The Rising Rate of C-Sections Exemplifies What's Wrong With U.S. Healthcare

June 28, 2010

Judy Norsigian, executive director of Our Bodies Ourselves, and Timothy R. B. Johnson, MD, chair of the Department of Obstetrics and Gynecology at the University of Michigan and an OBOS advisory board member, have penned an op-ed in today’s Boston Globe on the high cost of medically unnecessary caesarean sections, both in terms of a mother’s health and rising medical costs:

Even though caesareans are associated with higher rates of complications than vaginal births, they are becomingly increasingly common. Problems range from infections, including the more serious antibiotic-resistant ones, to blood clots, prematurity, respiratory problems for the baby, and more complications with subsequent pregnancies. There is even a small but measurably higher risk of death for the mother.

Between 2000 and 2006, while the Massachusetts caesarean rate climbed from 16th to 10th highest among all states, the state’s ranking on neonatal mortality has slipped from 4th best to a tie for 9th. Six hospitals in the state have caesarean rates greater than 40 percent for first time mothers, yet none of these hospitals is designated as a high-risk center. So much for the argument that high-risk pregnancies are the reason for these rates.

There are also cost consequences for taxpayers — the caesarean rate for Massachusetts mothers on Medicaid is increasing at a faster pace than among privately insured mothers. Nationally, in 2008, average hospital charges for an uncomplicated caesarean section were $14,894, while such charges for an uncomplicated vaginal birth were $8,919.

In the United States, about one in three births are via c-section, and in some communities the rate is much higher.  Childbirth Connection explains the myriad conditions that have led to the increase, including: low priority of enhancing women’s own abilities to give birth; side effects of common labor interventions; refusal to offer the informed choice of vaginal birth; casual attitudes about surgery and cesarean sections in particular; limited awareness of harms that are more likely with cesarean section; providers’ fears of malpractice claims and lawsuits; and incentives to practice in a manner that is efficient for providers.

In the op-ed, Norsigian and Johnson argue that while the media often focuses on how extreme obesity can raise the risk of having a caesarean, more emphasis is needed on “system-based approaches” — steps that hospitals and obstetricians can take, such as instituting policies that restrict the induction of labor, unless there is a good medical reason, and following the new National Institute of Health recommendations to offer the option of vaginal birth after a caesarean for women who want to avoid repeat surgery.

Finally, they note, hospitals should expand access to nurse-midwifery care:

Enhancing access to midwifery care might well be the most effective approach to safely reducing the overall caesarean rate — and could lead to significant cost savings and improvement in other priority areas such as breastfeeding. It would also address the impending shortage of obstetric providers. The Legislature should pass a bill to expand access to midwifery care in Massachusetts. We must finally make midwives more central in maternity care — as do all other countries whose birth outcomes are superior to ours.

Read the full op-ed here.


* Vaginal Birth after Cesarean — What the NIH has to say

* ACOG on VBAC: In Their Own Words

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