Some big Valley names missing from state C-section honor roll

California recognized hospitals Wednesday for meeting or exceeding a federal goal for reducing Cesarean births, but six of the biggest baby delivery hospitals in the central San Joaquin Valley did not make the list.

Health and Human Services Secretary Diana Dooley congratulated 104 California hospitals for reducing C-sections for first-time moms with low-risk pregnancies to a rate of 23.9 or lower, a goal set by the federal government for hospitals to meet by 2020.

Four hospitals in the Valley met the C-section rate: Community Regional Medical Center in Fresno, Kaiser Permanente-Fresno, Sierra View Medical Center in Porterville and Tulare Regional Medical Center.

“One of the most important things we can do to make California’s health-care system smarter is to help hospitals, physicians and nurses ensure that C-sections are only performed when medically necessary,” Dooley said. “Today’s award recipients represent an honor roll of California hospitals and their clinicians who are leading the way toward safer births and healthier babies and mothers.”

C-sections, under certain conditions, are necessary, but health officials are concerned that unnecessary procedures can pose serious health risks for babies and mothers. Additionally, C-sections are costly – on average 50 percent higher than vaginal deliveries, placing unnecessary financial burdens on families and adding to health care costs for the state.

C-section rates vary widely, depending on the doctor and the hospital where babies are delivered. California C-section rates range from 15 percent to more than 60 percent.

Dr. Tracy Flanagan, director of women’s health for Kaiser Permanente Northern California, said Kaiser was proud of exceeding the federal goal for reducing Cesarean births. The hospital minimizes in early labor and inductions and manages labor with patience, she said.

However, six of the Valley’s hospitals with some of the largest maternity wards were missing from the state’s honor roll: Clovis Community Medical Center, Saint Agnes Medical Center in Fresno, Kaweah Delta Medical Center in Visalia, Madera Community Hospital, Adventist Medical Center-Reedley and Adventist Medical Center in Hanford. Clovis Community had a C-section rate of 31.5 percent; Saint Agnes’ rate was 26.1 percent; Kaweah Delta had a rate of 25.8 percent; Madera Community had a rate of 25.1 percent; Adventist Medical Center-Reedley’s rate was 27.2 percent; and Adventist Medical Center in Hanford was 28.5 percent.

Several clinical reasons and patient preferences contributed to Clovis Community Medical Center’s rate, said Dr. Thomas Utecht, senior vice president and chief medical and quality Officer at Community Medical Centers, which operates the hospital.

“We are working diligently with our physician partners, patients and nursing to reduce this rate,” he said.

Community Regional met the federal C-section goal through a multidisciplinary approach to caring for laboring mothers and with the implementation of nursing, midwifery and doctor coverage 24 hours a day, Utecht said.

Adventist doctors are concerned about C-section rates and would like to get them as low as possible, said Dr. Thomas Schram Enloe Jr., head of obsetrical services for the medical staff at Adventist Health/Central Valley Network. However, Enloe said they don’t see many low-risk pregnancies.

“We really have an epidemic of teenage pregnancy, obesity and diabetes that increase the risk of Cesearan section,” he said.

The honor roll ratings don’t reflect the latest C-section rates at Kaweah and Saint Agnes, officials said.

In the last five months, Kaweah Delta has achieved a rate of 21.1 percent, said Dr. Ed Hirsch, vice president and chief medical officer.

Kaweah has emphasized that everything that can be done safely to avoid C-sections should be done, he said. The hospital has also stopped early elective deliveries. “If someone wants to do something like that, they have to medically justify it first before they do it.”

Obstetricians have embraced the changes, Hirsch said.

Having a neonatal intensive care unit at the hospital provides a level of assurance to the doctors, he said. “Sometimes physicians are less likely to push the envelope where they don’t have neonatal backup.”

Saint Agnes also is improving its C-section rate, said Dr. W. Eugene Egerton, chief medical officer.

“We track our rates monthly and, over the past year, have met the Healthy People goal more than once. We will continue to partner with our physicians over the next three years to reach the 2020 goal,” he said.

Increasing C-section rates have been a troubling pattern in California and nationwide. Between 1997 and 2015, California reported that overall C-section rates increased from 21 percent to 32.2 percent, while at the same time low-risk, first-birth rates increased from 19 percent to 25.6 percent.

Wednesday’s announcement of hospitals that had reached the Healthy People 2020 C-section rate of 23.9 percent was made on behalf of Smart Care California, a coalition of public and private health care purchasers that is promoting safe and affordable health care in California. The awards will be given annually.

This story was originally published October 26, 2016 at 6:02 PM with the headline "Some big Valley names missing from state C-section honor roll."