Tuesday, May 22, 2018
Health

Even for low-risk births, some Tampa Bay hospitals have high C-section rates

TAMPA — For years, health officials have struggled to reduce the high rate of surgical births in the United States, amid reports that American babies are more than twice as likely to arrive via caesarean section than in countries such as the Netherlands.

A new study from Consumer Reports shows that C-section rates vary not just between nations, but even between hospitals in the same area.

Consumer Reports looked at the rate of C-sections done in low-risk births at 1,500 hospitals in 22 states, including Florida.

In the Tampa Bay area, Tampa General Hospital and South Florida Baptist Hospital in Plant City were found to have the lowest local rates, placing them at the national average of about 12 percent.

But nearby St. Joseph's Women's Hospital in Tampa — which delivers the most babies in the area — had one of the highest rates for low-risk births, at 27 percent.

Florida Hospital Tampa, Bayfront Health St. Petersburg, Brandon Regional Hospital and Florida Hospital North Pinellas all posted rates of 24 percent, followed by Mease Countryside at 25 percent. Bayfront Health Dade City had the highest local rate at 28 percent.

Why are so many local babies delivered by C-section, even when there are no signs of risk to mother or child?

"Doctors tell us that it has just become acceptable, normal for that area, the way it's been done," said Doris Peter, director of Consumer Reports' Health Rating Center. "So doctors are trained to do it and patients hear that it's just what is done."

But that is changing, said Dr. William Sappenfield, director of USF's Lawton and Rhea Chiles Center for Healthy Mothers and Babies.

"We've known for a while that rates are high, yes, but at least in Florida, they are starting to decline," he said.

For all births, not solely the low-risk ones Consumer Reports looked at, the Florida C-section rate was about 38 percent in 2012 and 37 percent so far this year, according to the state health department. The U.S. rate in 2012 was just under 33 percent.

Florida numbers "are going in the right direction," Sappenfield said. "But we didn't get to this level quickly and it's going to take a little bit of time to reduce it further."

C-section is among the most common operations performed today. It is literally a lifesaver if mother or baby is at risk. It also can be convenient, since it allows birth to be scheduled.

While it is considered safe, it isn't without risk and many health experts worry that C-sections are done too often for the wrong reasons.

"Many people don't realize that a C-section is major surgery and there can be complications, more so than with a vaginal delivery," said Dr. Cathy Lynch, associate vice president for women's health and professor of obstetrics and gynecology at the USF Morsani College of Medicine.

Lynch, who delivers babies at Tampa General, says it's up to physicians to encourage vaginal births whenever appropriate.

"If we hope to lower C-section rates, we need to limit them to patients who truly need them and not set them up because of the miseries of pregnancy or out of convenience."

At the same time, she said, concern about C-sections has driven some women away entirely from hospital births to seek at-home deliveries, which could be dangerous in some cases.

Peter said that she hopes the survey helps emphasize that women should be part of the decision concerning delivery.

"Have that discussion when you're not under pressure, when you can communicate your preference, especially if you want to avoid a C-section," Peter said.

St. Joseph's and Mease Countryside are part of the BayCare Health System. Spokeswoman Beth Hardy called the Consumer Reports findings "another tool in the tool box to help women make decisions about their delivery."

Though St. Joseph's scored poorly in the Consumer Reports survey, it has made strides in another key issue regarding childbirth. For years, it has worked with the March of Dimes to curb elective deliveries during the 37th and 38th weeks of fetal gestation. At a few weeks shy of full term, such early births aren't considered premature. When the project launched at St. Joseph's in 2011, officials found that 39 percent of their early-term deliveries were being done for convenience, not medical necessity. That rate now is less than 1 percent, according to a study last year.

Irene Maher can be reached at [email protected]

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