All 46 hospitals that deliver babies in South Carolina have vowed to try to reduce the number of unnecessary Cesarean sections, the Medicaid agency just announced.

This means mothers may be encouraged to labor longer before physicians decide to operate and that fewer C-sections will be scheduled for sheer convenience.

While a new focus on reducing C-sections is considered controversial by some doctors who claim they're only making labor and delivery decisions based on their patients' best interests, several statewide health care leaders believe this signed commitment among the birthing hospitals is a significant step forward.

"We had no resistance from any of the hospitals to do this," said Dr. Rick Foster, senior vice president of quality and patient safety at the S.C. Hospital Association.

The South Carolina Medicaid program pays for about 30,000 births a year - more than half of all births in the state. The agency believes that reducing C-sections among first-time, low-risk moms will save millions of dollars and that vaginal deliveries are usually safer for mothers and babies anyway - as long as there's no medical indication to perform the surgery.

In the United States, approximately one-third of all babies are delivered by C-section. That's too many, according to new guidelines released in February by the American College of Obstetricians and the Society for Maternal-Fetal Medicine.

South Carolina's C-section rate is only slightly higher than the national average, but rates vary widely by county, according to data provided earlier this year by the Medicaid agency. C-section rates by hospital are not subject to Freedom of Information Act rules, according to state law.

The S.C. Birth Outcomes Initiative, a collaborative group organized by the Medicaid agency and the hospital association, sent a letter in late March asking each birthing hospital CEO and two in-house "physician champions" to sign a commitment "to support vaginal births in first-time mothers starting immediately."

"It's actually the first step we needed - to get the support of the hospitals," said BZ Giese, director of the Birth Outcomes Initiative. The doctors were harder to convince, she acknowledged.

"There are definitely some misgivings on the MD side because we felt that we weren't sure it was the highest priority," said Dr. Scott Sullivan, director of maternal-fetal medicine at the Medical University of South Carolina. "(Doctors) felt like they were being blamed for it a little bit. They didn't want to be portrayed as being greedy or lazy or doing things against the patient's best interest. There are a lot of forces at work that push C-section rates up - the primary one being a fear of liability."

Sullivan met with Medicaid leadership this spring and now endorses the statewide initiative to reduce C-section rates.

"We wanted to keep the relationship," he said. "Even though we have misgivings and we don't want to be blamed for the rate here ... there are some things, I think, that can be positive about this."

Meanwhile, Medicaid is tweaking the rate it pays for maternity services through six managed care organizations staring July 1, a spokeswoman for the agency confirmed.

The change is expected to save the program $2 million this year.

This will not affect how much hospitals or doctors are paid to treat mothers and infants covered by Medicaid, but another anticipated adjustment in January might do that, Giese said.

"We have not settled with our actuaries what that will be or what that will look like," she said. "It will be a different way the agency pays for C-sections and vaginal deliveries."

Reach Lauren Sausser at 937-5598.