Though the cesarean rate has increased 60 percent over the past 15 years, the cause of the epidemic is largely unknown. Clinical groups and hospitals are looking for ways to audit their practices to help reduce cesareans, but these activities focus largely on what provider can do. That’s where Ovia Health comes in: we’re using data to attack the cesarean epidemic, engaging millions of women to guide them with evidence-based information to make the best decisions for their health.
The cesarean rate in the United States has increased dramatically during the past 15 years, from 20 percent in 1996 to 32 percent in 2015 – a 60 percent increase. There is consensus among every health advocacy organization – from the National Institutes of Health to the American College of Obstetricians and Gynecologists (ACOG) – that this epidemic is bad for American women and babies, in terms of both health and cost. Cesarean is associated with increased risk of hemorrhage, infection, blood clots, and death. Cesareans cost employers and the taxpayers, on average, $10,000 more than a vaginal delivery.
And yet, remarkably, the cause of this epidemic is largely unknown. It probably has something to do with changing demographics in America: obesity and diabetes are on the rise, and these complications make cesarean more likely. Obstetricians are changing too: we are reluctant to use forceps or a vacuum, techniques that can avoid a cesarean; we’re less likely to encourage labor after a prior cesarean; and we’re worried about being sued for not doing a cesarean.
Puzzled by the inability of researchers to pinpoint the cause of this surgical crisis in American obstetrics, leaders in the field have focused on the stunning disparity in the cesarean rates between different hospitals that are seemingly similar (the low-risk, first-birth cesarean rate in California ranges from 11 percent to 77 percent), and asked the question: what can high-cesarean hospitals learn from the low ones? The 2014 consensus document, “The Safe Prevention of the Primary Cesarean,” with input from every major professional society in women’s health, provides advice to clinicians on how to safely reduce the risk of cesarean once the patient arrives at the hospital. State-level initiatives are also helping hospitals find ways to reduce unnecessary cesareans. These approaches are laudable, but they are focused on clinicians in hospitals.
At Ovia Health, we take a patient-centric approach. Ovia starts by assessing each woman’s risk for cesarean – even before she becomes pregnant. Some factors are entirely in her hands, such as her pre-pregnancy weight and the amount of weight she’ll gain during a pregnancy. We empower her with advice, nutritional guidance, and the tools to manage her weight – without being judgmental.
We also know that the most effective way a woman can reduce her risk of ending up delivering in an operating room is choosing a healthcare provider and hospital that have low cesarean rates. This is probably the best way for women to ‘influence’ the factors that contribute to cesarean risk that are generally out of her hands. Ovia Health applauds the work of public health advocates to help hospitals reduce their own cesarean rates, however we believe that the best approach is to choose a hospital (or birth center) that already has a low cesarean rate. We partner with leading academic experts and leverage the work of our own data science team to help women choose the best hospital for them. We mine our data and present it to users in our Apps, and even reach out with recommendations that are customized for them. This is where our work begins before women even become pregnant: since Ovia reaches millions of women who are trying to conceive, we help them consider healthcare providers who are averse to unnecessary surgery, such as midwives, and talk to them about hospitals with a low cesarean rate that are convenient for them.
During her pregnancy, we are proud to serve as a loyal and trusted source of reliable, evidence-based information for our users. We want women to reach the hospital informed and empowered to be her own advocate in the clinic and in the hospital. Because Ovia Health’s clinical team is led by a practicing obstetrician (who performs cesareans when necessary), we knows that the most important outcome is a healthy mom and a healthy baby, irrespective of the route of delivery. But at the heart of it, we’re a data-driven women’s health company, passionately focused on what’s best for the millions of women who trust us, so we intend to do our part to help address the cesarean epidemic.