Ob-gyns address pressure to lower cesarean section rates

Delivery decisions should be made based on the individual patient, not numbers, say doctors.

By Victoria Stagg Elliott, AMNews staff. May 28, 2001.

When Michael L. Socol, MD, took over as chief of obstetrics at Northwestern Memorial Hospital in Chicago in 1987, the cesarean section rate at the private teaching hospital was 27.3%. By 1996, it had dropped to 15.4%.

He achieved this decrease by instituting a protocol of active management of labor and circulating physicians' C-section rates among their peers rather than allowing them to remain private.

Northwestern was one of many institutions to react to the high cesarean rates of the 1980s and attempt to increase the rate of vaginal birth -- considered more safe and less of a strain on the health care system. "Pregnancy is a healthy time frame, and as a society we have to realize that the overuse of any of our interventions threatens the larger community as resources are limited," Dr. Socol said.

Reducing cesarean rates has its advantages, including lowered mortality and morbidity, reduced costs and shorter hospital stays. In addition, they have long been used as a measure of quality of care by insurers, managed care organizations and other agencies.

Ob-gyns complain, however, that this approach represents a disconnect. What should be a decision made based on a patient's choice, individual physiology and circumstances is too often being influenced by pressure to get the numbers down, according to attendees at the American College of Obstetricians and Gynecologists annual meeting in April.

"Personally, I wouldn't do a VBAC [vaginal birth after cesarean] on someone with four previous cesareans or someone whose last baby was 12 pounds, but that's what we're seeing," said Stanley Zinberg, MD, vice president of practice activities with ACOG. "The pendulum always swings a little too far." [...]