There may be a number of reasons why women need a cesarean delivery, but a recent study found wide variance in C-section rates in hospitals across the country. Photo credit: Bobjgalindo
There are plenty of reasons why a woman might require surgery to deliver her baby: stalled labor, an unusually large fetus or one with a known health problem, issues with the placenta or a multiple pregnancy.
The procedure, known as a cesarean section, is the most common surgery in the U.S., performed on 1.67 million women annually. One in three babies is delivered by C-section, a huge leap from 30 years ago when less than 6 percent of babies were born that way.
Despite the increased numbers, hospitals around the country seem to share little consensus when it comes to determining when a C-section may be necessary.
Recently published research by the University of Minnesota’s School of Public Health found hospital cesarean rates varied tenfold across the country, from 7 to nearly 70 percent.
C-sections typically cost more than vaginal deliveries - averaging about $13,000 - something worth noting given the debate over increasing costs in medicine. While the procedure can be life-saving for mother and child in an emergency, it also carries more risks, including bleeding and a greater chance of infection after delivery.
Women who have one C-section are much more likely to have another. Only about 2 percent of Delaware's births are vaginal deliveries after a C-section./Photo credit: Suzanne M. Day
And once a woman has one C-section, she’s more likely to have another in future pregnancies, even if she meets the criteria for a vaginal birth after a C-section, also known as a VBAC. Less than 2 percent of all births in Delaware are VBAC, according to state statistics.
The First State ranks above average when it comes to rates of cesarean births. C-sections accounted for nearly 4,100 of the 11,300 births in the state in 2009, the most recent statistics from the Delaware Division of Public Health.
That works out to 36 percent of Delaware births. By comparison, 33 percent of births nationally in 2011 were by cesarean, according to statistics from the Centers for Disease Control and Prevention.
The 2011 vital statistics report doesn’t break down C-section birth rates by hospital, but a 2010 story in the News Journal’s Delaware Health found local C-section rates at local hospitals ranged from a low of 25 percent at Nanticoke Memorial Hospital to a high of 42 percent at Milford Memorial Hospital, part of Bayhealth Medical Center. (Adding Milford and Kent General Hospital together, Bayhealth has a 30 percent C-section rate).
In the University of Minnesota study, researchers looked at hospital discharge data from 593 hospitals in 2009. They expected to find some variety between cesarean delivery rates among hospitals, based on different kinds of patients and risks.
But they were surprised in what they found by looking at a sub-group of low-risk patients, including those whose babies were not multiples, breech or whose mothers did not have a prior history of C-section.
In this smaller group, the rates were even more varied – with hospital rates ranging from just over 2 percent to more than 36 percent.
“The variations we uncovered were striking in their magnitude, and were not explained by hospital size, geographic location, or teaching status,” lead author Katy B. Kozhimannil said in a press release by the University of Minnesota School of Public Health. “The scale of this variation signals potential quality issues that should be quite alarming to women, clinicians, hospitals and policymakers.”
In the study, researchers couldn’t glean what reasons health professionals gave in recommending their patients opt for a cesarean birth. Results of the study suggest that small, rural hospitals had greater differences in C-section rates, while teaching hospitals were more consistent.
Typically, there are several likely causes a C-section becomes a consideration, including bigger babies, mothers who are older and less healthy and increasing use of reproductive technology, which can boost the risk of multiples and preterm deliveries. Concerns about the potential for a negative outcome also may prompt some obstetricians to recommend a C-section rather than attempt a lengthy labor.
Kozhimannil, an assistant professor in the University of Minnesota School of Public Health, said information about cesarean rates should be more available to pregnant women who want to consider their options.
But given the focus on reducing healthcare costs – the study noted that Medicaid pays for nearly half of the births in the U.S. – there’s a good reason to try to reduce the differences and improve quality when these surgical procedures are needed.
