Lessons from a Reservation Hospital

I found an article on this amazing hospital from this past March on the Pushed Birth blog. The Tuba City hospital is small and impoverished, yet it has significantly better birth outcomes than the majority of maternity wards in the U.S. It's cesarean rate is 13.7%, less than half that of the national average and in line with the WHO recommended rate. It also has offered women the option of having a VBAC for decades and with excellent outcomes.

"Tuba City ...with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times writes.

Doctors and midwives have salaried pay, stripping the incentive to cram more patients in and perform more unnecessary and costly procedures. The hospital receives its insurance coverage from the federal government and as such is more likely to opt for less expensive, and less invasive techniques. At least in terms of birth, those simple and inexpensive methods--massage, words of encouragement, staying at the woman's side for the entirety of labor, encouraging a woman to move, having a tub available in birthing rooms--return significantly better outcomes for the majority of women.

"Birth is a joyous affair here, and the entire family — from children to great-grandparents — often go to the delivery room... Linda Higgins, the head of midwifery at Tuba City, said: 'All of a sudden Mom is surrounded by women, and they’re all helping her and touching her.'

As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening."

We can learn a lot from this small hospital, both in practice and in the perception of birth in our society. With the change in ACOG statements about the safety of VBACs, the recognition that our cesarean rate has shown no signs of decreasing to the detriment of mothers and babies, and the recent push for legislative reform covering more birthing options, there is hope the methods of the Tuba City hospital are echoed in hospitals across the country.

Read the full Times article here.