Providence Sacred Heart Medical Center & Children’s Hospital has reduced Cesarean sections in recent years to a level a doctor here says is more acceptable and beneficial for the long-term health of mothers.

Dr. Steven Brisbois, medical director of women’s services at Sacred Heart, says 744 of the babies born at Sacred Heart so far this year, or 28 percent of all births there, were delivered via C-section. That’s down from 974 C-section births, or 34 percent of all births at Sacred Heart, in all of 2010. 

Brisbois says the rate of C-section births has been decreasing fairly consistently during the past five years. In 2011, 922 births, or 31 percent of all births in Sacred Heart, were C-sections. The number of C-sections dropped slightly to 877, or 30 percent, in 2012, and then rose slightly to 918—or 31 percent—in 2013, before falling again to 858 C-sections, or 29 percent of all births, last year. 

A co-founder of Northwest Ob-Gyn, Brisbois, 69, had delivered more than 3,000 babies before moving into robotic gynecological surgery seven years ago. In 2009, he was named the hospital’s medical director for women services. It was then that he noticed the alarming rise in C-section deliveries at the hospital.

“In 2010, the Cesarean-section rate at Sacred Heart reached an all-time high of 34 percent,” Brisbois says. “That was consistent with the national rate of 36 percent that year. When you did the math, in less than 10 years, Cesarean-sections were going to constitute half of all deliveries.”

It was about that time that medical journals and consumer publications across the U.S. began promoting vaginal birth over the surgical procedure. Brisbois assembled a taskforce of obstetricians to examine why Sacred Heart’s C-sections were at an all-time high and what could be done to reverse the trend.

C-sections are most commonly performed in one of four scenarios: when a baby is too big to be born vaginally, if the baby is experiencing fetal distress and oxygen to it is compromised, if the baby is in a feet-first breech position rather the normal head-first position, or if there’s more than one baby to deliver.

“So our research revealed that babies weren’t getting bigger, and we weren’t seeing an increase in multiple births, so why was there an increase? A Cesarean-section is a major surgery with a greater risk to the mom. Looking back, we were probably doing C-sections that didn’t need to be done,” Brisbois says.

Though still miniscule in number, he says there has been an increase in the maternal death rate in the U.S. due to hemorrhaging and other complications associated with C-sections.

“First, we were willing to ask tough questions,” says Brisbois, adding, “We had to recognize that maybe we weren’t doing the best job. Second, we instituted a policy to eliminate elective induction of labor in women who were less than 39 weeks pregnant.”

To help babies be born healthier, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine changed the way they defined births after 37 weeks of pregnancy.

The two organizations now define a full-term pregnancy as one that lasts 39 weeks to 40 weeks and six days. In the past, a pregnancy that lasted from 37 to 42 weeks was called a term pregnancy. Doctors once thought this five-week period was a safe time for most babies to be born.

Third, Brisbois says Sacred Heart also began publishing in-house the C-section rates of obstetricians. 

“I wanted the doctors to see and compare their own data,” Brisbois says. “It started a dialogue and got the doctors talking and thinking about their practice. That one action caused significant change and got the momentum going.”

At Providence Holy Family Hospital, on Spokane’s North Side, Brisbois says 22 percent of all deliveries are C-Section. 

“Sacred Heart is always going to perform more C-sections. We can’t, and don’t want to get to that 22 percent number, because of all the high-risk patients we see,” Brisbois says.

“What is the correct C-section rate? No one really knows the answer. For us, though, I don’t think getting much lower than 28 percent is going to be beneficial for our patients,” he says.

He says he is pleased with the  way doctors here adjusted to the change in perception about C-sections.

“And now what really has happened is the culture has changed; we established a new norm,” Brisbois says.