4A
THE DAILY ASTORIAN • WEDNESDAY, JULY 22, 2015
C-sections: The operation can be life-saving
Continued from Page 1A
Congress of Obstetricians and
Gynecologists, questioning
why the cesarean birth rate
has jumped during the past
few decades and what can
be done to safely lower it to
the bene¿ t of women, who
often experience longer re-
covery periods, a increased
likelihood of complications in
future pregnancies and other
disadvantages after the sur-
gery.
Contributing factors
Cesareans can be life-sav-
ing procedures in some cases,
but the WHO recommenda-
tion for the optimal C-section
rate is important. It indicates
that among health providers
who have a rate higher than
approximately 10 to 15 per-
cent, there is no evidence to
support that it is bene¿ cial for
either mothers or infants , ac-
cording to Dr. Aaron Caughey,
who is chairman of the depart-
ment of obstetrics and gyne-
cology and associate dean for
women’s health research and
policy at the Oregon Health
and Science University.
Maybe the high rate “is
preventing bad things from
happening, but we don’t really
have any evidence to support
that,” he said, which leads to
suspicion there are thousands
of babies being born through
C-sections who don’t need to
be.
When sorting through the
factors contributing to high
cesarean rates, the primary
one seems to be pressure from
the medical profession’s law-
yers, Caughey said.
As of 2011, according to
the American Congress of Ob-
stetricians and Gynecologists,
more than 90 percent of OB-
GYNs had been sued for mal-
practice at least once during
their career, with an average
of 2.7 claims per ob-gyn.
Claims related to a neurologi-
cally impaired infant made up
30.5 percent of the obstetric
claims, and of those, 49 per-
cent were closed with some
payment made to the plaintiff,
“either settled with payment,
closed by way of jury or court
award, or closed through
some other dispute-resolution
mechanism,” the association
states. The average payment
for claims involving a neuro-
logically impaired infant was
$1,155,222
Even years down the road,
if an infant or child’s neuro-
logical issues can be linked to
their perinatal care or method
of delivery, a doctor or hospi-
tal can be sued. It is much less
likely a woman can or will sue
because she had a C-section.
“It just doesn’t happen,”
Caughey said. “People don’t
get sued for doing C-sections;
they get sued for not doing
C-sections.”
As a response to the risk
of liability claims and be-
cause of insurance costs and
availability, doctors began
making changes to their prac-
tice, including decreasing the
number of high-risk obstetric
patients, no longer offering
or performing vaginal births
after C-sections — referred to
as VBACs —and increasing
the number of cesarean deliv-
eries, among others, accord-
ing to the OB-GYN group .
Cesareans have become
“very, very safe” to perform,
which can lead to some doc-
tors opting for that route
sooner, rather than later, when
complications arise to prevent
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According to State records, Cesarean births at Columbia Memorial
and Providence hospitals made up more than 30 percent of births at
each institution respectively in 2014. By comparison, the World
Health Organization recommends the C-section rate should not be
higher than 15 percent.
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potential infant injuries and
decrease liability, Caughey
said.
The pressure from liabil-
ity is often not predominant-
ly economic, Caughey said.
Doctors purchase insurance
for the sake of being ¿ nancial-
ly covered in such instances.
Rather than an economic cost,
it’s “the act of being sued or
having people around you
being sued,” Caughey said.
Most doctors enter medicine
“because they thought they
could make a difference in
people’s lives,” he said. To
be dragged through the court
system, negatively labeled
and personally blamed for
something bad happening —
“that’s pretty demoralizing,”
Caughey said.
“It’s probably one of the
strongest negative outcomes
a physician can experience,”
he added.
Paying the bill
As for other economic
considerations, Caughey said,
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“there is a lot of misunder-
standing about how hospitals
and physicians are paid.”
