Sunday, February 14, 2010
Dropping C-Section Rates in Kodiak
Over a year ago, a conversation with my friend Patty got me on my way with doula work and birthing classes. She told me that the hospital cesarean rate was around 27% and I was in disbelief. This was about 20% too high...the little that I knew about birth told me that some of those cesareans could have perhaps been prevented. A Cesarean surgery is MAJOR abdominal surgery. (The national average for cesarean rate is 33%. The World Health Organization recommends cesarean rate of somewhere around 10-12%. Any higher, there are unnecessary ones. Unnecessary abdominal surgery leads to unnessary infections in mom, un-necessary respiratory problems in babies, more difficult healing for mom, etc. If the rate is much lower than 8 or 10%, there are some births where a cesarean may have helped the health of mom and baby)
At that time, I had just opened A Balanced Approach and one of the reasons was so I could teach birthing classes after my business. The hospital classes were the only ones offered in town and I believed there was much to be desired with a birthing series. The hospital class was more power-point and video centered, as opposed to a fun, interactive group style of learning which had the potential to make childbirth education FUN!
In January of 2009 I started birthing classes and these classes along with doula services have been a strong part of my business ever since. Katie, A Balanced Approach office manager, is also a doula & childbirth educator and between the two of us, we have attended around 18 births last year.
My intent when I started was to prevent at least 1 cesarean. Many cesareans are very necessary, but some cesaerans occur when there are high levels of medical intervention, such as drugs, monitoring, epidurals, and not enough support for moms in labor, or enough time to let moms body do what it needs to do, instead of rushing mother nature.
This past week, I learned of the Cesarean rate for 2009...it went from 19% in 2008 to 8% in 2009! This is for primary cesarean, or women who are going through childbirth who have never had a cesarean. (Here in Kodiak, if a woman has had a prior Cesarean, they HAVE to have a repeat cesarean. They can opt to go to Anchorage for try at a vaginal birth, but the time and costs incurred make it prohibitive for many moms and families.) As you can see from the statistics that between 2001-2008 the Primary ceserean rate was between 12-19% percent, never lower.
What factors contributed to this sharp decline?
Good question. I believe a variety of factors have played into it.
-The improved childbirth class options may have contributed-in 2009, 40 women and their birth partners attended classes at A Balanced Approach. Thats a significant percentage of the 191 births last year.
-A new nurse anesthetist at the hospital--who encourages women to learn more about epidurals before the actual labor. The hospital is now offering a free weekly anesthesia clinic where women and birth partners can learn more about the pros/cons of epidurals, intrathecals, etc...
-Doula services by Katie and I have given extra labor support. Many large scale international studies have showed that the presence of a doula decreases chances for cesarean by 50% and decreases need for medical interventions (drugs, procedures, etc..) by 80%.
-A "Cascade Effect" in the community of positive birth stories. For every woman who has a good birth experience-she will tell friends and other pregnant friends. This, in turn, improves the overall perception of labor and birth as not something to be feared, rather seeing it as an empowering experience. So even if a woman hasn't attended birthing classes, or has a doula-there is an improved sense about birth in the community. Perceptions of the pain of labor are highly cultural and in our culture, it is seemed as something to be feared, rather than experience which is celebrated and shared by many. Also, the formation of the Kodiak Birth Network has provided a community venue for discussion and presentations related to birth. In the past year, there have been speakers and videos related to improving birthing options in Kodiak.
-As far as nursing or medical staff changes, I don't know enough to know how that played into the numbers. From my experience at the hospital this past year, there are lots of top notch OB nurses and great doctors, but I have nothing to compare it to,as I've only attended births for 1 year.
And who knows-the low numbers of last year could be a fluke. A year will tell. But I'm hopeful the progress with healthy birthing in our community will continue on this trend!
(To interpret the chart-look under 2008 Primary C-section...you'll see it was 19.9%. In 2009, that number is 8%. In future years, the TOTAL cesareans should decline, as fewer women will require repeat cesareans!)