), evidence-based medicine (allowing and supporting and teaching VBACs, holding off on inductions) and real information for patients (risks of surgery) might be three ways to make a huge dent in the steadily rising c-section rates in the U.S.
More Posts
Your Sad Kids Will Make You Rich
How Many Kids to Make a Mother Politically Successful?
How Your Fancy New Kitchen Poisoned Your Kids
Fewer Die in Birth Worldwide. Still, the U.S. Numbers Grow
Should a Severely Disabled Mom Get to See Her Kids?
Nannies Turn Baby Boys Into Womanizers
Photo: NYTimes.com
Go Back To Strollerderby
11 Comments
[...] Two Similar Hospitals, Two Vastly Different C-Section Rates [...]
Paying Extra to Cut in Line: Is it Fair? | Strollerderby commented on Apr 20 10 at 2:30 pmbettywu commented on Apr 20 10 at 3:00 pm“Still, it looks like a loyalty to the patient (rather than a fear of malpractice)” What? He’s not listening to patients. If they ask for one, he says no. If their doctor asks for one for them, he says no. As for fear of malpractice? It ‘ain’t Dr. Mitchell A. Maiman who is most likely get sued. I hope he’s kicking in to pay all those doctors’ malpractice insurance premiums.
mmeyer commented on Apr 20 10 at 3:21 pmIt’s nice to hear this story.
Robyn commented on Apr 20 10 at 4:13 pmI believe that all mothers should have the opportunity to have their ideal birth, whether that’s a home birth or a C-section. Of course, the world is not ideal, and sometimes moms have to be flexible. However, they should still have the choices.
Laure68 commented on Apr 20 10 at 5:38 pmI agree with bettywu. He is actually taking away pateints’ choices.
I actually like what is going on at Richmond – have any mom who opts for a c-section discuss it with a doctor first, so she can truly understand the risks. (In any case, there are very few women who actually have elective c-sections, so this alone would not result in a significant reduction in overall c-sections. On the other hand, the fact that Richmond is noted for its perinatal unit would result in a significantly higher c-section rate.)
Min commented on Apr 20 10 at 6:47 pmMy doctor wanted to induce my labor a week before my due date because she was going out of town. I almost went along with it because I didn’t know a doctor would ever do anything that would put her personal convenience over patient well-being. I definitely learned a lot. Articles like this just confirm to me that everything is so dependent on how good your doctor is…
Amy commented on Apr 21 10 at 12:49 pmActually I don’t see it as taking away their choices. He’s actually educating the patients about the true risks of procedures instead of just glossing over them. It’s also refreshing to know that their is a hospital out there where a mom doesn’t have to fight tooth and nail just to attempt a vbac. A 48.3% c-section rate is absolutely ridiculous even for a hospital with a high level nicu. Good for them for practicing evidenced-based medicine.
Laure68 commented on Apr 21 10 at 5:55 pm@Amy – actually, at Staten Island Univ Hospital, they flat-out tell the moms “no” if they ask for a C-section. The other hospital (Richmond) is the one that informs the moms of the risks, which seems like a better system to me.
I do agree that it is good to give moms an option for a VBAC. The more they educate the moms and give them the options, the better.
kat commented on Apr 24 10 at 11:45 amI know that it said that they tell the moms “no” optional c-sections but it said that the doc has a nearly 100% success rate of convincing the moms to not get unnecessary surgery. The moms can always trek the long 5 miles to the cut-happy doctors down the road if they really want to endanger their lives and their baby’s lives. Unnecessary abdominal surgery should not be taken lightly, and the doc knows way better than the moms that it’s a risk that you shouldn’t take if you don’t need to. Women DIE because of c-sections or complications after way more than from having a vaginal birth, so why wouldn’t the doctor tell them no? He knows that they can get one elsewhere if they really want to, but apparently almost 100% come to agree with him and try vaginal birth. Choices are great, but when you are making a stupid medical choice that endangers your life it’s better to have a doc who will tell you what’s up than a doc who will go along with it just to make an extra buck. C-sections are 3 times more expensive than vaginal births so I applaud the doctor who refuses to do them unnecessarily. He rocks.
Donna M Dixon commented on Dec 28 10 at 12:10 amI am a maternal and infant nurse and I can’t believe the survey missed the main reason for C-sections – doctor convenience overriding a sense of value in a natural female process. By not respecting birth as a transition and a way for women to increase their confidence, doctors (mostly male) then can justify the convenience factor. In other words, my need to see patients in the office overrides your (the pregnant woman) need to have a natural birth. The high C-section rate is not only unnecessary, it is unethical and immoral. When midwives and countries that use midwives have C-section rates about 8%, 33 % in the US is absolutely outrageous. Where is the childbearing woman’s anger about this issue?? I just get comments from pregnant women of passivity – I’ll just do what the doctor wants. We wonder why postpartum depression is increasing – all one has to do is look at the C section rate. The medicalized birth of 2010 robs women of this significant accomplishment and rite of passage.
Aubreyyyy commented on Aug 01 11 at 9:41 amI agree with Kat…if you want a C-section..go 5 miles down the road and have it your way.
Add your take:
Note: Babble is a supportive, diverse community. We encourage a range of opinions,
but any unduly hostile comments will be removed.
Comments are delayed up to 15 minutes
Lori Garcia 
Joslyn Gray 
Amber Doty 
Julianna Miner 
Monica Bielanko 
Sierra Black 
Meredith Carroll 
Carolyn Castiglia 
Sunny Chanel 
Madeline Holler 
Rebecca Odes 
Danielle Smith 
Danielle Sullivan 
Katherine Stone 
The Walt Disney Company supports Babble as a platform dedicated to honest, engaged, informed, intelligent and open conversation about parenting. However, the opinions expressed on this site are those of individual parents/writers and do not reflect the views of Disney. In addition, content provided on this site is for entertainment or informational purposes only and should not be construed as medical advice, diagnosis, treatment, or safety advice.
11