I read with interest the article “In California, where moms deliver affects whether they have a C-section." As a private-practice OB-GYN for the past 23 years working mostly in a community hospital, the numbers showing high variability in the state certainly raise the question, who is controlling the birth process?
Just as the National Institutes of Health discovered in its 2010 consensus report on vaginal birth rates after a C-section, the variation cannot be explained by relative risks alone. If we look at our lowest-risk population, namely the moms who are undergoing their first birth with a full-term, head-down baby, regional variation becomes striking, with Northern California seemingly more committed to allowing the first birth to be vaginal, compared with data from our Southern California counterparts.
We are comparing similar populations, but we have different outcomes. How committed are we to that first birth being vaginal, and what is driving the differences? Time, reimbursement, institutional bias? Most likely all of these contribute, as well as the providers in labor and delivery (laborists/hospitalists and midwives).
Certainly, with new guidelines on the onset of active labor, the older, more rigid time constraints have been discarded and new norms call for giving first-time moms more time for a normal delivery. Adherence to these new guidelines will help along with the understanding that an induced labor can take 18 hours before the onset of significant cervical change.
Labor and delivery should be an area where the traditional hospital emphasis on quick patient turnover is avoided. First-time moms and their providers—aware of the new guidelines and committed to them—need more time to pass without intervention. Patience should be the norm.
