California sees slight dip in C-section rates, but challenges remain

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California's hospitals have scored modest gains in their efforts to minimize the number of Cesarean sections performed on women at low risk of complications, according to data released Monday. But the data also show that as a group, the state's medical facilities still have not hit a national target and many remain far from reaching the goal.

In addition, there continues to be wide variation in how facilities perform on this measure, says Dr. Bruce Spurlock, executive director of the California Hospital Assessment and Reporting Task Force, a multi-stakeholder group that published 2014 data on hospital performance.

"Californians deserve better care and more active improvement than we've seen," Spurlock says.

The task force analyzed state data from 244 hospitals regarding C-sections performed on first-time moms with low-risk pregnancies, defined as those that have reached the 37th week or later and consisting of one fetus in the head-down position. (The technical term for this type of pregnancy is Nulliparous Term Singleton Vertex.)

Statewide, the average rate of these types of C-sections dropped from 27.4 percent in 2013 to 26.5 percent in 2014, according to the new data. The federal government has set a goal of reducing C-sections in low-risk pregnancies to 23.9 percent by 2020.

The average rates mask the wide variation among hospitals: The top performing 10 percent of hospitals had C-section rates of 19 percent or lower. Meanwhile, the worst performing 10 percent had rates of 33 percent or higher. The number of births at a hospital doesn't seem to be a factor, since there is a mix of facilities with high and low volumes throughout the rankings.

Complications can arise in low-risk pregnancies, and in those cases, C-sections can save the lives of mothers and infants. But experts say the procedure, which is major surgery, is frequently performed when it is not medically indicated. 

C-sections carry with them the risk of bleeding, infection, blood clots and injury to other organs. First-time mothers who undergo the procedure are very likely to have it again with future births, and that brings risks of additional complications, experts say.

Like the rest of the state, there is wide variation in the performance of Southern California hospitals.

Loma Linda University Medical Center in Murrieta and La Palma Intercommunity Hospital in northern Orange County both performed C-sections on less than 20 percent of first-time moms with low-risk pregnancies in 2014, according to the data. Loma Linda brought its rate down from 23.7 percent in 2013 to 18.1 percent in 2014; La Palma dropped its rate from 21.1 percent in 2013 to 17.5 percent in 2014.

Kaiser Permanente of Woodland Hills also achieved a significant decrease, from 25.7 percent in 2013 to 19.3 percent in 2014.

Dr. Jeffrey Martin, chief of obstetrics and gynecology at Kaiser Woodland Hills, says the hospital has taken a number of steps to reduce its C-section rate. One key change, he says, is that doctors now allow first-time moms who are fully dilated to push for an hour longer than they previously did before the physician will recommend a C-section.

"The data shows that if we allow women to continue to push in that second phase of labor, assuming the baby is doing well, there's a higher chance of them having a vaginal delivery than we used to think," he says.

At the high end of the rankings, Memorial Hospital of Gardena and Sun Valley-based Pacifica Hospital of the Valley both performed C-sections on more than half of moms with low-risk pregnancies in 2014 - 55.4 percent at Memorial and 55.7 percent at Pacifica.

In a statement, Memorial CEO Kathy Wojno says she's disappointed by the hospital's C-section rate.

"The health and wellbeing (sic) of the communities we serve is paramount, and it worries me that patients will see our scores and mistakenly determine that we are not providing high quality maternity care," Wojno says. "That's just not true."

The facility has hired a perinatologist who's available around the clock to consult with obstetricians when patients develop pregnancy complications, she adds.

The persistence of high C-section rates is in part a reflection of hospitals' labor and delivery units developing cultures that don't prioritize "supporting normal birth," says Dr. Elliott Main, director of the California Maternal Quality Care Collaborative, which helped analyze the data released by the Task Force.

Beginning next month, the Collaborative will launch a program that aims to reduce unnecessary C-sections. Main says mentors will work with eight hospitals at a time to identify and share best practices.

