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Unnecessary Procedures: Cesarean Section

Unnecessary Procedures: Cesarean Section

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Unnecessary Procedures: Cesarean Section

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  1. Unnecessary Procedures:Cesarean Section Nancy K. Lowe, CNM, PhD, FACNM, FAAN Professor & Chair Women, Children & Family Health University of Colorado Denver College of Nursing

  2. Magnitude of this Healthcare Issue • Nearly 25% of ALL hospital admissions are related to pregnancy and childbirth (Merrill & Elixhauser, 2005) • Among 18-44 yr old hospitalized individuals, • 75% are women • Majority of these pregnancy-related/childbirth • 6 of top 10 hospital procedures billed to Medicaid & private insurers alike are related to pregnancy and childbirth (Merrill & Elixhauser, 2006)

  3. Percentage of All Births by Cesarean

  4. The Historical Picture • Total Cesarean rate in the US: • 5.5% in 1970 • 22.8% in 1989 (primary rate 16.1%) • 20.7% in 1996 • 30.3% in 2005 (primary rate 25%) • 31.8% in 2007

  5. Healthy People 2010 • Objective 16-9: Reduce cesarean births among low-risk (full term, singleton, vertex presentation) women among: • 16-9a: Women giving birth for the first time to 15% (from baseline of 18% in 1998) • 16-9b: Women with a prior cesarean birth to 63% (from baseline of 72% in 1998)

  6. Progress toward 16-9a

  7. Maternal Specific cardiac disease Specific respiratory disease Conditions associated with increase ICP Obstruction of the lower uterine segment Vulvar obstruction Fetal Non reassuring fetal status Breech (?) or transverse Maternal herpes Congenital anomalies Maternal-fetal CPD Placental abruption Placenta previa Indications for Cesarean Dystocia

  8. What is wrong? • Childbirth is a physiologic process of reproduction • Why does it no longer “work” in the U.S.? • There is no understanding of, respect for, nor commitment to the normalcy of childbirth in the U.S. • Can the pattern of unnecessary intervention be changed?

  9. Conundrum of Etiology Sociopolitical Environment Social & Physical Environment Woman’s Physical & Psychological Characteristics Cesarean in Healthy Nulliparous Women Intrapartum Care & Interventions Fetal Factors Assessments & Clinical Decision-Making Of HC Providers Lowe, 2007

  10. Strategies • Tort Reform • Maternity Care (Healthcare) Reform • Evidence-based Maternity Care Reform • Payment Reform • Physician/Midwife Training Reform • Public Health Education Reform • Real diagnostic standards for indications for cesarean