DiversityNursing Blog

By KAREN BARROW

www.nytimes.com 

Elisabeth Bing, who helped lead a natural childbirth movement that revolutionized how babies were born in the United States, died on Friday at her home in Manhattan. She was 100.

Her death was confirmed by her son, Peter.

Ms. Bing taught women and their spouses to make informed childbirth choices for more than 50 years. (“We don’t call it natural childbirth, but educated childbirth,” she once said.)

She began her crusade at a time when hospital rooms were often cold and impersonal, women in labor were heavily sedated and men were expected to remain in the waiting room, pacing.

Ms. Bing pushed for change. She worked directly with obstetricians, introducing them to the so-called natural childbirth methods developed by Dr. Fernand Lamaze, which incorporated relaxation techniques in lieu of anesthesia and enabled a mother to see her child coming into the world.

Along with Marjorie Karmel, Ms. Bing helped found Lamaze International, a nonprofit educational organization.

She became known as “the mother of Lamaze,” championing the technique in her book “Six Practical Lessons for an Easier Childbirth” (1967) and on the lecture and television talk-show circuits.

Today, Lamaze and other natural childbirth methods are commonplace in delivery rooms, and Lamaze classes, with their emphasis on breathing techniques, are attended by an estimated quarter of all mothers-to-be in the United States and their spouses each year.

For years Ms. Bing led classes in hospitals and in a studio in her apartment building on the Upper West Side of Manhattan, where she kept a collection of pre-Columbian and later Native American fertility figurines.

Ms. Bing preferred the term “prepared childbirth” to “natural childbirth” because, she said, her goal was not to eschew drugs altogether but to empower women to make informed decisions. Her mantra was “Awake and alert,” and she saw such a birth as a transformative event in a woman’s life.

“It’s an experience that never leaves you,” she told The New York Times in 2000. “It needs absolute concentration; it takes up your whole being. And you learn to use your body correctly in a situation of stress.”

There was one secret she seldom shared, however: Her own experience giving birth to her son, Peter, was decidedly unnatural. As Randi Hutter Epstein reported in her book “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank” (2010), she continually asked her doctor, “Is my baby all right? Is my baby all right,” until the doctor said he could not concentrate with her chatter and gave her laughing gas and an epidural.

“I got everything I raged against,” Ms. Bing told Ms. Epstein. “I had the works.”

Elisabeth Dorothea Koenigsberger was born in a suburb of Berlin on July 8, 1914. Her parents, of Jewish descent, had converted to Protestantism years before her birth, but the family nevertheless felt the virulent anti-Semitism sweeping Germany before World War II. She was kicked out of a university two days into her freshman year, and two of her brothers — a historian and an architect — could not find work because of their Jewish background, she told The Journal of Perinatal Education in 2000.

After Ms. Bing’s father died in 1932, the family left the country; most members settled in England, while one sister moved to Illinois. In London, Ms. Bing studied to become a physical therapist and began work at a hospital. Mostly she helped patients with paralysis, multiple sclerosis and broken bones, but every morning she also visited the maternity ward, to give massages to new mothers and help them exercise. At the time, women were not allowed out of bed for as many as 10 days after giving birth.

She became interested in natural childbirth in 1942 when a patient handed her Dr. Grantly Dick-Read’s influential book “Revelation of Childbirth,” published that year (and later titled “Childbirth Without Fear”). Dick-Read proposed that pain during childbirth was caused by fear, and that a woman could avoid anesthesia by following a series of relaxation techniques aimed at reducing that fear.

Ms. Bing became intrigued and hoped to train with Dick-Read in the north of England, but with the war on and travel all but impossible, she began her own independent study. She read as much as she could and observed obstetricians and their patients — heavily anesthetized women who, she saw, had little control over the birth of their children.

“What I saw I disliked intensely,” she said in her interview with the perinatal journal. “I thought there must be better ways.”

Ms. Bing, who drove an ambulance during the war, began pursuing her interest in natural childbirth after 1949, when she moved to Jacksonville, Ill., to be with her sister, who had recently married. There, while working with handicapped children, Ms. Bing met an obstetrician who, she discovered, knew very little about natural childbirth. Resolving to champion the techniques, she began approaching obstetricians and having them send patients to her for one-on-one classes.

