How does a hospital cater to the variety of birthing requests that are coming from a new generation of mothers?
Holy Name Medical Center has already established programs catering to various ethnic minorities — including providing post-birth comforts like seaweed soup for new Korean mothers.
But it is also able to cater to the needs of mothers interested in natural births or water births.
It’s an important topic, as certain health advocates push for reductions of Cesarean sections, which have been a growing trend among working mothers.
Holy Name has always had one of the lowest C-section rates in the state, according to CEO Michael Maron.
The Leapfrog Group, which rates hospitals for patient safety, shows Holy Name has a C-section rate of almost 19 percent. Leapfrog’s target for C-sections is about 24 percent.
Maron said the reason behind Holy Name’s success is that margins don’t dictate how the hospital operates.
“We don’t allow margins to negatively impact the first directive, which is take care of people the right way,” he said. “There is a reason for C-sections. C-sections are emergent; they are for when something goes wrong. It is not the convenience of the patient or convenience of the doctor.
“A lot of patients today say, ‘I don’t have time for this. I don’t want to be in labor for 24 hours and then it takes me longer to recover. Just do the C-section, it’s fast, it’s quick, I can schedule it, I know when I’m going to have my baby.’ So, a lot of it is patient-driven. Doctors love it because it’s convenient … and also (they) get paid more.”
But some advocates, like the New Jersey Health Care Quality Institute’s CEO and president, Linda Schwimmer, have been vocal about greater awareness and reduction of C-sections.
Schwimmer has previously said that C-sections are like any other major surgery and carry the same risks.
“Cesarean sections carry serious risks of infection or blood clots, and many women experience longer recoveries and difficulty with future pregnancies,” according to the Leapfrog Group.
“C-sections can also cause problems for babies, like breathing difficulties that need treatment in a newborn intensive care unit. To measure a hospital’s rate of C-sections, Leapfrog uses one standardized, endorsed measure that reflects the percentage of first-time mothers giving birth to a single baby, at term, in the head-down position.”
Which is why hospitals have had to adapt to the changing needs of those who do, in fact, seek natural births.
Holy Name’s chief of obstetrics and gynecology, Dr. Payal Shah, said the hospital is open to discussing birthing plans and has classes to educate new mothers.
“We make it clear that these things are available, but not pushed upon, as far as pain medication and medicine to augment labor or having the resources a hospital would give,” she said. “We want to make the process as comfortable for the patient. However, obstetrics is very unpredictable at times.”
Which is why the hospital is open to a variety of plans — including bringing in music, birthing balls, a doula or having other people to guide through the delivery, Shah said.
A recent article in the New York Times highlighted the increasing collaboration between midwives and hospitals, and the growth of birthing centers around the country.
According to the American Association of Birth Centers, there has been an 82 percent increase since 2010 in the number of freestanding, or non-hospital, birthing centers, and many are staffed by midwives.
Maron said the collaboration with hospitals is important because it allows a quicker emergency response if anything goes wrong.
Another reason for the popularity of C-sections is because doctors can ensure they are with the patient they have been caring for during delivery, and they get paid more because it’s a major surgery.
Doctors used to be able to simply run out of their offices at the time their patient went into labor, but, as reimbursement models have changed, there is less financial incentive to do so, Maron said.
“The economics don’t allow that anymore, so doctors can’t do that,” he said. “They have to be in the office, they have to see patients. So, a lot of hospitals, and we’ve done it here, have laborists. We have doctors who are on a schedule and just stay at the hospital for the day. So, you have to have that attention to make that work.”
But without a better economic incentive, it is unlikely that C-sections can be significantly reduced.
“If the payors turned around and said (they) are no longer going to pay a premium for C-sections, or C-sections that aren’t emergent need to be pre-certified … (they) will not be paid for,” Maron said. “It (could be) like cosmetic surgery. If the mother wants that, and if the family wants it for convenience, that’s fine, but then pay for it out of pocket.”
But, to get to a point where a change like that becomes reality, a conversation has to happen, Maron said.
“To really solve it, there really needs to be a convergence and a recalibration of the economic side, the risk side and the convenience side,” he said.