The Secret Weapon To These Doctors’ 12% C-Section Rate

The Secret Weapon To These Doctors' 12% C-Section Rate

When I was pregnant with my first child 10 years ago, I didn’t know much about birth except that I didn’t want a c-section.

I did a bit of research and decided a midwife was the way to go to reduce my risk of an unnecessary c-section (not to be confused with a medically necessary one).

At the time, the c-section rate in the US was higher than the World Health Organization (WHO) recommended rate of 10-15%. In some hospitals around 1 in 3 women were having c-sections.

After years of high c-section rates, many hospitals are now working hard to reduce their rates as c-sections come with the risk of serious complications for both mother and baby.

One US hospital, Einstein Medical Center Montgomery (EMCM), has established a c-section rate not only lower than the national average, but within the WHO’s recommended rate.

What Is The Secret To Reaching A 12% Primary C-section Rate?


Two years ago, EMCM made reducing c-section rates a major goal to improve outcomes for their patients. They met that goal by joining the American College Of Nurse Midwives’ Reducing Primary Cesareans Project.

Why Are C-Section Rates Important?

There’s no doubt that c-sections can and do save lives. Eliminating c-section births wouldn’t be a safe goal. However, c-sections are major surgery and thus performing them when not truly necessary exposes mother and baby to unnecessary risks. You can read What Are The Risks Of C-section For A Baby? and What Are The Risks Of C-section For The Mother? to find out more information.

The WHO uses evidenced based information to come up with an appropriate recommended c-section rate. A c-section rate of less than 10% suggests that mother-baby pairs who would benefit from a c-section birth don’t have proper access to one.

A c-section rate over 15% suggests that some women are having c-section births where the benefit of the procedure doesn’t outweigh the possible risks.

Reducing first time c-section rates can be important in reducing overall rates of c-section births. While vaginal births after a c-section (VBAC) are possible and a safe option for most mother baby pairs, many women in the US automatically have a repeat c-section.

How Can Midwives Reduce C-Section Rates?

Obstetricians have a higher level of education, so it’s better that all women just see one to get the top level of care, right?

While that might seem true, evidence shows the opposite.

Obstetricians do have a high level of education, including surgical training. They’re trained to manage birth complications. They provide excellent care for women at risk for pregnancy or birth complications.

You might think of an outdated and uneducated “medical professional” when you think of midwives, but they’re well educated and trained professionals.

EMCM works with certified nurse midwives (CNM) who are advanced practice nurses with graduate degrees. Nurse midwives are trained to facilitate normal physiological birth in addition to recognising and managing birth complications (or transferring care to an obstetrician if necessary).

Due to their training and experience with normal physiological birth, CNM are ideal maternity care providers for low-risk women and babies. Most midwifery training and models of care include a holistic approach. Nutrition, overall physical wellness, preventative care, etc. are all aspects which can improve overall outcomes for both mother and baby, including reducing the risk of a c-section.

Understanding and supporting normal physiological birth reduces interventions. This can reduce the risk of a c-section by avoiding the cascade of interventions.

When obstetricians and midwives work together, like EMCM’s Women’s Associates for Healthcare, women and babies receive the best of both worlds.

Why Is Collaborative Care Important?

Perhaps one of the biggest aspects of collaborative care is that women really should get a say in the type of care they receive. When midwives and obstetricians work together, this makes choice a reality for more women.

Another important aspect of collaboration is the ability to learn from each. Being able to provide top medical care, holistic and preventative care, and support for normal physiological birth in one place not only means better care, it also means continuity of care for women of all risk levels.

The Chief of Obstetrics and Gynecology at EMCM, Dr. Cheung Kim, MD, summed up the benefits of collaborative care in a recent press release:

“With our model, obstetricians and midwives work together in the same office, learn from each other, and our patients benefit from this combined level of expertise. Also, women who previously may have considered receiving care from a midwife but had complicated pregnancies, can now do so because our midwives work closely with our doctors and together they can manage any condition that develops.”

In addition to Women’s Associates for Healthcare, EMCM has several private midwifery practices and obstetrician groups that attend births at EMCM. It’s rare in many US regions for hospitals to have on-call staff CNMs in addition to the expected obstetricians. EMCM has this, making it possible for more women to benefit from collaborative care.

Is Collaborative Care Truly The Key To Better Maternity Care?

A lot of evidence supports access to midwifery care as an important part of public health. While pregnancy and birth are natural physiological processes, occasionally things deviate from the norm.

By providing women with access to midwifery care, we can reduce the overall rate of intervention. However, we also need access to obstetric care when things deviate from normal to ensure the safety of mother and baby.

Collaborative care means low risk women can benefit from midwifery care throughout their pregnancy and birth, while also having the back up of obstetric care. For high risk women, it means receiving top medical care to manage or treat medical complications while also having access to midwifery support during pregnancy, and sometimes even birth.

For me, a former home and freestanding birth center client times four, it meant that when my water broke at 29 weeks the transition to obstetric care was smooth and still included my midwifery practice. I was able to be assessed and admitted by my midwife, someone who was familiar with my medical and birthing history.

I was able to receive important obstetric management to prolong my pregnancy as long as possible for the benefit of my daughter. And when she arrived prematurely at 31 weeks, a staff CNM, the obstetrician my care was transferred to, and my private practice midwife all played a role in the birth and recovery.

For me personally, yes, collaborative care was key to excellent maternity care. In the bigger picture, I think this hospital’s achieved goal of lowering primary c-sections shows that collaborative care really is key to better outcomes for both mother and baby.


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Maria Silver Pyanov is a mama of four energetic boys and one unique little girl. She is also a doula and childbirth educator. She's an advocate for birth options, and adequate prenatal care and support. She believes in the importance of rebuilding the village so no parent feels unsupported.

One comment

  1. I really enjoyed reading your article as a once midwife, home birther with midwife, & now able to direct my daughters to such articles as they are in their mid twenties.

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