"In this way, hospitals can share their successes, their barriers, and the strategies to overcome them," he says. This technique, he adds, has also been used to cut the state's maternal mortality rate in half over the past five years.

Memorial Hospital of Gardena's Wojno says that her facility will be one of those working with the Collaborative.

The Leapfrog Group, which focuses on hospital safety and quality, released statewide and hospital-level C-section data last fall. But more than 45 percent of California hospitals declined to respond to its survey.

California Hospital Assessment and Reporting Task Force data on NTSV* C-section births at Southern California hospitals

Hospital City 2014 NTSV Births* Percentage of NTSV C-Section Births*
AHMC Anaheim Regional Medical Center Anaheim 537 22.3
Antelope Valley Hospital Lancaster 1475 33.7
Arrowhead Regional Medical Center Colton 734 20.7
Barstow Community Hospital Barstow 100 20
Beverly Hospital Montebello 231 35.1
California Hospital Medical Center Los Angeles 1194 23.5
Cedars-Sinai Medical Center Los Angeles 2873 28.8
Centinela Hospital Medical Center Inglewood 158 27.2
Citrus Valley Medical Center - Queen of the Valley Campus West Covina 1242 23.3
Coastal Communities Hospital Santa Ana 200 31.5
Community Hospital of San Bernardino San Bernardino 537 32.4
Community Memorial Hospital Ventura 955 23.7
Corona Regional Medical Center Corona 326 18.7
Desert Regional Medical Center Palm Springs 1006 24
Desert Valley Hospital Victorville 308 22.4
Downey Regional Medical Center Downey 328 22.6
East Los Angeles Doctors Hospital Los Angeles 116 52.6
Foothill Presbyterian Hospital Glendora 257 38.9
Fountain Valley Regional Hospital & Medical Center Fountain Valley 1309 28.4
Garden Grove Hospital and Medical Center Garden Grove 498 27.9
Garfield Medical Center Monterey Park 1601 28.1
Glendale Adventist Medical Center Glendale 834 33.1
Glendale Memorial Hospital and Health Center Glendale 658 34
Good Samaritan Hospital - Los Angeles Los Angeles 1142 26.2
Greater El Monte Community Hospital So. El Monte 120 35.8
Hemet Valley Medical Center Hemet 361 28
Hi-Desert Medical Center Joshua Tree 144 36.8
Hoag Memorial Hospital Presbyterian Newport Beach 2529 25.9
Hollywood Presbyterian Medical Center Los Angeles 1228 30.7
Huntington Memorial Hospital Pasadena 1346 28.2
John F. Kennedy Memorial Hospital Indio 569 24.8
Kaiser Ontario Medical Center Campus Ontario 752 27
Kaiser Permanente Baldwin Park Medical Center Baldwin Park 1043 23.3
Kaiser Permanente Downey Medical Center Downey 1272 23.6
Kaiser Permanente Fontana Medical Center Fontana 1210 26.5
Kaiser Permanente Los Angeles Medical Center Los Angeles 1022 27.1
Kaiser Permanente Moreno Valley Medical Center Moreno Valley 378 26.2
Kaiser Permanente Orange County Anaheim Medical Center Anaheim 1242 24.6
Kaiser Permanente Orange County Irvine Medical Center Irvine 985 25.7
Kaiser Permanente Panorama City Medical Center Panorama City 772 20.6
Kaiser Permanente Riverside Medical Center Riverside 1056 22.4
Kaiser Permanente South Bay Medical Center (Harbor City) Harbor City 893 25.3
Kaiser Permanente West Los Angeles Medical Center Los Angeles 719 23.6
Kaiser Permanente Woodland Hills Medical Center Woodland Hills 633 19.3
La Palma Intercommunity Hospital La Palma 137 17.5
Little Company of Mary - San Pedro Hospital San Pedro 192 22.9
