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To Make Childbirth Safer, Look No Further Than Valley Hospitals

Sep 18, 2018

High-risk childbirths for celebrity mothers like tennis star Serena Williams and performer Beyonce are shining a light on a health story that’s historically flown under the radar: Childbirth is risky for women, particularly women of color. Williams, Beyonce and their babies all survived, but the U.S. does have the one of highest rates of mothers dying in childbirth of any developed country. Alarmingly, that rate rose 65 percent from 2006-2013. Simultaneously, however, California slashed its own maternal mortality rate in half—and much of that improvement is being driven at the local level.

The birthing unit at Community Regional Medical Center in Fresno is bustling. Nurse midwife Lorraine Farkas, a smile permanently on her face, stands in blue scrubs near a nursing station, a fetal monitor pulsing nearby. She says the providers on these two floors deliver around 450 babies a month. “When you think of that in kindergarten sizes, just imagine,” she laughs.

As Farkas walks me through the labor unit, she stops another nurse in the hallway. “Did she deliver vaginally?” she asks. When the nurse says yes, Farkas lets out a belly laugh, her smile even bigger than usual. “That’s so good,” she says.

Portraits of mothers and fathers with their babies line the birth center at Community Regional Medical Center.
Credit Kerry Klein / Valley Public Radio

Vaginal births are not something most of us would casually chat about, but here it’s on staff’s minds: Community Regional has been intentionally cutting back on C sections, as well as other routine procedures like episiotomies. When unnecessary, they can both harm a woman’s body and put her at risk for later complications.

Dr. Jeffrey Thomas is an obstetrician gynecologist and the Chief Medical and quality officer with Community Regional Medical Center. “We have changed our focus from volumes and curtains and cafeteria food to: What is the safest and the best place to have your baby in the Valley?” he says.

From 2013-2016, Community Regional’s C section rate for low risk births fell by 16 percent, to about 22 percent of all low-risk, full-term births. It's one of four Valley birthing hospitals that now boast a C section rate below the state average. Simultaneously, episiotomies fell by 60 percent. These downward trends are part of a nationwide push to minimize unnecessary risks to women, which together can reduce the risk of mothers dying in childbirth. After all, the CDC Foundation does estimate 60 percent of maternal deaths are preventable.

In California, however, data show we are preventing them—in part thanks to local hospitals like Community Regional reevaluating how they care for mothers. “I think that we are taking some steps back and redefining how we practice medicine,” Thomas says.

NTSV (nulliparous, term, singleton, vertex) C sections as a percentage of all live births at a given birthing hospital for the year 2016.
Credit Cal Hospital Compare

Redefining that practice includes being better prepared with new protocols for potentially fatal complications like preeclampsia, which signals a risk of organ failure, and hemorrhaging. Before the new protocols were in place, Thomas describes responding to these emergencies like a frantic, high-pressure scavenger hunt. “You had someone running to the stock room to get this, someone running to the pharmacy to get that,” he says, “that is the old mentality.”

Now, they’ve introduced easy-access toolkits and reference guides, on hand and sometimes posted on walls wherever they may be needed.

Hospitals also have access to a data clearinghouse on things like C sections, vaginal birth after C sections, and episiotomies. They can see how they compare to other hospitals, which Thomas jokingly refers to as public shaming.

Marinda du Toit kind of agrees. She’s the Clinical Director for Maternal Child Services at Kern Medical in Bakersfield and she says before seeing that data, every hospital was essentially an island. “It was very siloed, every facility doing their own thing,” she says. “You don’t realize you have a problem until you look at what other places are doing and say ‘this is something we need to look at.’”

Kern Medical is one of the highest rated hospitals in the San Joaquin Valley for maternal measures, and Du Toit says access to detailed hospital data is one reason their scores have improved.

As at many hospitals around the state, Community Regional is encouraging mothers and babies to spend time together during recovery, and increasing its emphasis on breastfeeding.
Credit Community Regional Medical Center

The impetus for these changes was an innovative program called the California Maternal Quality Care Collaborative, or CMQCC. Since its debut in 2006, Administrative Director Cathie Markow says it’s brought in hospitals, medical societies and lawmakers as collaborators in reducing deaths and complications from childbirth. “Our goal is healthy moms and babies,” she says.

Those emergency toolkits and detailed hospital data are two of the CMQCC’s flagship innovations, and benefits for hospitals that sign up as members.

Although not all hospitals have improved at the rate of Community Regional and Kern Medical, Markow says CMQCC’s goal is to encourage hospitals, not to shame them. “A majority of the hospitals and certainly the staff within the hospitals, they want to do the right thing,” she says. “They want healthy moms and babies, and they work hard at making that happen.”

Every birthing hospital in the San Joaquin Valley is now a CMQCC member. As a result, says Rose Mary Rahn, Director of Maternal Child and Adolescent Health at the Fresno County Department of Public Health, maternal care here is improving. “I think there’s definitely an intention and I think they’re getting much better,” she says.

And that’s important for the Valley’s babies, too, who are at a higher risk for health complications themselves than in other parts of the state. “We have a higher infant mortality rate than the state average, we have a higher preterm birth rate here in Fresno County, and so we have a few more challenges that way,” she says.

Overall, she says, birth outcomes are appear to be improving along with maternal outcomes. But not at the same rate for everyone. In Fresno, for instance, African American babies are still more than 50 percent more likely to be born early and underweight than white babies—something many other health agencies and advocacy groups are working on improving.

Another side effect of focusing on moms, says Community Regional nurse midwife Lorraine Farkas, is more holistic care during recovery: Keeping moms and babies together and encouraging breastfeeding.

It’s all in the name of healthier babies growing up with their mothers.