Hospital Midwives Reduce C-Sections

Expecant mothers with private insurance are significantly less likely to undergo Cesarean sections if their care includes midwives and obstetrician coverage.

That was the conclusion of researchers at UC San Francisco Medical Center and Marin General Hospital. 

Marin General underwent an overhaul of its obstetrics services four years ago. Prior to that, services were usually supervised by a physician or a partner, often by telephone. After the changes, Midwives were made available to patients around the clock and 10 obstetricians were enlisted as “laborists” who had no other medical duties.

The results: about 31.7% of expectant mothers underwent C-sections prior to the change of medical staff duties. Afterwards, it immediately shrank to 25%, and continued on a downward spiral of 1.7% per year until the study concluded in 2014.

The lower C-section rate reflected that of mothers enrolled in Medi-Cal, who already have access to midwife services, according to the study.

The change is significant. The rate of C-sections in the U.S. has risen by more than half over the past 20 years, although it has leveled in recent years. Various studies have suggested that the procedure is tied to deliveries prior to 39 weeks of gestation, which is linked with breathing and other developmental problems.

“There are several ways in which the in-house model of care may have resulted in fewer C-sections,” said study co-author Malini Nijagal, M.D., formerly with Prima Medical Group in Novato  and now at Boston Medical Center. “Competing surgical and office responsibilities in the former model of private care may impact a provider’s decision-making around proceeding with C-section...previously, decisions about C-sections were made independently by one physician. Under the new model, which includes midwives with specific expertise in normal physiologic birth, there is a team approach of care with clinicians discussing each patient twice daily. This often leads to consideration of alternative options.” 

The study was published online in the journal Obstetrics & Gynecology.