Ms. Bing had planned to return to England in about a year and was on her way back when she stopped in New York to visit friends. There she met Fred Max Bing, an exporter’s agent, and decided to stay. The two were married in 1951.

Besides her son, Ms. Bing is survived by a granddaughter. Her husband died in 1984.

In New York, Ms. Bing again started giving private childbirth education classes. They caught the attention of Dr. Alan Guttmacher, the chief of obstetrics at Mount Sinai Hospital, which had opened its first maternity ward in 1951. He asked her to teach a formal class there.

In her search for other childbirth alternatives, Ms. Bing began to learn about the psychoprophylactic method developed in the mid-1950s by Lamaze, a French obstetrician. Lamaze refined Dick-Read’s approach by incorporating breathing exercises he had observed in the Soviet Union, where anesthesia was a luxury poor women in labor could scarcely afford.

In 1960, Ms. Bing, by then a clinical assistant professor at New York Medical College, and Ms. Karmel founded the American Society for Psychoprophylaxis in Obstetrics, known today as Lamaze International.

Ms. Karmel, an American, had become a natural-childbirth crusader after seeking out Lamaze in Paris to help her deliver her first child, and her best-selling book, “Thank You, Dr. Lamaze” (1959), largely introduced the method to Americans and drew Ms. Bing’s attention.

(In the late 1950s, Ms. Bing had persuaded Ms. Karmel to smuggle into the United States an explicit French educational film, “Naissance,” depicting a woman giving natural birth. When New York City hospitals and the 92nd Street Y refused to show it in prenatal classes — they considered it obscene — the two women held a private screening at Ms. Karmel’s home on the Upper East Side. Ms. Karmel died of breast cancer in 1964.

At the heart of the methods the women promoted was the idea of family teamwork, with the father helping the mother by coaching her in responding to her contractions with breathing exercises and massaging her back, and being present during the delivery.

But in her book, Ms. Bing cautioned, “You certainly must not feel any guilt or sense of failure if you require some medication, or if you experience discomfort or pain.”

Some obstetricians were skeptical of the methods and thought Ms. Bing, not being a physician, was ill qualified to be instructing patients. But the natural-childbirth movement found a receptive public. Women coming of age in the 1960s embraced the idea of taking a more active role in childbirth and wanted fathers to participate more as well.

“It was a tremendous cultural revolution that changed obstetrics entirely,” Ms. Bing said in an interview in 1988.

Ms. Bing was modest about her role in the movement. “It wasn’t really a movement by Lamaze or Read or me,” she told the Disney-owned website Family.com. “It was a consumer movement. The time was ripe. The public doubted everything their parents had done.”

But she rejoiced in the outcome. “We are not being tied down anymore,” she said in 2000. “We’re not lying flat on our backs with our legs in the air, shaved like a baby. You can give birth in any position you like. The father, or anybody else, can be there. We fought for years on end for that. And now it’s commonplace. We’ve got it all.”

Lamaze, himself, did not acknowledge Ms. Bing, never responding to her requests for an interview even though she had made his name part of the American vernacular. During their only meeting, at a lunch in New York, he directed all his comments to a male obstetrician at the table.

“I’ve never thought of myself as someone with a legacy of any kind,” Ms. Bing said in an interview at an Upper West Side cafe. “I hope I have made women aware that they have choices, they can get to know their body and trust their body.”

“If my ideas supported feminist ideas,” she continued, “well, that’s all right. But I’ve never been politically active.”

By Michelle Matthews

Source: www.al.com

Shortly before their baby, Eli, was born, Brandi McGlathery and Troy Thompson talked about the physical qualities they hoped he would possess.

"I said I wanted him to have blond hair," Brandi said. "And Troy said, 'I hope he doesn't get my nose.'"

At the time, it was just a joke between two parents anxiously awaiting their baby's arrival. After Eli was born, though, it became the kind of memory that now makes them wince at its irony.

When Eli was born at South Baldwin Hospital on March 4, weighing 6 pounds, 8 ounces, Dr. Craig Brown immediately placed him on Brandi's chest. As the doctor helped Troy cut the cord, Brandi looked at Eli for the first time.

"I pulled back and said, 'Something's wrong!' And the doctor said, 'No, he's perfectly fine.' Then I shouted, 'He doesn't have a nose!'"

The doctor whisked Eli away, and for about 10 minutes Brandi was left alone in the delivery room thinking surely she hadn't seen what she thought she saw - or didn't see.

