By Jessica Alaimo • CentralOhio.com • January 9, 2010
More than a quarter of the low-risk babies born in Ohio to first-time mothers are born by a Caesarian section.
There is a wide disparity in these numbers within state hospitals, according to 2008 data just released by the Ohio Department of Health. The rates range from 6.6 to 60 percent.
Women who undergo C-sections face the normal risks of surgery -- infection, blood loss and an extended recovery time. Babies have a greater chance of respiratory problems or injury from the incision, medical professionals say.
Janet Runner, vice president of patient care services at Bellevue Hospital in Sandusky County, said even though the hospital's C-section rate is higher than the state average, the mothers and babies have good outcomes.
"We have a system in place where we check all C-sections for appropriateness," she said.
Many women request scheduled Caesarian sections. When that happens, doctors have a frank conversation with the mom-to-be about the risks involved.
Total C-sections in Sandusky County stayed level, around 22 percent, between 1990 and 1995. They dropped off between 1996 and 2000, and have increased since then, according to state data.
In the late 1990s, the hospital had midwives on staff. Since midwives spend more time with their patients, the mom is more likely to give birth vaginally.
But more recent research showed having a traditional birth after a previous Caesarian is harmful to the mother. So more women who had a C-section had the procedure for subsequent babies, said Dr. Elizabeth Koffler of Licking Memorial Hospital in Newark.
Now, only a limited number of hospitals allow vaginal birth after Caesarians, which has become a special procedure.
Dr. Cynthia Flynn at Memorial Hospital in Fremont said repeat procedures are driving the hospital's increase in C-sections.
Generally, the decision to have a primary C-section is made by the doctor, but the American Congress of Obstetricians and Gynecologists supports a woman's right to choose a C-section for any reason, Flynn said.
Dr . Guy Capaldo, an obstetrician and gynecologist at Women's Care in Mansfield, said the C-section rate in his area is on par with the national average.
Common reasons for low-risk pregnancies to end in C-sections are because the baby is too big, or because it is not coming out head first. The baby also may have fetal hemorrhaging or some other symptom that requires a quick delivery.
Capaldo said he tries to avoid C-sections simply by request.
"They come in, they want to pick the day, want to pick the time that they'll have their baby," Capaldo said.
When that happens, he discusses the risks of both birthing methods. Going into labor has far fewer risks, he said.
Dr. Bijan Goodarzi, an obstetrician at Genesis Bethesda Hospital in Zanesville, said C-section requests don't happen often, but when they do they're handled on a case-by-case basis.
Once, Goodarzi said, a woman's husband was ready to be deployed to Afghan-istan. While she wasn't ready to go into labor, doctors determined a C-section could safely be performed, so she could give birth before her husband left.
There is some evidence C-sections are better for the woman's long-term health. Brazil, Goodarzi said, has the highest level of C-sections. Those women also have lower instances of urinary incontinence and pelvic organ prolapse.
Miami Valley Hospital in Dayton has the state's lowest C-section rate among first-time, low-risk births in the state. Of these 1,315 births, 88 were Caesarians, a rate of 6.6 percent.
The hospital specializes in high-risk births, so there are a number of specialists on staff, said Dave McKenna, a maternal fetal medicine specialist at Miami Valley.
"Some hospitals are too quick to do C-sections," McKenna said. "Babies do better after vaginal delivery. There is a lower rate of admission to the neonatology critical care unit due to low rates of respiratory problems. They're more likely to successfully breast-feed."
jalaimo@nncogannett.com 740-328-8576
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