Little Company of Mary Hospital - Torrance Torrance 1068 29.1
Loma Linda University Medical Center Loma Linda 816 24.1
Loma Linda University Medical Center - Murrieta Murrieta 421 18.1
Long Beach Memorial Medical Center Long Beach 2024 27.6
Los Alamitos Medical Center Los Alamitos 463 22.7
Los Angeles Community Hospital Los Angeles 20 70
Los Angeles County - Harbor - UCLA Medical Center Torrance 256 32.4
Los Angeles County - Olive View - UCLA Medical Center Sylmar 155 26.5
Los Angeles County + University of Southern California Medical Center Los Angeles 285 27.4
Los Robles Hospital & Medical Center Thousand Oaks 652 31.7
Memorial Hospital of Gardena Gardena 224 55.4
Methodist Hospital of Southern California Arcadia 856 22.7
Mission Hospital - Mission Viejo Mission Viejo 894 28.7
Montclair Hospital Medical Center Montclair 308 28.6
Monterey Park Hospital Monterey Park 495 41.6
Northridge Hospital Medical Center Northridge 383 32.9
Orange Coast Memorial Medical Center Fountain Valley 563 32.3
Pacific Alliance Medical Center Los Angeles 683 27.4
Pacifica Hospital of the Valley Sun Valley 79 55.7
Palo Verde Hospital Blythe 43 25.6
Parkview Community Hospital Medical Center Riverside 714 31.4
Pomona Valley Hospital Medical Center Pomona 2195 20.4
Presbyterian Intercommunity Hospital Whitter 1427 25.3
Providence Holy Cross Medical Center - Mission Hills Mission Hills 1123 22.9
Providence Saint Joseph Medical Center - Burbank Burbank 1032 32.1
Providence Tarzana Medical Center Tarzana 998 34.9
Redlands Community Hospital Redlands 838 20.3
Riverside Community Hospital Riverside 1096 35.1
Riverside County Regional Medical Center Moreno Valley 422 21.6
Ronald Reagan UCLA Medical Center Los Angeles 757 26.6
Saddleback Memorial Medical Center - Laguna Hills Campus Laguna Hills 1071 27
Saint John's Health Center Santa Monica 1037 28.6
San Antonio Community Hospital Upland 783 28.9
San Dimas Community Hospital San Dimas 197 36.5
San Gabriel Valley Medical Center San Gabriel 1252 26.8
San Gorgonio Memorial Hospital Banning 107 32.7
Santa Monica UCLA Medical Center and Orthopaedic Hospital Santa Monica 670 25.5
Santa Paula Hospital Santa Paula 111 17.1
Simi Valley Hospital Simi Valley 259 20.5
Southwest Healthcare System - Rancho Springs/Murrieta Campus Murrieta 1018 19.7
St. Bernardine Medical Center San Bernardino 559 24
St. Francis Medical Center Lynwood 1372 30.1
St. John's Regional Medical Center - Oxnard Oxnard 654 29.7
St. Joseph Hospital - Orange Orange 1759 31.7
St. Jude Medical Center Fullerton 816 21.2
St. Mary Medical Center - Apple Valley Apple Valley 707 24.8
St. Mary Medical Center - Long Beach Long Beach 864 31.5
Torrance Memorial Medical Center Torrance 1213 29.7
UC Irvine Medical Center Orange 446 22.9
Valley Presbyterian Hospital Van Nuys 936 26.9
Ventura County Medical Center Ventura 420 20.5
Verdugo Hills Hospital Glendale 245 38
Victor Valley Community Hospital Victorville 293 31.4
West Hills Hospital & Medical Center West Hills 336 31.3
Western Medical Center - Anaheim Anaheim 311 23.8
Western Medical Center - Santa Ana Santa Ana 502 31.1
White Memorial Medical Center Los Angeles 1101 24.7
Whittier Hospital Medical Center Whittier 1173 31.5

*NTSV (Nulliparous Term Singleton Vertex) births involve a first-time mother at full term carrying one baby in the head-down position.

 

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