According to recent medical data, a higher percentage of Maine women are giving birth by cesarean section than ever before. While some medical officials say the rising c-section rate is nothing to worry about, others call it an alarming trend that may cause unnecessary deaths. And an examination of state data on coastal hospitals reveals that some hospitals have much higher c-section rates than others, so where a pregnant gives birth might determine how likely she is to have a c-section.
Over the last decade, Maine’s c-section rate has risen dramatically. In 1996, two in ten Maine women gave birth by cesarean; by 2006, that number rose to three in 10. While Maine’s c-section rate is consistent with the national average, it’s still twice as high as what’s recommended by some health officials. According to the World Health Organization, no industrialized nation should have a c-section rate higher than 15 percent.
Cesarean surgery, like all abdominal surgery, carries some risks, including life-threatening complications. Mothers are four times more likely to die during c-section surgery than during vaginal birth, according to the World Health Organization, and still twice as likely if the cesarean is elective.
While c-section rates generally rose among all hospitals along the coast, the increase hasn’t been even across the board, according to state data. In 2007, Waldo County General Hospital in Belfast had the second-highest c-section rate in Maine at 43.7 percent, outpacing larger medical centers like the Eastern Maine Medical Center in Bangor and the Maine Medical Center in Portland. Meanwhile, the Southern Maine Medical Center in York had less than half that rate at 19.3 percent.
Dr. Jay Naliboff, chairman of the Maine chapter of the American College of Obstetricians and Gynecologists (ACOG), said c-section rates are not a great indicator of hospital performance. The only reason c-section rates were lower in the nineties was because doctors were encouraging women who previously delivered by c-section to try for vaginal births with subsequent pregnancies, a procedure known as Vaginal Birth After Cesarean (VBAC).
But then several medical studies found an increased risk of 0.5 percent of uterine rupture during VBACs than previously thought. After the studies became public, ACOG guidelines discouraged VBACs in all but hospitals equipped to administer immediate emergency c-sections. This closed off the option for VBACS in many smaller hospitals.
Naliboff also blamed a lawsuit-happy culture for contributing to the high c-section rate. U.S. doctors favor c-sections more than doctors in other countries because they face a greater threat of malpractice lawsuits here, argues Naliboff.
“How many lawyers are there in Angola?” he said.
He felt the 15 percent cesarean-section rate goal championed by the World Health Organization was unrealistic. In fact, his organization no longer tries to lower cesarean-section rates, he said.
“Basically, the college has given up,” Naliboff said. “No one knows the ideal cesarean-section rate.”
But Dr. Marsden Wagner, the retired director of women and children’s health at the World Health Organization, said the 15 percent goal was set after careful examination of all available medical studies and worldwide maternal mortality rates. The 15 percent limit was first set in 1985, but revalidated in 2005. The evidence for the limit is overwhelming, Wagner said.
Attempts for interviews with officials at Waldo County General Hospital and York Hospital, two hospitals with high cesarean-section rates, were unsuccessful.
Officials at the Southern Maine Medical Center, which has the state’s lowest cesarean-section rate, were more responsive. Karen Chasse, the hospital’s community relations specialist, said the secret for their low cesarean-section rate was a result of “working with the patient to manage the labor.” New pain medications can block out much of the worst pain of labor while still allowing the necessary muscle control to facilitate vaginal births, she said. Chasse has experienced the technique first-hand.
“We all love it,” she said.
Other hospitals employ the use of nurse-midwives for most normal deliveries; studies show that women who deliver with nurse-midwife attendants often experience a lower than average cesarean-section rate.