A great article was published recently lauding SF General as the safest place in the city to give birth. While it’s definitely a hard sell esthetically, there is something to be said for suffering a less-than-fancy delivery room if it allows your baby a greater chance at a natural birth. After reading the article I felt it really spoke to the heart of the matter in childbirth, which is patience. The first great lesson of parenthood!
With a reputation of being a hospital largely for the poor, San Francisco General, according to data compiled by the state of California, is one of the safest places to have a baby. While it may not be a luxurious delivery experience nor send you home with lush amounts of “baby swag”, you can be ensured that they are doing one thing very well, and that is evidence-based medicine. This evidence states that doctors should do far fewer cesarean sections, with a target rate set at 15.5% for first-birth low-risk C-sections.
C-sections are not only more expensive, but they come with a large list of potential complications, which only increase with each subsequent cesarean birth – worse outcomes for more money. America’s C-section rate is growing quickly, having risen 50% in the last 10 years, and is used in 1/3 of all births. These numbers are not in correlation with the aging population of first time mothers, nor the increase in obesity. The largest increase in C-section rates is among women who are under 25 and a low-risk pregnancy. In 2012, Los Angeles Community Hospital did C-sections for 62.7% if the lowest-risk births – full term mothers, with normal presentation a single baby, and who have never had a C-section prior. That rate for San Francisco General was just 10.1%.
San Francisco General also has the state’s best rate on vaginal births after C-section, or V.B.A.C. At General, 36.6% of women who have had a previous cesarean section deliver vaginally. The state average for V.B.A.C. is just under 10%. Many hospitals do zero – by never giving a woman who has had a cesarean the chance to try a vaginal birth. This quickly puts women on a track to deliver every single baby they have via C-section, with increased risk each time
What does San Francisco General do differently to have such great rates to show? Policies clearly matter. The doctors at General are salaried and on shifts. Their pay does not increase nor decrease based on the amount of patients seen, tests ordered, or procedures attended. At General, the doctors are paid the same amount of money no matter the type of birth – which is not the case at many other hospitals. Doctor’s at other hospitals have a strong incentive to deliver their patients’ babies themselves. This is a problem because it leads to more C-sections scheduled for the doctor’s convenience, with little consideration of the mother.
At General, the doctors have no incentive to rush a delivery. “We’re here no matter what,” said Juan Vargas, chief of obstetrics. “There’s no time that a woman needs to be delivered by.”
If you are a patient at General in a normal pregnancy, you can choose a nurse-midwife as your primary caregiver, and you would see a doctor only if there are complications. Nationally, nurse-midwives are rare; Morton says they attend 7 percent of all births. Even rarer is General’s model of an autonomous nurse-midwife service with its own caseloads.
The clout of nurses at General is another way the hospital encourages labor to take its course. The hospital’s chief executive officer is a nurse, as was her immediate predecessor.
Patients at General learn early in their pregnancies about the risks of C-sections. Ana Delgado, a certified nurse-midwife who is assistant director of inpatient obstetrics, said that midwives are trained in “the art of doing nothing, well. Patients get the message from the beginning: We will intervene when needed, but if you don’t need it, we don’t.”
“A lot of us recognize that midwives are the real experts in labor,” said Vargas, the OB chief at General. “I trained as a high-risk obstetrician. I’m best at dealing with complications. So I stand by and try to be patient.” San Francisco General encourages and rewards patience. Any hospital wishing to bring down its C-section rates might start there.
Read the original article here.