C-sections are more costly
for patients. Doctors, however,
do not make signi¿ cantly more
money from a C-section than
a vaginal delivery. Hospitals
also tend to lose money from
the “birth business” in general,
Caughey said. The one area
hospitals make money through
births is from charges relating
to care for the newborns, who
along with the mothers, are
not discharged for a few days
after a C-section. Also, if com-
plications led to the C-section
that may indicate the infant
or mother needs further post-
partum care, which chalks up
more hospital charges.
“Safe Prevention of the
Primary Cesarean Delivery,”
a research paper developed by
the OB-GYN association and
the Society for Maternal-Fetal
Medicine in 2014, suggest-
ed alternative causes behind
the increasing cesarean rate
could be “modi¿ able factors,”
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such as “patient preferences
and practice variation among
hospitals, systems and health
care providers.” Research has
found maternal characteristics
— such as age, weight and
ethnicity — do not account
fully for the increase in the
C-section rate or its regional
variations, the paper state d.
Local hospitals
Columbia Memorial Hos-
pital Community Outreach
Manager Paul Mitchell said
the hospital was part of the na-
tional Partnership for Patients
initiative through the Oregon
Association of Hospitals and
Health Systems, which start-
ed in February 2013 and went
through 2014 . The was aimed
toward reducing patient harm
by 40 percent and readmis-
sions by 20 percent. The ini-
tiative had 10 focus areas, in-
cluding birth-related injury to
babies, Mitchell said.
Data from Oregon Health
Authority shows the hospi-
tal’s C-section rate increased
from 2013 to 2014.
Mitchell said he believes
the hospital has seen a de-
crease in its C-section rate .
“The hospital has reduced
early elective deliveries by
developing criteria for de-
termining when delivering a
baby before 39 weeks of ges-
tation is medically warranted
and educating patients on the
bene¿ ts of allowing babies to
gestate,” Mitchell said.
At Providence Seaside
Hospital, C-sections “are per-
formed for many indications/
reasons that may occur during
pregnancy or labor, includ-
ing the position of the baby
and arrest of labor,” Public
Affairs Manager Paulette Mc-
Coy said. “C-sections can be
scheduled procedures or un-
scheduled during the hospi-
talization, due to events that
occur in labor.”
Providence Seaside does
not have a high-risk birthing
facility, but collaborates with
Providence St. Vincent and
Northwest Perinatal Center
for high-risk patients, McCoy
said. CMH does offer care for
women with high-risk preg-
nancies as part of its mission
to provide care close to home,
Mitchell said.
Mitchell and McCoy did
not provide information on
their hospitals’ liability man-
agement frameworks.
Coming Thursday: What
are the alternatives?
Power: A balloon from a nearby
celebration caused the outage
Continued from Page 1A
Seaside, Gearhart and
parts of Warrenton were
without power from about
440 to 1020 p.m. as Paci¿ c
Power employees replaced
the damaged equipment. The
outage was caused by a me-
tallic-skinned helium balloon
that got away, according to
Paci¿ c Power.
“We found unmistakable
red, white and blue Mylar
shreds when we did the re-
pairs the evening of July 4,”
Steve McGrorty said. He is
Paci¿ c Power’s operations
manager for the North Coast
The balloon from a near-
by celebration caused a main
substation transformer to
short circuit near Seaside
Factory Outlet Center. Other
equipment also was damaged
on nearby poles.
“Balloons may seem like
small things,” Paci¿ c Power
Safety Manager Gene Mor-
ris said. “But when escaped
balloons touch power lines or
substations, even the smallest
amount of metal content ma-
terial can conduct electricity.
This can interfere with lines,
causing power À uctuations
and outages.”
Emergency response
When the power went out,
the city went into response
mode and activated its Emer-
gency Operations Center,
headquartered at Seaside Po-
lice Department. All the city’s
department heads collaborat-
ed on how to collectively re-
spond , Seaside Division Chief
Chris Dugan said.
Usually a power outage is
not a huge safety concern and
does not activate the Emer-
gency Operations Center,
Seaside Police Chief Dave
Ham said. Because it was
Fourth of July, however, and
there were throngs of people
on the beach , it caused some
concern.