When Dr. Brown returned, he put his arm on her bed and took a deep breath. "He had the most apologetic look," she said. She knew something was wrong with her baby. She started to cry before he said a word.

She looked to Troy, who, she said, never cries. He had tears in his eyes.

She'd been right. Eli didn't have a nose.

Meanwhile, he had started breathing through his mouth right away. She remembers that he was wearing a tiny oxygen mask. Not having a nose "didn't faze him at all," she said.

"I was the first person to see it," she said. "Even when they took him away, my family still didn't know something was wrong, due to being caught up in the excitement of his arrival. It wasn't until they opened the blinds of the nursery that everyone else saw."

Before she knew it, Eli was taken to USA Children's and Women's Hospital in Mobile. Throughout the night, Brandi called the number they'd given her every 45 minutes or so to check on her baby. She wasn't sure he would make it through the night -- but he did.

And her "sweet pea," her "miracle baby," has been surprising his parents and others who love him, as well as the medical staff who have cared for him, ever since.

Nothing unusual

The next day, her doctor checked her out of the hospital in Foley so she could be with her baby in Mobile. The doctor had also had a sleepless night, she said. "He said he'd gone back over every test and every ultrasound," but he couldn't find anything unusual in her records.

There were a few aspects of her pregnancy that were different from her first pregnancy with her 4-year-old son, Brysen.

Right after she found out he was a boy, at around 17 weeks, she said, she lost 10 pounds in eight days because she was so severely nauseated. Her doctor prescribed a medication that helped her gain the weight back and keep her food down. She continued to take the medication throughout her pregnancy, she said.

On a 3D ultrasound, she and Troy even commented on Eli's cute nose. The imaging shows bone, not tissue, she said - and he has a raised bit of bone beneath the skin where his nose should be.

After going into early labor three times, Brandi delivered Eli at 37 weeks. At 35 weeks, her doctor told her that the next two weeks would be critical to the development of the baby's lungs and respiratory system. "He said, 'Let's try to keep him in as long as we can,'" she remembered.

Happy, healthy baby

For the first few days of his life, Eli was in one of the "pods" in USA Children's and Women's Hospital's neonatal intensive care unit. At five days old, he had a tracheotomy. "He has done wonderfully since then," Brandi said. "He's been a much happier baby."

Because of the trach, he doesn't make noise when he cries anymore, so Brandi has to watch him all the time. She has been going back and forth between the Ronald McDonald House and Eli's room during his stay.

"Between the nurses here and Ronald McDonald House, everyone has gone above and beyond," she said. "The nurse from the pod comes to check on her 'boyfriend.' She got attached to him."

Besides not having an external nose, he doesn't have a nasal cavity or olfactory system. (Despite that fact, she said, he sneezes. "The first time he did it, we looked at each other and said, 'You heard that, right?'")

Eli Thompson has an extremely rare condition known as complete congenital arhinia, said Brandi, adding that there are only about 37 cases worldwide like his. The chance of being born with congenital arhinia is one in 197 million, she said.

Even at USA Children's and Women's Hospital, Eli's case has baffled the NICU. "Everyone has used the same words," Brandi said. As soon as they found out he was on his way, she said, the staff started doing research. They only found three very brief articles on the condition. Now, his doctors are writing a case study on him in case they ever encounter another baby like Eli.

After he got the trach, Brandi wanted to start breastfeeding. The lactation consultant encouraged her, and together they searched the Internet for more information. Brandi became the first mother ever to breastfeed a baby with a trach at the hospital, she said - and now the lactation consultant "is actually using him to put an article together about breastfeeding with a trach to encourage mothers of other trach babies to attempt it."

Thanks to her Internet research, Brandi found a mother in Ireland, Gráinne Evans, who writes a blog about her daughter, Tessa, who has the same condition as Eli. She also found a 23-year-old Louisiana native who lives in Auburn, Ala., and a 16-year-old in North Carolina, she said. With every case she found, Brandi started to feel better and more convinced that Eli could not only survive his babyhood, but that he'll grow to adulthood.

Communicating with Tessa's mother in Ireland has been especially gratifying for Brandi. She knows she and Eli are not in this alone.

'He's perfect'

While it would seem easy enough for a plastic surgeon to build a nose for Eli, it's not that simple, Brandi said. "His palate didn't form all the way, so his brain is lower," she said. "It's a wait-and-see game."

