May 09, 2021 2 mins, 24 secs

"If you had a C-section on your first birth, 90 percent-plus of all your future births are going to be a cesarean.".

California aimed to reduce C-section rates in several ways, including by educating doctors and nurses about national guidelines for labor and ways to better support women in labor, along with informing doctors about how their C-section rates compared to those of other physicians.

But in recent years, there has been a growing realization of the downsides of cesareans when it's less clear that the surgery is absolutely necessary, said Main, who said doctors, for instance, are seeing more placental complications in pregnant women who have had previous C-sections.

"We know that if you had a C-section on your first birth, 90 percent-plus of all your future births are going to be a cesarean," he said.

C-section rates in low-risk first deliveries vary widely across the country, depending on the state, hospital and provider; some hospitals have rates as high as 50 percent or more, Main said.

It's not because so many women want to schedule their deliveries, Main said.

Melissa Rosenstein, an assistant professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said that it's not that doctors have bad intentions "or that they are trying to do it just for convenience" but that it can be challenging to try to determine whether a patient who had a C-section would have been able to go on to deliver vaginally.

Jude Medical Center, where Petrus gave birth, started ramping up efforts to reduce first-time C-sections in January 2015, focusing at first on teaching nurses how to better support women in labor and encourage them to walk around more and change positions during labor, said Dawn Price, a nurse who is the hospital's executive director of women's and children's services, who helps oversee the program.

The hospital also works to educate expectant women about why it's best to avoid first-time cesareans.

The hospital's C-section rate in low-risk first births dropped from 34 percent when the program began to 19.9 percent last year, she said

David Nelson, an assistant professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center and chief of obstetrics at Parkland Health and Hospital System in Dallas, said the new study supports educating providers, standardizing labor management practices to promote consistency and tracking C-section rates among physicians, all to help other hospitals reduce their rates

It's difficult for doctors to lower their cesarean rates without knowing what their rates are and how they compare to the target goal, said Nelson, who co-authored an editorial that accompanied the study

"For us to effect change on the cesarean rate, it's really important to measure and report the rate," he said

Experts also encourage women to talk with their doctors about any delivery concerns and ask about their C-section rates

Main said, "It's very important that women feel empowered and supported in labor."

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