A guide to C-section rates

Expectant moms have many things to consider when choosing where to deliver their baby. For many women, a hospital's cesarean section rate is an important deciding factor. But what exactly does this rate mean, and what drives it?

Dr. Lisa Johnston, an OBGYN and chief medical officer at Sharp Mary Birch Hospital for Women & Newborns, answers common questions about C-section rates.

When we talk about a hospital's C-section rate, what do we mean?
There are a couple ways to look at hospital C-section rates. A rate can reflect the total number of C-sections relative to the total deliveries at a facility. The rate equals the number of C-section births per 100 births in a given hospital. However, some hospitals care for more women with high-risk pregnancies. That will naturally result in a higher overall C-section rate, so this rate can vary widely between birthing facilities.

A more apples-to-apples comparison is what's known as the NTSV cesarean birth rate. NTSV stands for nulliparous, term, singleton, vertex - meaning a first-time mom who has a full-term pregnancy with a single baby in the head-down position. This measure controls for some factors that might raise the probability of a C-section, so it is a more consistent comparison of rates across birthing facilities.

What are hospitals doing to reduce their C-section rates?
At Sharp Mary Birch, we're especially focused on reducing the NTSV rate. This is the most effective way to reduce the overall rate, because once a woman has had a C-section, she's more likely to deliver via cesarean in the future.

Our current NTSV rate is 27.6 percent. This is down significantly from 32.4 percent in 2015, yet there is still work to do.

Our focus remains on reducing barriers to vaginal delivery. For example, we provide enhanced education for women about when to come to the hospital. Most are encouraged to spend early labor at home and come to the hospital only once active labor has begun, as this has been shown to enhance the likelihood of a vaginal delivery.

We have a successful doula program here at Mary Birch which many women find helpful for an additional labor coach. Some of our practices also utilize certified nurse midwives for uncomplicated term patients. We continue to support natural, unmedicated childbirth should patients chose this for themselves. We've also helped our patients and their support people understand the "new" labor curves allowing women to labor and push longer safely. Our introduction of spinning babies (position changes during labor) and the peanut ball for leg positioning have helped to decrease the time in active labor and has improved the rate of vaginal delivery.

What can I do to increase my chances for a vaginal delivery?
I encourage patients to have a conversation with their doctor before delivery. Ask about his or her C-section rate, and the rate within their call group. Depending on when you go into labor, another doctor within the group may deliver your baby.

Write down your questions and discuss your birth plan to ensure you understand what you can do to improve your opportunity for having a successful vaginal delivery. This includes going into pregnancy with a normal body weight and gaining the recommended amount of weight during your pregnancy. You should follow your doctor's recommendations on induction, as induction may reduce your opportunity for a successful vaginal delivery.

Be sure to talk to your support people before labor. Your labor may take longer than you anticipate, so it's important to encourage them to be patient. And you should wait to come to the hospital until you are in active labor, unless otherwise directed by your care provider.

Once admitted into the delivery room, consider using items like birthing balls and the peanut ball. Movement helps support natural labor, so ask about being able to walk and move during labor.

Finally, it's important to remain flexible, as emergencies can occur during labor and your doctor wants to keep you and your baby safe. Remember that ultimately your delivery experience is a partnership between you, your doctor, your nurses and your support people.