His condition affects his pituitary gland, she said. He'll have to be past puberty before his nasal passageways can be built. Until then, she'd like to spare him any unnecessary facial surgeries.

"We think he's perfect the way he is," she says, nodding toward the sweet, sleeping baby in his crib. "Until the day he wants to have a nose, we don't want to touch him. We have to take it day by day."

Within a month after Eli goes back home to Summerdale, he will have to travel to the Shriners Hospital for Children in Houston and Galveston, Texas, to meet with craniofacial specialists. "They will work with him for the rest of his life," she said. "Every three to six months, we'll be going back for scans and checkups for at least the next ten years."

Brandi said that, of the people she's found online, some are opting to have noses and nasal passageways built (including Tessa), while others haven't.

"We're going to do our best to make sure he's happy," she said. "The rest of him is so cute, sometimes you don't realize he doesn't have a nose."

Brandi's older son, Brysen, and Troy's four-year-old daughter, Ava, are too young to interact with Eli in the hospital. Brandi was grateful to one of the nurses who unhooked him and let the kids see him. "Ava asked me, 'When you were little, did you have a nose?'" Brandi said. "She said, 'I think he's cute.'"

Brysen pressed his hands against the window separating him from his baby half-brother and said, "He's perfect!"

'Facebook famous'

Brandi, who got pregnant with Brysen when she was a senior in high school, had planned to start going to school to become an LPN like Troy's sister and his mother. "That's all on the back burner now," she said. Because of her experience at USA Children's and Women's, she said she now wants to be a NICU nurse.

Her best friend, Crystal Weaver, logged onto Brandi's Facebook account and created the Eli's Story page to let friends and family members know what was going on. "It's easier that way to update everyone at once rather than to call everyone individually," Brandi said. "It's overwhelming. It's all on my shoulders." Within a day, she said, Eli's Story had 2,000 likes (it now has around 4,500). "People I didn't know were sending messages," she said.

Crystal also started a Go Fund Me account, which has raised about $4,300. "We've got years and years of surgeries and doctor's appointments nowhere close to us," said Brandi, who returned to her job as a bartender this past weekend. She plans to keep working two nights a week for a while. Being around her work family, she said, helps her maintain a sense of normalcy.

A fish fry is planned as a fundraiser for Eli's medical fund on April 11 at Elberta Park in Elberta, with raffles for prizes including a weekend stay at a condo in Gulf Shores and a charter fishing trip.

"It makes me feel really good that I have a support system," Brandi said. "Everybody's been awesome."

Updating Eli's page, adding photos and reading the positive, encouraging comments from hundreds of people, as well as reaching out to others who have been through what she's going through "keeps me sane," Brandi said.

Recently, Brandi posted a video of Eli waking up from a nap. From Ireland, Gráinne Evans commented: "I've actually watched this more times than I could admit!"

Eli is "100 percent healthy," she said. "He just doesn't have a nose. He has a few hormone deficiencies, but other than that he's healthy."

Brandi seems wise beyond her years. She is already worried about "the day he comes home and someone has made fun of his nose," she said. "We don't want anyone to pity him. We never want anyone to say they feel sorry for him. If other people express that, he'll feel that way about himself."

She jokes that Eli is "Facebook famous" now. "I can't hide him," said Brandi, who is a singer. "Eli's gotten more publicity in the past two weeks than I have in my whole life!"

She's been putting together a "journey book" full of medical records and mementoes to give Eil one day. "I'm excited to show him one day, 'Look, from the moment you were born people were infatuated with you.'"

'I'm doing something right'

In his short time on earth so far, Eli has brought his family together, Brandi said. She and Troy had been engaged, then called off the wedding and were "iffy," and then they broke up. A week later, she found out she was pregnant.

"Eli has made Troy my best friend," she said. "He has brought us closer than when we were engaged. To see Troy with him is really awesome."

Troy has been her rock, reassuring her since Eli was born, she said. "He tells me, 'Brandi, it's OK. It will end up happening the way it's supposed to be."

Last Thursday, Brandi posted on the Eli's Story page that Eli had passed his car seat trial and newborn hearing screening. "He now weighs 7 pounds, and we'll be meeting with home health to learn how to use all of his equipment so we can go home Monday."

