Tuesday, March 24
NORTH ADAMS — While more and more women choose to undergo Cesarean section births despite a national push by the federal government to decrease the number, the local rate has declined and is well below the state average.

North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent, according to reports released by the state Department of Public Health.

The hospital also has a better prenatal care record, according to the reports: 94 percent of women giving birth have had nine or more prenatal care visits versus the state average of 87 percent having that many visits.

"I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before," Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. "It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby."

In 2004, federal health officials, after seeing a 40 percent increase in c-section births between 1996 and 2004, announced a goal of decreasing the total percentage of c-section births in the county from about 30 percent to 15 percent or below by 2010.

"We usually have a rate of about 16 percent, which is a pretty good range to be in," Dr. Charles O'Neill, an obstetrician/gynecologist with Northern Berkshire Obstetrics & Gynecology [at North Adams Regional Hospital], said.

"I think there are several things that conspired to push the number of c-sections up over the years," he said. "There has been a trend away from offering vaginal births after c-section (familiarly known as VBAC) because of several high-profile malpractice suits and a trend to deliver most twins by c-section."

During 2008, the hospital performed 29 first-time c-sections out of 207 births or 10.7 percent, which is well-below the state average of 20 percent. It had 20 repeat c-sections — 7 percent of the births versus the state average of 13 percent.

"Recently there have been several high-profile studies done that conclude there is overuse of high-tech interventions," Rivinus said. "The conclusions have been that all women should be offered a midwifery model, or a 'back-to-basics' approach to childbirth, where spontaneous, natural birth is the focus."

While some may find a planned Cesarean to be more convenient for the practitioner and family, Rivinus said there are several significant high-risk complications that come with c-sections: infection, uncontrolled bleeding, respiratory distress for the infant and increased risk of the placenta detaching from the uterine wall in future pregnancies.

"Vaginal births are a very natural process," she said. "I think births have become very clinical and sterile, which they shouldn't be. We strive to have personal relationships with our patients and treat the whole individual, not just the pregnancy."

O'Neill said that while he and Dr. Susan Yates have always offered a 'patient-centered' practice, subtle differences have evolved with the addition of two full-time and one part-time certified nurse midwives to the practice.

"To me, the take-home message is that our collaborative practice has made an impact on our overall rates in the end," O'Neill said. "They've helped us improve our standards with the progress of labor and help to remind us and the patients that patience is always a virtue."

Northern Berkshire Obstetrics & Gynecology plans to have two additional obstetrician/gynecologists on staff later this year.