THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, May 31, 1996 TAG: 9605310494
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 118 lines
For the first time, women in Virginia can clearly see how hospitals compare when it comes to their rates of performing Caesarean sections, the surgical removal of a baby from the uterus.
A report released Thursday by the Virginia Hospital & Healthcare Association, HCAA, and Virginia Health Information, rates 67 hospitals across the state, including 10 in South Hampton Roads.
It shows Norfolk Community Hospital, which does significantly fewer deliveries than most area hospitals, with the region's highest rate of Caesarean sections. The hospital also serves the highest percentage of poor women, who often don't get adequate prenatal care.
DePaul Medical Center in Norfolk, with 1,500 deliveries a year, has the region's lowest rate.
The report's authors cautioned consumers about using the information as the only criteria for choosing a hospital to deliver their babies.
Rather, said Barbara S. Brown, VHHA's director of clinical services and one of the report's authors, prospective parents should use the information as a starting point for discussions with their doctors.
``It is not saying this is a good or bad hospital, or a good or bad group of physicians,'' she said. ``It is saying if you have concerns that you don't want this practice pattern where you deliver, then you need to discuss it with the doctors.''
The report used hospital discharge information from July 1, 1993, through June 30, 1994. The data was adjusted to account for hospitals, such as Sentara Norfolk General, that traditionally deliver women with more medical problems.
The report comes at a time when there is a nationwide effort to lower Caesarean section rates. A Caesarean is medically riskier and more expensive than a vaginal delivery.
A Caesarean section - commonly referred to as a C-section - is a surgical procedure in which incisions are made in a woman's abdomen and uterus to remove the baby. It is done when maternal or fetal conditions exist that could make vaginal delivery hazardous.
The nation's overall rate of Caesarean sections has dropped from 24 percent in 1984 to 22.8 percent in 1993, according to the American College of Obstetrics and Gynecology. The decrease is mainly due to a growing trend to encourage women who have had a previous Caesarean section to deliver vaginally.
The country's C-section rate is still higher than in most other developed countries, and a national health objective by the year 2000 is to reduce the overall rate of Caesarean deliveries to 15 percent.
DePaul Medical Center is already there, with a 14.7 percent Caesarean rate. Ted Hughes, chairman of obstetrics and gynecology, said the hospital has always had a low C-section rate.
``There's nothing specific that we do,'' he said. ``The doctors and nurses are more patient. We will wait it out'' on a lengthy or complicated vaginal delivery.
At Norfolk Community, Dr. Joseph Isaac, chairman of obstetrics and gynecology, said the hospital's rates look more dramatic simply because the hospital does far fewer deliveries than the others in Hampton Roads.
However, he said, it isn't surprising that the hospital has a higher rate, given the population it serves.
Almost half of Norfolk Community's patients use Medicaid, the government insurance program for the poor. The hospital gives more charity care than any other hospital in the state.
The hospital also sees a high number of mothers who used drugs during their pregnancy, Isaac said. ``We have patients that have no prenatal care.''
About two years ago, Norfolk Community began a campaign to lower the C-section rates. The rates for 1995 are much lower - 20 percent, said Phillip Brooks, Norfolk Community's president.
``This is something we're very sensitive to,'' Brooks said.
Some of the improvement has resulted from education. Recently, Norfolk Community created a substance-abuse program for pregnant drug abusers.
But Isaac said the hospital can only do so much, because some women will insist on C-sections regardless of their doctors' advice. The state report doesn't track how often the mothers demanded the procedure.
At the four Sentara hospitals, reducing C-section rates has been a priority for more than a year, said Dr. Willette L. LeHew, who headed a Sentara task force on the issue.
In the past year, LeHew and other doctors have met with medical staffs at every Sentara hospital to emphasize the importance of vaginal delivery, even after a woman has previously delivered by Caesarean section. ``Unless there's a true, recurring reason to do the C-section, the patient should try labor,'' he said.
Consequently, Sentara's rates of vaginal births in women who have had previous Caesarean sections have increased to between 60 and 80 percent in the past year, he said, compared with about 39 percent shown in the state report.
Education is crucial, LeHew said. So the hospitals send information about vaginal births after Caesareans to every pregnant woman who previously had a C-section and is planning to deliver at a Sentara hospital.
At Virginia Beach General Hospital, reviewing C-section rates for individual doctors - and publishing those rates internally every three months - has helped bring down the hospital's overall rate, said Douglas D. Dibona, a Virginia Beach obstetrician.
``We ask, `why are we sectioning people?' And we'll pull records of sections that need reviewing and, if need be, go back to the physician and ask him to explain what happened,'' DiBona said.
Making such information public is one way to reduce the rate even further, according to a 1995 Centers for Disease Control and Prevention study.
The HCAA initially wanted to publish rates for each doctor, Brown said, but doctors objected, saying the information provided by hospitals often wasn't accurate.
Eventually, she said, that information should be available to consumers. MEMO: The reports also contain information on hospital charges for
vaginal and Caesarean deliveries and on pre- and post-natal services
hospitals provide.The reports also contain information on hospital
charges for vaginal and Caesarean deliveries and on pre- and post-natal
services hospitals provide.
For a free copy, contact Virginia Health Information at (804) 643-5573.
Staff writer Marie Joyce, news researcher Diana Diehl and editorial
assistant Kathryn Darling contributed to this story. ILLUSTRATION: Graphics
KEN WRIGHT/The Virginian-Pilot
HOSPITAL BIRTHS
SOURCE: Eastern Virginia Guide to Obstetrical Services
[For complete graphics, please see microfilm]
KEYWORDS: HOSPITALS HAMPTON ROADS TIDEWATER
BIRTHS CAESAREAN SECTIONS by CNB