Everyone in their family has taken CPR classes, and Brandi and Troy have learned how to care for Eli's trach. The couple has extended family nearby, and Troy's father and stepmother plan to move to Baldwin County from Mobile to be closer to Eli.

As she prepared to take her baby home from the hospital on Monday morning, almost four weeks since he came into the world, Brandi was excited to take care of him for the first time in the comfort of her own home, and to finally introduce him to his big brother and sister.

Though Brandi said her heart melts when Eli's little hand wraps around her finger, he's the one who already has her wrapped completely around his. He recognizes his parents' voices, and seems comforted by them. "As soon as he hears us, he looks around for us, finds us, then stares at us smiling," she said. "It makes me feel like I'm doing something right, that through the ten to twelve other women, the nurses who have been caring for him for the past month, he still knows who Mommy is!"

Source: http://nursingonline.uc.edu

Publisher: http://nursingonline.uc.edu/ (University of Cincinnati Online)

By LINDSAY CROUSE

When Paula Radcliffe won the New York City Marathon in 2007, nine months after giving birth to a daughter, Isla, Radcliffe was considered an anomaly. Her intense training through her pregnancy, which included twice-a-day sessions and grueling hill workouts, was scrutinized and criticized.

Seven years later, maintaining a top running career and a family has become relatively common. About a third of the women in the professional field of 31 for the New York City Marathon next Sunday have children.

“I watched Paula win New York, basically leading from the starting gun to the finish tape, and afterward she picked up her baby,” said Kara Goucher, a top American marathoner. “I realized I can do both. And I want to do both.”

Goucher, 36, finished third in the 2008 New York City Marathon, and this year she will run the New York race for the first time with her 4-year-old son, Colt, cheering her on.

When she contemplated having a child, Goucher engaged in the careful strategizing common to elite female athletes, who consider precisely when to become pregnant so as not to risk missing out on an Olympic medal or sacrificing a corporate sponsorship.

Elite female distance runners now run competitive times well into their late 30s. The average age of a top female marathoner is 30, and 19 women in next Sunday’s professional field are that age or older.

As athletic peaks for these top runners have overtaken fertility peaks, the decision to combine motherhood and training has become increasingly unavoidable. Competitive careers are stretching: The American Deena Kastor, expected to be another top finisher next Sunday, is 41.

“I always wanted to have a child,” Goucher said, “and I didn’t want to wait until I was done, because I don’t really see an end date on my career. I wanted more in my life than just running. But the details of how you do that can get incredibly complicated.”

Elite runners often try to squeeze in a pregnancy and recovery in the 16-month window between world track championships in years with no Summer Olympics. This is one such year, and pregnancies abound.

Maternity leave in professional running is rare. A pregnancy is still frequently treated as if it were an injury, and women can experience a pay cut or not be paid at all if they do not compete for six months. During that period, they often remain bound to sponsors in exclusive contracts that can last upward of six years. Because the athletes are independent contractors, they are not covered by laws that protect employed women in pregnancy.

Lauren Fleshman, an N.C.A.A. 5,000-meter champion and a professional runner, switched to a women’s-oriented sponsor, the running apparel company Oiselle, before having a son in June 2013.

Referring to Goucher and Radcliffe, Fleshman said: “Kara and Paula showed that pregnancy doesn’t necessarily need to be an impediment to the athletic part of our careers, and blew up the vestiges of the myth of the ‘fragile woman’ who can’t be both a top athlete and a mother. But in terms of your career, there’s still the feeling that if you say you want to have a kid, you’re saying you don’t want to be an athlete.”

It does not help that so many people seem to have an opinion on the matter. After Alysia Montaño, a 2012 Olympian, ran an 800-meter race in June during her eighth month of pregnancy, her decision became the subject of intense public scrutiny.

“I wanted to help clear up the stigma around women exercising during pregnancy, which baffled me,” Montaño said. “People sometimes act like being pregnant is a nine-month death sentence, like you should lie in bed all day. I wanted to be an example for women starting a family while continuing a career, whatever that might be. I was still surprised by how many people paid attention.”

Montaño’s daughter was born in August.

“Giving birth is a very athletic activity, like going through intervals on the track,” Montaño said. “Like contractions, intervals can start out easy and progress as they get harder. There’s sometimes a point where you wonder, ‘Can I do one more set?’ But you know you’re going to make it. And then you kick to the finish.”

Other women have chosen different paths.

