When a problematic delivery has been scheduled, "we talk with them personally, and if we don't get an answer that it is in fact medically indicated, than this C-section will not be done in our system," he said.
Geisinger's vice president of operations for Women's Health, Kerri Potsko, added that her healthcare system now uses "behavioral interviewing" to make sure clinicians who work there "are a good cultural and clinical fit.
"During the interview process, we might ask a candidate, 'I'm sure in the past you might have had a patient who expressed a strong desire to deliver on a particular date, for example, her father's birthday, but that would be 38.6 weeks. Describe the conversation you had with that patient.'
"This has been extremely helpful (because) we find out what type of physician we may or may not be hiring."
Nash pointed to an article in the March Journal of the American College of Obstetrics and Gynecology that points to much higher neonatal morbidity and mortality, including unexplained stillbirths, in women who previously gave birth by Cesarean, and choose to schedule a second Cesarean prior to 39 weeks.
Nash added that for mothers who have elective inductions or C-sections "there's a 50% decrease in maternal morbidity if they wait until 39 weeks."
"The medicalization of women's healthcare is something that should be avoided and done only when necessary," Nash said, adding that programs such as Geisinger's lower-risk, midwife-centric experience, "have been a resounding success. So we encourage spontaneous labor as long as there's not a medical complication that would prevent that."