Going Back to Basics as Hospitals Reduce C-sections
Jan 7, 2021
Emma Dugas
Doctor in hallway

Dr. Katarina Lanner-Cusin has been passionate about babies since she was a child herself. Now, after more than 25 years as an obstetrician, Lanner-Cusin has teamed up with nurses, midwives, doulas and others to rethink childbirth in hospitals across Northern California.

“For the most part babies are still born today in the same way that they have been born for generations,” said Lanner-Cusin. “But many things associated with childbirth started to change at the end of the last century. We saw less patience with labor that is progressing slowly, more use of technology during childbirth, and ultimately a rise in cesarean deliveries.” A cesarean birth, or C-section, is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus rather than vaginally.

In 2015 one in three newborns were delivered by C-section in California. That’s a 60% increase over the State’s cesarean rate in 1997. “Alarmingly, obstetricians like myself couldn’t find any medical justification for the sharp increase in these surgeries, which themselves carry real risks,” remembers Dr. Lanner-Cusin.

A vaginal birth is not always feasible and a cesarean birth can save the lives of mothers and infants when difficulties arise. However, C-sections can come with a higher risk of complications. They can require a longer recovery period, and a higher cost than vaginal birth (to account for surgical services), so they should only be initiated when medically necessary.

To respond to the observed rise in C-sections statewide, Sutter Health developed detailed reporting and quality improvement programs. They have aided the entire team of professionals who help deliver babies in the 18 Sutter network hospitals that offer labor and delivery services.

“We’ve worked hard to ensure every C-section was done for the right reasons, and our work quickly showed results,” said Dr. Lanner-Cusin. In 2016 the first C-section honor roll was published in California. Eleven Sutter hospitals were honored for having a C-section rate of 23.9% or lower among low-risk, first-time moms with normal pregnancies. Today, 17 hospitals in the Sutter network met this goal, which happens to also be the National “Healthy People 2020” target. Nine of those hospitals have been on the honor roll for five years in a row.

The not-for-profit Sutter Health network has an overall average C-section rate of 21% across 18 birthing hospitals. Keeping cesarean births low not only improves outcomes for patients, but saves patients, insurers and government programs, like Medicaid, costs associated with C-section surgeries. “Our progress here shows that the best of both worlds – improved outcomes resulting in lower cost of care – is possible,” said Dr. Lanner-Cusin.

“Our hospitals deliver approximately three kindergarten classes’ worth of babies every day across our Northern California network and we maintain some of the lowest rates of birth by C-section in the state,” said Dr. Lanner-Cusin. “This is only possible because of our integrated network and our investments in system-wide quality and teamwork.”

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