Hospital Rate for Cesarean Sections Falls : Health: Ventura County Medical Center’s 16.9% figure is lowest in area. But critics say the surgery is still done too often.

The Ventura County Medical Center had the lowest rate of births by Cesarean section in the county last year, according to state officials.

That compares to Los Robles Regional Medical Center, which had the highest rate of births by Cesarean section among Ventura County’s eight hospitals last year, state health officials said.

The county hospital in Ventura had a Cesarean section rate of 16.9% in 1992, a slight decline from its 17.2% rate in 1991. Los Robles’ Cesarean section rate was 34% in 1992.

Ventura County Medical Center was one of five hospitals in the county to reduce its Cesarean section rate from 1991 to 1992. The decreases come amid charges by some public health advocates that up to one-third of all such surgeries are unnecessary.

Other medical facilities in the county that lowered their Cesarean rates were St. John’s Regional Medical Center in Oxnard and Simi Valley, Pleasant Valley and Community Memorial hospitals.

“Our physicians strive to deliver the best possible care and, of course, it is going to be better for the mom anytime you can deliver vaginally,” said Karen O’Connell, clinical manager of the Women’s Center at St. John’s. The Oxnard hospital reduced its Cesarean section rate from 21.1% to 17.36% from 1991 to 1992.

Still, some of the hospitals that lowered their Cesarean rates haven’t lowered them enough, one national health advocate said. Sidney M. Wolfe of the group Public Citizen said any Cesarean section rate over 12% is too high.

Wolfe and others said Cesarean sections are more costly and often lead to postnatal health complications for new mothers.

“It’s a huge operation,” said Mary Ann Scheuer, a state health-policy researcher. “In a third of the cases, women get infections.”

Countywide, the Cesarean section rate for hospitals stood at 21.4% in 1992, down from 22.9% a year earlier. For the state, the rate was 19.9% last year, compared to 21.5% in 1991.

“In California, about a third of the C-sections are still unnecessary,” said Wolfe, who estimated hospitals in the state still could reduce Cesarean sections by about 38,000 a year.

California health officials agree, but still credited hospitals in the state with bringing their level of Cesarean sections down in the past year.

“The U.S. national health objective for the year 2000 is to reduce the Cesarean delivery rate to no more than 15% overall,” Scheuer said. “So this is good progress toward that goal.”

Janis Ploeger, a spokeswoman for the Office of Statewide Health Planning and Development, the agency that released the Cesarean section data, attributed the lower rate to several factors.

Ploeger said recent attention to the high number of unnecessary Cesareans across the country has made patients more discerning when it comes to deciding on how to birth a child. Secondly, she said, more women who have had Cesarean sections increasingly are choosing to have vaginal births with later children.

Los Robles has traditionally led Ventura County in the rate of births by Cesarean section.

Carol Freeman, a Los Robles vice president, said the hospital is aware of the increasing public criticism regarding that distinction. “We’re trying to get answers for it ourselves,” she said.

One cause for Los Robles’ disproportionate Cesarean section rate appears to be that it caters to mothers who are generally older than the statewide average, Freeman said. The average age of women having babies at Los Robles: 30.5. And Freeman said 10% of them are over 35.

In 1992, 1,311 babies were delivered at Los Robles--447 by Cesarean section. The 34% rate compared to 32.1% at the hospital in 1991.

At hospitals like Los Robles, Public Citizen’s Wolfe said, there are doctors “who like doing C-sections. And the hospital likes to take in the extra hundreds of thousands of dollars.”

Freeman denied that Los Robles’ Cesarean section rate is driven by profit concerns.

“When you’re making clinical decisions, you’re not counting in your checkbook to see how many C-sections (you) have done,” she said.

Ventura County Medical Center officials did not return phone calls seeking comment. But some public health advocates said that medical centers such as the county hospital that serve a large number of the poor often perform fewer Cesarean sections than those facilities that cater to the more affluent.

“To the extent that money drives C-sections, people who don’t have as much money aren’t being as jeopardized as people who do have money,” Wolfe said. “It’s almost an advantage to be poorer.”

Births by Cesarean Section (By hospital as percent of total births in 1992) Los Robles Regional Medical Center: 34% Simi Valley Hospital: 27.5% Santa Paula Memorial Hospital: 23.3% Pleasant Valley Hospital: 23% Community Memorial Hospital: 21.59% Ojai Valley Community Hospital: 19.8% St. John’s Regional Medical Center: 17.36% Ventura County Medical Center: 16.9% Countywide: 21.4% Statewide: 19.9% Cesarean Section Deliveries Ventura County 1983: 20.8% ‘84: 23.1% ‘85: 23.4% ‘86: 25.4% ‘87: 25.5% ‘88: 24.9% ‘89: 25.5% ‘90: 23.3% ‘91: 22.9% ‘92: 21.4% Sources: Office of Statewide Health Planning and Development, State Department of Health Services