It has been about 512 years since Jacob Nufer allegedly performed a cesarean section on his wife.
In 1500, the Swiss man performed what's thought to possibly be the first written record of a mother and child surviving a c-section, according to the U.S. National Library of Medicine.
The procedure has been around for several centuries, and thanks to significant advances in medical technology, c-sections are known as relatively safe procedures.
But in the past few years, attention in Oklahoma has shifted to the medical community about whether c-sections that are performed are always medically necessary.
“I do know that a lot of women feel like they're pressured into having c-sections, and a lot of women feel like they're pressured into have inductions that they may not feel 100 percent ready for, and it really comes down to — we as women have to ask questions,” said Kathryn Konrad, a co-leader at the Oklahoma BirthNetwork.
In the past year, the Oklahoma Health Care Authority has taken aim at how Oklahoma can improve its c-section rates.
The Oklahoma Health Care Authority, which administers the state's Medicaid program, started the C-section Quality Initiative in 2011 in an attempt to ensure that best practices were being met for SoonerCare patients.
The March of Dimes reported that Oklahoma had the 14th highest total cesarean deliveries in the U.S.
Oklahoma County had an average c-section rate of 32 percent from 2006 to 2009, according to the March of Dimes data. Tulsa County had a rate of 31.6 percent. The rural counties of Oklahoma overall had the highest c-section rates.
In 2011, the organization ranked Oklahoma with a D in its Premature Birth Report Card. One of the reasons the state scored so poorly was because of its late preterm birth rates. “The rise in late-preterm births (34-36 weeks) has been linked to rising rates of early induction of labor and c-sections.”
Over the past two decades, the c-section rate has steadily increased without corresponding data to show improvements in maternal and neonatal outcomes, according to the health care authority.
For example, babies born by c-section tend to have higher rates of admission to the neonatal intensive care unit, Lopez said.
As part of the authority's c-section initiative, nurses and an obstetrician review medical records of doctors who perform c-sections at a rate of 18 percent or higher.
If the authority finds that the doctor performed a SoonerCare birth that wasn't medically necessary, the doctor is paid about $200 less. The hospital is paid about $1,600 less.
The health care authority initially planned to begin reviewing medical charts in January 2011. But the hospital community asked them to wait until September. Between January and September, the authority regularly sent data about doctors and their c-section rates.
If the agency had started the program in January, about 67 percent of birthing doctors would have been under chart review because their rates were higher than 18 percent.
But when the program started in September, only a third of doctors were at a high enough number to come under medical chart review.
“So they changed their practices in those eight months because a significant number were now under that 18 percent benchmark,” Lopez said.
Konrad said she is happy to see hospitals changing how they approach delivery. As part of the birth network, Konrad has seen a recent shift in how mothers and doctors approach when it's time for a baby to be born. Programs like the c-section initiative help with that shift, she said.
“We as a society perfectly accept that not all 5-year-olds are ready for kindergarten, but we don't always accept that a 39-week baby, which is a week early before their due date, isn't ready for birth,” Konrad said. “We have to be patient and wait until the baby is ready.”