(Pic by abarefoot)
(Pic by abarefoot)

Several Miami hospitals reported C-section rates higher than 50 percent in 2010

By | 09.02.11 | 12:08 pm

As of last year, the state of Florida held quite a dubious record: the highest Caesarean rate in the country. In Florida, however, there is no city that has a higher C-section rate than Miami.

In all of Florida, Miami has the highest number of hospitals that are delivering more babies via C-section than natural deliveries.

Reproductive justice advocates and some public health professionals have been wary of the rising rate of C-sections, or Caesarean sections, in the U.S.; many advocates, researchers and doctors claim the rate increase is a sign of trouble.

According to a recent HealthGrades Obstetrics and Gynecology in American Hospitals report, Florida’s C-section rate was 38.6 percent in 2010 — the highest in the nation. The lowest rate belonged to Utah, which had a 22.4 percent C-section rate. The national C-section rate between 2002 and 2009 rose from 27 percent of all single births to 34 percent.

HealthGrades says this “an all time high.”

According to information provided and certified by the Agency for Health Care Administration’s Florida Center for Health Information and Policy Analysis, five hospitals in Miami alone reported a C-section rate higher than 50 percent. That means multiple hospitals in Miami are currently performing more Caesarians than natural child births. Miami is leading the nation in Caesarian sections.

Childbirth Connection — a national nonprofit research, education, advocacy and policy organization — says the rising C-section rates are not a positive trend.

“Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5 percent to 10 percent,” the group claims. “Rates above 15 percent seem to do more harm than good.”

Childbirth Connection says that there are a lot of misconceptions as to why the rate is growing, nationally. The group lists seven factors that contribute to the rise:

(1) A “low priority of enhancing women’s own abilities to give birth.”

(2) “Side effects of common labor intervention.”

(3) “Refusal to offer the informed choice of vaginal birth.”

(4) “Casual attitudes about surgery and cesarean sections in particular.”

(5) “Limited awareness of harms that are more likely with cesarean section.”

(6) “Providers’ fears of malpractice claims and lawsuits.”

(7) Last, is “incentives to practice in a manner that is efficient for providers.”

The New York Times reported last year on the growing national trend. According to a March 2010 article:

The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”

Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.

The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit. The report states, “In addition to health and safety risks for mothers and newborns, hospital charges for a Caesarean delivery are almost double those for a vaginal delivery, imposing significant costs.”

These are concerns that women’s health advocates and public health professionals have been discussing for years.

Right now there is no bigger cause for concern than Miami.

Miami, alone, accounted for six out of the seven hospitals in Florida with a C-section rate of over 50 percent, according to data from the Agency for Health Care Administration.

In 2010, South Miami Hospital reported a 62 percent C-section rate. Behind South Miami, Kendall Regional Medical Center reported a 59 percent rate, Mercy Hospital also reported 59 percent, Jackson Memorial reported 57 percent, Hialeah Hospital reported a 56 percent rate and Mount Sinai Hospital reported a 52 percent C-section rate. With the exception of Holy Cross Hospital in Fort Lauderdale, each of the state’s hospitals performing over 50 percent of deliveries via C-section were located in the Miami-Dade area.

According to South Florida Parenting, from 2009 to 2010, Kendall Regional Medical Center reported a 70 percent C-section rate, one of the highest rates seen in the state.

Manuel Fermin, the CEO of the Healthy Start Coalition of Miami-Dade, says hospitals in Miami that report these types of numbers are not looking out for women. He says that doctors and hospitals can end up making more money from C-sections, as compared to vaginal births. Coupled with decreased risk, C-sections are better for hospitals’ bottom line.

“Here in Miami, this has become a business,” Fermin says.”It is so out of whack it’s scary. You don’t find this anywhere else in the U.S.”

However, Dr. Aaron Elkin, a board-certified obstetrician and gynecologist, says it is not that simple.

First, he explains, there is little difference in the cost of C-sections and vaginal births. While C-sections require the cost of surgery, vaginal births rack up costs in the long monitoring process. The equipment and the presence of nurses for such a long period of time, Elkin explains, disproves the assertion the C-sections make more money for hospitals. While it may have been different in the past, he says it is no longer the case.

“We no longer get paid more for Caesareans,” he tells The Florida Independent. “The reimbursements from insurance and even Medicaid are the same.”

The biggest factor explaining the C-section rate in Miami, according to Elkin, is the rate of repeat C-sections.

He says that in Miami there is a high rate of immigrant women from South America who have elective C-sections. Because women can risk a uterine rupture by having a vaginal birth after a prior C-section, most doctors and patients decide together that another C-section is the best course of action.

Elkin says he agrees that 70 percent is a high number.

Other doctors have pointed to the fact that “obstetricians fear malpractice suits if mother or baby is injured during a protracted labor and delivery” and the rising health complications from the increase in obese mothers, according to reporting from St. Petersburg Times.

Either way, public health professionals such as Fermin says this is a growing problem in Miami-Dade that needs to be addressed.

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