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'Evidence-Based Medicine,' Nurse-Midwives Help Hospital Cut C-Section Rates

'Evidence-Based Medicine,' Nurse-Midwives Help Hospital Cut C-Section Rates

May 9, 2014 — In what might be a "surprising" fact, a San Francisco medical center that "is largely a hospital for the poor" is also likely "the safest place in California to have a baby," Tina Rosenberg writes in a New York Times opinion piece, citing state data.

According to Rosenberg, an author and former Times editorial writer, while San Francisco General Hospital is certainly "[n]ot the most luxurious" facility, "it does something else very well: evidence-based medicine." For example, Rosenberg writes that "evidence says doctors should do far fewer cesarean sections" because the procedure is often not medically necessary and "puts a woman at increased risk for hysterectomy, hemorrhage, infection and deep vein thrombosis, and the risk rises with each subsequent C-section." In addition, the procedure is more costly than a vaginal delivery.

Rosenberg notes that San Francisco General "has the state's best rate on ... vaginal births after C-section," at 36.6%, compared with a statewide average of "just under 10 percent."

Recommendations for Other Hospitals

Rosenberg recommends that other hospitals "[e]xamin[e] what San Francisco General does to achieve its low rates." She writes, "Probably the single most important factor" that other hospitals should emulate is that the physicians at San Francisco General "are salaried and on shifts," so "[t]heir pay doesn't vary by the number of patients they see or tests they order."

She argues that physicians, nurses and midwives who are salaried "can help increase the rates of vaginal births" because they "have no incentive to rush a delivery," given that they will remain at the hospital for their entire shifts regardless.

San Francisco General also allows patients with normal pregnancies to "choose a nurse-midwife as [their] primary caregiver." Rosenberg notes, "In the labor and delivery ward, nurse-midwives led a successful effort to greatly decrease the use of episiotomies and were co-leaders in developing new guidelines for V.B.A.C.s." Nurse-midwives also teach pregnant women about c-section risks early in their pregnancies to set the expectation that they will only intervene in labor if necessary (Rosenberg, New York Times, 5/7).