Kimberlee Streiff, 39, of Newport Beach, holds up her daughter Elize Lorraine Streiff, born Oct. 7, as they pose for a photo together. Last October, Streiff underwent a VBAC at Hoag Hospital. Her first two children were delivered by C-section. (KEVIN CHANG, Daily Pilot / February 27, 2014)

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After giving birth to her second child by cesarean section in 2010 at Newport Beach's Hoag Hospital, Kimberlee Streiff felt something wasn't right.

She and baby Rhone, now a curly-headed 3-year-old, were fine; it was the process, and her sense that the birth was out of her hands, that had unsettled her.

Streiff, whose oldest son was also born by cesarean, had hoped to attempt a vaginal birth after C-section, or VBAC, she said.

But when her labor didn't progress fast enough, her doctor quickly ushered her into surgery.

"There's so much focus on this worst-case scenario," the trim West Newport mom said recently. "It creates the impression that doctors are more worried about their liability and their schedule than they are about reaching the best possible outcome."

Now, doctors are sifting through mountains of data in search of ways to avoid unnecessary C-sections, which during the last several decades had become a reliable — though much less desirable — default for women and doctors facing birthing complications.

Last month, the American College of Obstetrician-Gynecologists released new guidelines recommending that women be allowed to stay in the early stages of labor for longer before they're diverted into surgery, a move aimed at curbing rising C-section rates.

According to an ACOG statement related to the new findings, a 60% increase in C-sections between 1996 and 2011 raised "significant concern that cesarean delivery is overused without clear evidence" that it's better for moms or babies in most situations.

At Hoag, where C-section rates had climbed almost 10% higher than the national average, leaders of the hospital's obstetrics unit are working to rein in the practice by stepping up data analysis and patient education.

The result, they say, has been a shift from the type of prescribed childbirth, which has frustrated women like Streiff, to a model of care that factors in safety, but gives moms the tools they need to decide what kind of birth fits them best.

"We just have more evidence available to us," said Dr. Allyson Brooks, executive medical director of the Hoag Women's Health Institute. "Women need to have a variety of options available to them, and that's where the data helps."

Experts say that ability to track even minute differences among patient outcomes and standardize recommended practices paradoxically lets doctors present women with a more personalized picture of risks involved with various birthing options.

And being able to weigh those risks for themselves, in turn, helps moms-to-be feel more in control.

"We need to be consistent among ourselves about how we're describing and assessing the baby," said Dr. Jeanne A. Conry, ACOG's president. "Standardization actually improves our communication between ourselves and our patients."

Dr. Patrick D. Roth, who heads Kaiser Permanente's obstetrics practice in Orange County, added that the Joint Commission, a group that accredits hospitals, has started closely tracking C-section rates through data that's publicly reported and shared among institutions quarterly.

"This is new," he said. "That's a much bigger incentive for hospitals to curtail their C-section rates."


Vaginal births are preferable

Experts have always recommended natural childbirth whenever possible. It's healthier for the baby, for one thing, and because C-sections are major surgery, they typically require a longer, more expensive in-hospital recovery period than natural births.

But starting about 40 years ago, C-sections — easy to pencil in for doctors and emergency staff and less likely to result in potentially life-threatening complications, such as uterine rupture — steadily gained ground. Surgical births became common practice, even in cases when they were not medically necessary.