9 Investigates

Thousands of Florida women are having unexpected cesarean sections

ORLANDO, Fla. — There's a disturbing national trend that can lead to death. 9 Investigates uncovered a study that reveals state health officials are so worried, they're working with local hospitals to reverse the trend.

9 Investigates' Daralene Jones has been reviewing a state database for more than a month. The major concern is healthy women who have first-time cesarean sections unexpectedly. Doctors clearly state that some women need to have the procedure to protect the life of the mother and baby.

Kristin Morris said she was one of those who suddenly had to have a C-section. She started feeling pain in the middle of the day and went to the emergency room at Winter Park Memorial Hospital.

"Within a few minutes, the doctor came over and told me I had to have an emergency C-section and for me to hurry it up, sign these papers. Not what I had planned for at all," Morris said.

The unexpected C-sections have caught the attention of the state. William Sappenfield now oversees a new project called the PROVIDE Initiative at the University of South Florida to get the rate down. PROVIDE stands for Promoting Primary Vaginal Deliveries.

Sappenfield is a medical doctor, a professor in the College of Public Health and the director of the Chiles Center and Florida Perinatal Quality Collaborative.

"Cesarean is one of the big issues in the state of Florida that needs to be addressed. Florida has the second-highest cesarean rate in the United States, 31 or 32, which puts us far above most of the other states and the rest of developed countries in the world," Sappenfield said.

9 Investigates spent more than a month sorting a Florida Department of Health database. According to the Centers for Disease Control and Prevention, there were about 23,128 first-time C-sections among low-risk women, statewide, in 2017, accounting for about 32 percent of all births (73,728). The national rate is 26 percent.

Dr. Anna Varlamov is an Ob-Gyn at Winnie Palmer Hospital for Women & Babies, where about 2,061 first-time C-sections were performed last year. The hospital is also one of 45 statewide that are voluntarily working with the Florida Perinatal Quality Collaborative to reduce the numbers of C-sections, with a focus on waiting for natural birth to occur.

"We try our best not to admit women who are 1 centimeter, 2 centimeters, 3 centimeters (dilated). You end up sitting in the hospital. You end up receiving unnecessary interventions," Varlamov said.

Some doctors aren't using current guidelines that recommend you wait until a woman is close to 6 centimeters before admitting her to the hospital for delivery. Often women receive a drug called Pitocin, a synthetic form of oxytocin, to speed up contractions, with hopes your body will kick into natural labor on its own.

But that doesn't always work, and sometimes doctors don't wait long enough for the drug to take effect.

"If you don't need it yet, what you're doing is pushing a woman toward increasing the likelihood of having a cesarean section, because we're doing more and more things that makes the need to deliver the baby, today, a requirement," Sappenfield said. "We're not necessarily supporting women now to have vaginal births because we worry so much about watching the risks."

For example, Sappenfield questions why a woman is placed on a monitor, which keeps her attached to a bed, which could delay the labor progress. If we used the old research, we would intervene earlier, Sappenfield said.

Jones asked Varlamov what should be said to critics who suggest hospitals are performing first-time C-sections in order to speed up deliveries, to free up beds or for profit.

"We don't compromise lack of beds or profit. We don't take that into consideration," Varlamov said.

A C-section can cost up to $50,000, compared to about $30,000 for a natural birth. And that's a cost mother Kristin Moore didn't anticipate because, even with insurance, there's an out-of-pocket expense. “More people need to question their doctors, especially if it's their first child. At the end of the day, you should be able to deliver the child (the way) you want, not what's convenient," Morris said.

The Florida Agency for Health Care Administration is also concerned about the increase in the number of C-sections performed. C-sections have already cost the state an estimated $50 million this year and $141 million last year.

Most of the patients getting the procedure are low-income and Medicaid patients. The agency recently awarded new contracts to health plans to serve Medicaid recipients under the Statewide Medicaid Managed Care Program.

The agency will transition to the new plan contracts beginning in December, with three goals, one of which is improving birth outcomes.

As part of the negotiation with plans that were eventually awarded contracts, the goal is a 12 percent average reduction in primary C-section rate. But the agency will not pay a direct incentive to providers. The health plans will be held to these benchmarks, and they will have the flexibility to offer incentives to their network providers in order to help them achieve the benchmarks.

Unexpected C-sections on the rise in Florida

Florida has the second highest C-section rate in the nation. 9 Investigates what’s behind the high numbers and what doctors are doing to reverse the trend, on Eyewitness News at 5:45 p.m. at.wftv.com/2uFdtCT

Posted by WFTV Channel 9 on Tuesday, July 17, 2018