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Taking a Closer Look at Local C-Section Rates

February 05, 2001|SHARI ROAN | TIMES HEALTH WRITER

The nationwide trend of rising caesarean section rates is mirrored--and sometimes surpassed--in Southern California hospitals.

Data generated by the state Healthcare Information Resource Center at The Times' request shows that Los Angeles County's 10 largest hospitals providing childbirth services all experienced increases in caesarean sections from 1996 to June 1999. In Orange and San Bernardino counties, the majority of hospitals reviewed also showed an upturn in C-sections. Fewer hospitals in Riverside County reported increases.

As of June 1999, for example, the C-section rate at Queen of Angels-Hollywood Presbyterian was 28.5%--up from 25.1% in 1997.

In Orange County, Hoag Memorial Hospital's C-section rates rose from 20.5% in 1993 to 26.3% in June 1999.

At Torrance Memorial Medical Center, C-section rates rose from 19.2% in 1995 to 26.5% through the first six months of 1999, a relative rate increase of 30%.

"We really don't know why the numbers have increased," says Dr. Catherine Bannerman of Torrance Memorial. "We're looking at it closely. One of the things we think may be a factor is the demographics of our population. We have many older mothers who tend to be at higher risk for C-sections."

According to experts, the national increase in C-section rates is primarily linked to stricter policies on how to handle patients who have already had previous caesareans and changing attitudes about how risky C-sections are compared with vaginal births.

Not all hospitals have witnessed a marked shift in C-section popularity. Kaiser hospitals tend to have among the lowest rates compared with neighboring hospitals--although several of the Kaiser hospitals have seen small increases in C-section rates in recent years.

And one hospital, Corona Regional Medical Center, has defied the trend by setting its lowest caesarean rate in a decade: 21% in 1999.

Officials there say the low number is the result of a vigorous effort to avoid rates that topped 40% in the late '80s.

"We encourage [vaginal births after caesarean] and a trial of labor," says Dr. Lawrence Koning, chief of obstetrics at Corona Regional. "We feel it's a reasonable course of action as long as the patients are informed and give consent."

The hospital also keeps a close eye on individual doctors' C-section rates, issuing each doctor his or her personal rate each quarter, says Avelina Ortiz, quality management director.

"We've found if something is not measured, it can't be improved," she says.

*

C-Section Rates

* For information on caesarean section rates at other Southern California hospitals, go to http://www.latimes.com/HEALTH.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

On the Upswing Again

C-section rates at U.S. hospitals rose steadily throughout the 1970s to the late 1980s, when a national effort began to reduce the frequency of the surgery. But rates have recently begun to rise again.

A review of state hospital data found that C-section rates rose at 31 of 38 Southern California hospitals between the end of 1997 and June 1999. The Times reviewed data for hospitals in Los Angeles, Orange, Riverside and San Bernardino counties with the highest total numbers of births in 1999. Listed below are C-section rates of the five hospitals with the greatest number of total births.

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