Clara Horowitz Peterson, a former top runner at Duke, focused on starting a family in her mid-20s, aiming for a racing peak afterward. Now 30, she is pregnant with her fourth child.

“I think if I’d chosen to train at altitude and log 120-mile weeks, I could have made it to the Olympics,” said Peterson, who typically runs 80 to 90 miles a week when not pregnant. “But that comes with sacrifices; you put your career first, and before you know it, you’re 28, maybe confronting fertility issues. I always felt like having children was more important to me than a running career.”

Still, Peterson ran right up until the births of her first three children. She qualified for the 2012 United States Olympic marathon trials just four months after delivering her second child, and she logged a 2-hour-35-minute time at the race four months later.

“I trained hard through that pregnancy,” Peterson said. “You can tell when you’re pushing it. You get twingy, or feel tendons pulling, so I backed off when that happened.”

To bounce back for the trials, Peterson said, she breast-fed her second child for only five weeks — finding that the hormones related to breast-feeding made her feel sluggish — and dropped the 20 pounds she typically gained during pregnancy in eight weeks without dieting. (She breast-fed her third child for six months.)

The understanding of women’s physical resilience during and after pregnancy has also developed in recent years.

“We still don’t have good science to guide us,” said Dr. Aaron Baggish, associate director of the cardiovascular performance program at Massachusetts General Hospital in Boston, which counsels elite athletes through pregnancy. “But unequivocally I think women should exercise through pregnancy, both for their baby and their own health. The body has evolved that way. Your baseline fitness level is the best guideline: Elite athletes start out with a higher threshold, so they can do more.”

After athletes give birth, efforts to get back into shape are consuming, coupled with the usual adjustments to caring for an infant. Breast-feeding interrupts the sleep that heals spent muscles and restores energy to a tired body. Babies are often kept out of group day care to prevent them from bringing home illnesses that could compromise rigid training plans.

Pregnancy can be hard to combine with any job. As in other fields, partners are generally a key component of elite athletes’ ability to continue their careers after having children.

Edna Kiplagat, a 35-year-old Kenyan who is among the favorites in next Sunday’s race, had two children before becoming a two-time marathon world champion and the 2010 winner in New York.

Her husband and coach, Gilbert Koech, gave up his running career to focus on hers and manage their family, making breakfast for their five children, three of whom are adopted, and taking them to school while Kiplagat trains.

Goucher’s husband, Adam, retired from professional racing a year after their son’s birth and started a running-related business. He tries to balance supporting her racing career with managing his new one, saying that he and Kara work to share equally in caring for Colt.

“Kara’s putting her body through a lot right now,” her husband said, “and we need to do everything possible to alleviate the stress of training. When she needs to go out and run, or needs to rest and recover, that’s my first priority.”

Goucher said she was taking the trade-offs in stride.

“It’s scary because the fact is for all women when you have a child, you do need to drop out for a long time, and you don’t know how you’ll come back,” she said. “It’s a huge risk. Of course, I’m serious about my job, but in life I needed to be more than that. So I think it was worth it.”

Source: www.nytimes.com

By Robert Preidt

Cesarean delivery was the most common inpatient surgery in the United States in 2011 and was used in nearly one-third of all deliveries, research shows.

The new study found that 1.3 million babies were delivered by cesarean section in 2011. The findings also revealed wide variations in C-section rates at hospitals across the United States, but the reasons for such differences are unclear.

"We found that the variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity. This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions," lead author Katy Kozhimannil, an assistant professor in the School of Public Health at the University of Minnesota, said in a university news release.

The researchers analyzed data from more than 1,300 hospitals in 46 states. They found that the overall rate of C-section was about 33 percent. Between hospitals, however, that rate ranged between 19 and 48 percent, according to the study.

For women who'd never previously had a C-section, the overall C-section rate was 22 percent. Depending on the hospital, that rate ranged between 11 percent and 36 percent, the researchers said.

C-section rates ranged from 8 percent to 32 percent among lower-risk women and from 56 percent to 92 percent among higher-risk women, according to the study published Oct. 21 in the journal PLoS Medicine.

The findings highlight the roles that hospitals' policies, practices and culture may have in influencing C-section rates, the study authors concluded.

"Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth, and these results indicate that we have a long way to go toward reaching this goal in the U.S.," Kozhimannil said in the news release.

Source: www.nlm.nih.gov