“You have an enormous
amount of people trying to get
off a relatively small space,
with limited avenues to À ood
out,” Ham said.
Additionally, city staff
wanted to have a contingen-
cy plan for the anticipated,
post-¿ reworks heavy traf¿ c
when no traf¿ c lights were in
operation.
As part of its response,
the city got several large light
structures to set up at key
locations throughout town .
Fortunately, power was fully
restored at an optimal time
— just as the ¿ reworks show
ended.
Before the show, the ¿ re
department also strategically
stationed crews at three loca-
tions to respond to calls, since
traf¿ c becomes gridlocked
once the ¿ reworks are over,
Dugan said.
Overall, during Fourth of
July weekend, the department
had 39 documented runs
Because of how dry this
summer has been, Dugan
said, he expected more brush
¿ res, but there were only two.
He said he believes people
were aware of the heat and
dryness and stayed alert and
conscientious to decrease the
risk.
Courtesy of Pacific Power
The rather charred remains of the balloon that caused the power outage on the North
Coast on the Fourth of July.
Unemployment rate rose in June
The Daily Astorian
Seasonally adjusted unem-
ployment rates in northwest
Oregon continued their upward
march through June, according
to data released Tuesday by the
Oregon Employment Depart-
ment.
Clatsop County
Clatsop County’s seasonally
adjusted unemployment rate
was 5.5 percent in June, up a
third of a percent from May but
still down more than 1 percent
from a year ago. Clatsop Coun-
ty had the ninth-lowest unem-
ployment rate in Oregon in
June, while matching the state-
wide average and coming in
just above the national average.
The county added 440 jobs
in June, 70 fewer than the state
expected. That left total non-
farm payroll employment at
17,350, 260 more than the year
prior for a growth rate of 1.5
percent.
The private sector added all
440 jobs in June, including 260
in leisure and hospitality; 90 in
food manufacturing; 50 in other
services; and 30 in retail trade.
Over the past year, leisure
and hospitality have added 270
jobs; education and health ser-
vices 80; state government 70;
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and professional and business
services 60. Meanwhile, retail
trade has shed 150 jobs; non-
durable goods manufacturing
120; and local government, ex-
cluding education, 60.
Columbia County
Columbia County’s season-
ally unemployment rate in June
was 6.9 percent, up slightly
from May but 1.5 percent lower
than the year prior. The county
has 29th-lowest unemployment
rate of Oregon’s 36 counties.
The county added no jobs
in June, although the state had
expected a gain of 40. Total
nonfarm payroll employment
remained at 10,220, 250 more
than a year prior, a growth rate
of 2.5 percent.
The private sector lost 10
jobs in June, and government
added 10. Retail trade added
30, the only industry to register
a signi¿ cant change.
Over the past year, the pri-
vate sector has grown by 180
positions, including 140 in du-
rable goods manufacturing and
60 in retail trade. Construction
has cut 50 jobs, while govern-
ments have added 70, mostly at
the state level.
Tillamook County
Tillamook County’s season-
ally adjusted unemployment
rate in June was 5.7 percent, up
0.4 percent from May but 1.3
percent lower than a year prior.
It had the 11th lowest unem-
ployment rate of Oregon, tied
with Morrow County.
The county added 170 jobs,
as the state projected. That left
nonfarm payroll employment
at 8,630, 20 more than the year
prior, or a 0.2 percent growth
rate.
The private sector added
160 jobs, including 120 in lei-
sure and hospitality. Govern-
ments added 10 jobs.
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Our people make
The Planetree Difference
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Devon is one of the caregivers at
CMH who exemplifies our Promise of
Excellence:
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Respect
Integrity
Compassion
Leadership
Safety
Teamwork
Caregivers like Devon make your
community hospital one to be proud of.
“To me, patient-
centered care means
involving the patient
and his or her family as
partners and primary
decision makers to
help enhance their care
experience.”
– Devon Weaver, Nurse
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