December 15, 2009
Choices in Childbirth publicized cesarean rates for the New York metro area. Dr. Mitchell Maiman offered the following statement for their press release:
“The rising c-section rate, both locally and nationally, is extremely disturbing,” said Dr. Mitchell Maiman, chairman of obstetrics and gynecology and director of gynecologic oncology at Staten Island University Hospital. “Every effort must be made by physicians, hospital administrations, and medical leadership to aggressively lower this trend. Potential interventions should include strict criteria for inductions of labor, support for vaginal birth after c-section, incentives and disincentives based on c-section rates, condemnation for c-section section on demand without medical indication, and mandatory serious and effective quality assurance programs in every obstetrical department. Patients must be made aware of the relationship between c-section rate and quality of care.”
March 10, 2010
The New York Times covered the new NIH VBAC recommendations in the article “Panel Urges New Look at Caesarean Guidelines.”
“We take N.I.H. consensus panels seriously, and would engage with them to see if there are opportunities to improve the care of laboring women,” said Dr. Alexander Hannenberg, president of the American Society of Anesthesiologists, who practices at the Newton-Wellesley Hospital in Massachusetts.
Dr. Jeffrey Ecker, an obstetrician at Massachusetts General Hospital and vice chairman of the committee that issues practice guidelines for the American College of Obstetricians and Gynecologists, said the committee would consider the recommendation at its next meeting.
Women’s health advocates said they were pleased with the panel’s findings. Debra Bingham, president-elect of Lamaze International, said it was important that the group had recognized that the lack of access to vaginal birth after Caesarean and even to unbiased information about it was a problem for many women.
March 23, 2010
The New York Times article, Caesarean Births Are at a High in U.S., was written after the CDC NCHS publicized its report, Recent Trends in Cesarean Delivery in the United States, which analyzed the final 2007 birth data. From the article:
Dr. Macones said the panel’s advice made sense, but he added: “The first thing we should be trying to do is lower the primary C-section rate. Then we wouldn’t get into this trouble.”
Dr. Menacker said: “It looks as if this is a trend that is continuing. I don’t know what the future will hold.”
April 20, 2010
Another New York Times article covered Dr. Mitchell Maiman’s approach to keeping cesarean rates at bay.
Caesarean births are generally considered more prone to complications than natural births, so most hospitals at least pay lip service to their devotion to reducing them. But very few have pulled it off. What seems to have made the difference for Dr. Maiman’s department is building that goal into policy, even when it is unpopular with doctors — even, sometimes, when it may be unpopular with patients.
To start, Dr. Maiman and his colleagues do not allow unnecessary inductions for first-time pregnancies at any point before the 41st week, since they are a main cause of C-sections. They also do not allow C-sections for no reason other than the mother wants one.
C-sections are thought to be relatively lawsuit-proof, and they also let everyone go home on time. But such conveniences do not inform Dr. Maiman’s thinking. “You have to draw the line somewhere,” he said in an interview. “If you went to your doctor and said, ‘I want my gall bladder taken out electively,’ your doctor wouldn’t do that, probably.”
April 21, 2010
Public Citizen publicized its Guide to Avoiding Unnecessary Cesareans in New York via a press release with the headline “Cesarean Sections Are Overused in New York, Giving the State One of Highest C-Section Rates in the Country.”
April 30, 2010
St Vincent’s Hospital in Manhattan, the only hospital in the city that accommodated midwives who perform home deliveries, closed its doors.
June 5, 2010
Obese Mothers a Burden on Hospital Resources; Growing Obesity Increases Perils of Childbearing appeared in the New York Times. A shorter version of the article was in local papers all over the country this morning thanks to syndication by the New York Times News Service.
The article states that “medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections.” ANaturalAdvocate discussed the article here.
June 17, 2010
The American Congress of Obstetricians and Gynecologists held a press conference to protest the Midwifery Modernization Act and to call midwifery care that is independent of physicians “suboptimal”, “an absolute disaster”, and “a step backwards in patient safety”.
Ob/Gyns are speaking out against the Midwifery Modernization Act, saying allowing midwives to become independent of physicians will put patient safety in jeopardy.
“This is a step backwards in patient safety,” says Dr. Adina Keller.
“I see it as an absolute disaster for our women,” adds Dr. Ronald Uva.
Currently mid-wives must practice with a licensed Ob/Gyn with insurance and sign a practice agreement. However, under the proposal midwives would be declared independent professionals.
The answer can never be sub-optimal care,” says Dr. Keller. “If a patient is going in for a vaginal birth and there’s no obstetrician as a backup, that patient within minutes could require an emergency caesarian. If you’re in a rural area and there’s no Ob/Gyn, the patient or the baby could die.”
“It’s too bad for the people of New York State, that this bill has gotten as far as it has,” adds Donna Montalto, the executive director for the American Congress of Obstetricians and Gynecologists. “We don’t want this bill. If it does pass, women are going to suffer.”
Side note about the interviewed physicians:
Ronald Uva is the Chief of OB/GYN at Oswego Hospital. His hospital has a 33% overall cesarean rate and a 23.2% primary cesarean rate.
Adina Keller attends births at Northern Westchester Hospital, which has a 39.5% overall cesarean rate and a 28.3% primary cesarean rate.
June 18, 2010
A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.
In a memorandum, backed by a press conference in Albany on Thursday, the congress challenged the safety of midwife-attended births and suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors. “While this legislation does not intend to extend a midwife’s scope of practice, it has the ability to pave the way for midwives to open their own independent birthing centers,” it said.