Doctors Offer Reasons Behind C-Section Rates Patients' Health Histories Differ among Hospitals, Physicians Say

Article excerpt

Hospitals vary widely in their number of deliveries by Caesarean section for several reasons - some of them more medically sound than others, obstetricians here say.

Such surgery varies as much as 20 to 30 percent among hospitals, and affluent white women are more likely to have C-sections than poor, less educated women, according to a recent study by the Missouri Health Department.

On Friday, some of the area's top obstetricians sought to elaborate on the reasons for the wide differences in C-section rates.

About two-thirds of C-sections are done on women who already have delivered babies by such surgery, says Dr. Klaus Staisch, head of obstetrics at St. Louis Regional Medical Center.

Staisch's hospital, a referral center for local poor patients, had the lowest C-section rate among hospitals in the St. Louis area, according to the Missouri Health Department report.

For most of this century, "An obstetrical dictum has been `Once a C-section, always a C-section,' " Staisch said. C-sections are advisable when vaginal deliveries pose a danger to the fetus or the mother, he said.

"In 1975, we lost more babies during labor than we do today," he said. Technology, such as electronic monitoring of the fetus, picked up problems that prompted early delivery by C-section. Used wisely, technology saves babies, he said.

"But there's also been an overreaction to technology, and electronic monitoring always leads to higher C-section rates," Staisch said. Some studies show no better outcome for babies who were monitored electronically than for those who received standard care, he said.

"But the National Institutes of Health convened expert panels who in 1981 found there was high safety in vaginal deliveries, and that was followed by a supportive document in 1987 by the American College of Obstetricians and Gynecologists," Staisch said. …