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A Northern Virginia Hospital is Leading the Way in Cutting Down on C-Sections

In the last few decades, the number of cesarean section births has skyrocketed, and many leaders in the medical community feel it’s at a crisis level. But one hospital in Northern Virginia may have come upon a way of solving the problem.

The lobby of the Virginia Hospital Center in Arlington is buzzing with activity. Patients. Doctors. Nurses. Pregnant Women. Mothers and their children. It’s here we meet P.J. Lepp, mother of three. It’s been more than a decade since she gave birth, and all three of her children were delivered by C-section. She says she listened to her doctors without questioning it.

“I don’t think that doctors want to get into the situation where they’re telling their patients, ‘Hey, what do you think we ought to do?’ Because then as a patient you’ll be like, ‘Oh my gosh, my doctor doesn’t know what’s best for me.’ So at the time when you’re delivering, you really look to your doctor and say, ‘What should I do?’”

Deliver C-section. That was the advice her doctors gave her. And Doctor Michael Moxley here at the Virginia Hospital Center says there were many reasons that was the prevailing sentiment among doctors at the time.  

“If you have to go manage somebody in labor, you have to close down your office. You’re losing money, and it’s so much easier to just go over and do a C-section.”

It was quicker. Doctors didn’t need to close their offices for extended periods of time. And, of course, doctors got paid more for C-section deliveries.

“If you look at the timing of caesarian deliveries, you see them more at lunchtime or first thing in the morning. Or at 5 o’clock. And so that tells you that it was less patient centered then than it is now. And I think that patients are starting to wake up and realize that.”

Patients are starting to wake up just as the medical community is demanding change. After the American College of Obstetricians and Gynecologists sounded the alarm about C-section rates spiraling out of control a few years ago, a local NPR affiliate identified the Virginia Hospital Center as having one of the top ten C-section rates in the country. At its peak, 32 percent of deliveries — one in three — were C-section. Dr. Miguel Fernandez recalls the response to that was hospital administrators demanding that number come down.

If you look at the timing of caesarean deliveries, you see them more at lunchtime or first thing in the morning. Or at 5 o'clock. And so that tells you that it was less patient centered then than it is now.

“The very first meeting, the chief medical officer called me and said this is an important thing and we need the C-section rate to come down, and I think I had just become chair at that point and he said this is the one thing that we are going to want from you and from the department is a lowering of the caesarian section rate.”

And so they brought in Dr. Moxley, who is the vice chairman of patient safety and quality improvement for ACOG — that’s the group the sounded the alarm about C-section rates.

"Despite all the safety measures we take, compared to vaginal birth it is still seven times more likely to result in maternal death than vaginal birth. The complications that go along with surgery — bleeding, infection, risk of placental problems with subsequent pregnancies.”

Moxley says it was a tough slog at first.

“We started off having regular meetings, and they turned out being almost four hours a month worth of meetings because we had so many cesareans to review. Currently with the decrease in the rate we now meet for about an hour a month.”

Those rates came down because the Virginia Hospital Center created a new culture — one where vaginal deliveries were the norm, and every C-section delivery would prompt a host of questions. Fernandez says they’ll continue these monthly meetings indefinitely.

“We put on seat belts, but we don’t think about medical safety. And this is a medical safety issue, and we just have to be sure that if you’re ending up with major surgery that that major surgery has implications to future pregnancies and complications that it’s being done for the right reason.”

These days, the rate of C-sections at the Virginia Hospital Center is down to 22 percent — about one in four as opposed to one in three. That’s well below the recommended guideline, and it’s a number doctors here say can be emulated by hospitals across the county.

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.

Michael Pope is an author and journalist who lives in Old Town Alexandria.