Sunday, March 7, 2010

Navajo hospital a model for births

Denise Grady reports in today's New York Times about the low rate of C-sections--and in particular the high rate of vaginal births after C-Section (VBAC), at the Navajo Nation hospital in Tuba City, Arizona.

The Tuba City Regional Health Care Corporation is different. Its hospital, run by the Navajo Nation and financed partly by the Indian Health Service, prides itself on having a higher than average rate of vaginal births among women with a prior Caesarean, and a lower Caesarean rate over all.

As Washington debates health care, this small hospital in a dusty desert town on an Indian reservation, showing its age and struggling to make ends meet, somehow manages to outperform richer, more prestigious institutions when it comes to keeping Caesarean rates down, which saves money and is better for many mothers and infants.

Tuba City is the largest population center in the Navajo Nation, with 8,225 residents. Although it is a relatively rural area, some of the challenges of spatial isolation are ameliorated because the doctors, who are ensured by the federal government, live on the hospital grounds or very nearby. They can therefore be called in on very short notice.

Another characteristic of rural communities may also play a role in the success with vaginal births: lack of anonymity. The director of obstetrics and gynecology at Tuba City is quoted as praising the midwifes who deliver most babies not born by C-section: “I think the midwives tend to be patient. They know the patients well." As a related matter, nurse-midwife Michelle Cullison is quoted: “I’ve had 12 family members in the room. ... I’ve frankly never seen a place like this. Whoever that woman wants to be there is there. It’s something I would take out to the community.”

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