Great Article: "Lessons at Tuba City Hospital"

I saw this article posted on a group I follow, and it was amazing - it covers a small hospital here in Arizona (serving primarily Native American women) which has amazingly low cesarean rates and high VBAC rates.

Lessons at Tuba City Hospital About Births

The article goes into some of the reasons why this hospital has such a low cesarean rate, and some of them are very interesting. For example:

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On malpractice:

"The hospital and doctors are federally insured against malpractice, in contrast to other hospitals, where private insurers have threatened to raise premiums or withdraw coverage if vaginal birth after Caesarean is allowed.

"'As a result,' Dr. Leib said, doctors in Tuba City are free to “think about what’s best for the patient and not what covers our butts.”

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On joint midwifery/obstetrical care:

- "Nurse-midwives at these hospitals deliver most of the babies born vaginally, with obstetricians available in case problems occur. Midwives staff the labor ward around the clock, a model of care thought to minimize Caesareans because midwives specialize in coaching women through labor and will often wait longer than obstetricians before recommending a Caesarean. They are also less likely to try to induce labor before a woman’s due date, something that increases the odds of a Caesarean....

"Dr. Kathleen Harner, an obstetrician in Tuba City, said: “Midwives are better at being there for labor than doctors are. Midwives are trained for it. It’s what they want to do.”

"Dr. Amanda Leib, the director of obstetrics and gynecology at Tuba City, said: “I think the midwives tend to be patient. They know the patients well, and they don’t have to leave at 5 to get home for a golf game or a tennis game. As crass as that sounds, I do think it has some influence.”

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On physiologic labor:

"Donna Rackley, a nurse-midwife in Tuba City, said that at a previous job in North Carolina, doctors who did not want to work late would sometimes set an arbitrary deadline and declare that if a woman did not deliver by then, she would have to have a Caesarean.

“I found myself apologizing to patients,” Ms. Rackley said.

In Tuba City, she said, if labor is slow but there is no sign of fetal distress and the patient wants more time, the doctors will wait.

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On VBAC guidelines:

"Something that has led many other hospitals to ban vaginal birth after Caesarean poses less of a problem at Tuba City. The American College of Obstetricians and Gynecologists recommends that an obstetrician and an anesthesiologist be “immediately available” during labor for patients who have had a previous Caesarean in case something goes wrong.

"Many hospitals, especially small ones, say they cannot afford to pay these specialists to wait around. But in Tuba City, doctors live on the hospital grounds or just minutes away, and they are immediately available even if they are at home."

(My note: I love that! Why didn't we ever think of having doctors live on-site?)

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On financial incentives for birth outcomes:

"Doctors and midwives here earn salaries and are not paid by the procedure, so they have no financial incentive to perform surgery. (Doctors earn $190,000 to $285,000 a year, and midwives $80,000 to $120,000.)"

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On birth culture and birth support:

- "Some of Tuba City’s success probably arises from Navajo culture and customs. Couples often want more than two children, but repeated Caesareans increase the risk of each pregnancy, so doctors and patients are motivated to avoid the surgery. Also, Navajos regard incisions as a threat to the spirit, something to be avoided unless necessary."

"Birth is a joyous affair here, and the entire family — from children to great-grandparents — often go to the delivery room.

“'I’ve had 12 family members in the room,” said Michelle Cullison, a nurse-midwife. “I’ve frankly never seen a place like this. Whoever that woman wants to be there is there. It’s something I would take out to the community.'

"Linda Higgins, the head of midwifery at Tuba City, said: “'All of a sudden Mom is surrounded by women, and they’re all helping her and touching her.'

"As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening.

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Great food for thought!