The vast majority of hospitals in Los Angeles, Orange and San Diego counties report Caesarean section birth rates significantly above what health experts call optimal, according to a Times analysis of Southern California hospital records.
Rates at some hospitals, the research shows, are double those characterized by several Caesarean-policy experts as a justifiable upper limit.
And while a national controversy over the Caesarean birth rate has not resulted in a consensus on how much is too much, the situation in Southern California parallels that in other population centers, leading a health care consumer group to charge that hundreds of thousands of unnecessary surgical births occur in the nation, the state and the region each year.
The consumer organization, the Ralph Nader-affiliated Health Research Group, charges in a recent report--based on national data, trends in 10 states including California and specific hospital rankings in Maryland--that 455,000 "unnecessary" Caesareans occur in the United States each year. The organization contends that 45,292 unnecessary Caesareans occurred in California in 1985.
"It is clear that the increase in the Caesarean section rate shows no sign of slowing down, despite soundings of alarm by organizations and physicians for several years," the Health Research Group concluded. "Additional action outside the medical profession is urgently needed."
Corrective measures recommended by the group ranged from far greater availability of vaginal delivery to women who have had Caesarean deliveries to better hospital surveillance of the practices of individual doctors.
Times' Ranking Told
A ranking of Caesarean rates at Southern California hospitals--developed by The Times from data collected by the California Department of Health Services Maternal and Child Health Data Base--adds immediacy and intensity to the dispute. (The data were prepared and analyzed by the Community and Organization Research Institute at UC Santa Barbara.)
Between 1970 and 1985, the California Caesarean rate--mirroring national trends--rose from just over 6.5% to 21.6% of all babies delivered in the state. (The 1986 rate is not yet available for California.)
In Southern California, statistics for hospitals operating delivery facilities show rates in the region mirror those of the state. For 1984--the last year for which hospital-by-hospital figures are available--the state Caesarean rate was 20.9%, while Los Angeles County recorded 21%, Orange County had 23.7% and San Diego County, 20.2%.
Some area hospitals recorded rates significantly higher than the county averages.
The Hospital Council of Southern California--expressing concern about publication of the comparative ranking--emphasized that consumers should be "extremely cautious about interpreting raw data in terms of quality of care."
In a sense, said David Langness, a hospital council spokesman, the rates at hospitals here are "just numbers."
In the Times-prepared rankings, the AMI Tarzana Regional Medical Center had the highest rate in Los Angeles County--39.1%. The facility is owned by American Medical International, a large for-profit chain. In Orange County, Coastal Communities Hospital in Santa Ana had the highest rate, 33.9%, and in San Diego County, Scripps Memorial Hospital in La Jolla led with 37.6%.
AMI Tarzana's director of maternal-fetal medicine, Dr. Barry Schifrin, said the hospital is "very definitely concerned about the rate itself, but the problem is there is no evidence the rate is in any way related to the (quality) of obstetrical care. The problem is that this can never be quantified."
Some Hold Rate Down
But still other hospitals--including several large academically affiliated medical centers that deliver many high-risk babies but have strong Caesarean-control programs--have held rates down. Of these, UCLA Medical Center reported 16.4%; Martin Luther King Jr. Drew Medical Center, 13.3%; the Kaiser Foundation Hospital in Anaheim had 16.8%, and the Naval Regional Medical Center in San Diego, 12.2%.
There was little difference in Caesarean rates between for-profit and not-for-profit health centers. However, hospitals owned by county governments, University of California hospitals and those operated by the Kaiser Foundation Hospitals all had rates significantly below the statewide average.
Perhaps the most significant factor influencing the Caesarean rate, many experts agree, is the practice of performing Caesarean sections in each subsequent delivery after a woman has had a first. The practice follows an old medical dictum: "Once a section, always a section." Dr. Warren Pearse, executive director of the American College of Obstetricians and Gynecologists, a leading professional group, said an appropriate Caesarean section rate would be between 12% and 15% of all births. But Pearse refused to join in characterizing anything over that as "unnecessary."