C-section rates vary, may be climbing unnecessarily

Cesarean-section rates for low-risk deliveries vary widely across hospitals, but may be climbing unnecessarily in many areas of the country, according to a Consumer Reports investigation issued this month.

The study, which looked at more than 1,500 hospitals in 22 states, showed that C-section rates for low-risk deliveries—women who hadn't had a C-section before, did not deliver prematurely, and were pregnant with a single baby who was properly positioned—ranged from as low as 4% in some locations to as high as 57% in others. Higher C-section rates were generally found in for-profit hospitals and those that serve large urban areas. Regionally, the lowest rates were in the Mountain states, the upper Midwest and on the West Coast.

But demographics and geography did not entirely explain C-section rate discrepancies, as some hospitals in the same communities had dramatic variability in their rates. For example, in El Paso, Texas, C-sections account for 37% of low-risk deliveries at Sierra Medical Center. But at University Medical Center of El Paso, just four miles away, C-sections occur in 15% of low-risk deliveries.

A similar situation exists in Denver, where Denver Health Medical Center has a C-section rate of about 8%, compared with 20% for the city's Presbyterian-St. Luke's Medical Center.

Overall, the average C-section rate for low-risk deliveries is about 18% nationally. That's about 43% higher than it was in 2000 and about 500% higher than in 1970.

But those rates do not reflect professional guidelines and recommendations, according to Consumer Reports. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine published in March new practice guidelines designed to curtail the number of unnecessary C-sections, while acknowledging that, in some cases, the procedure is medically necessary for the health and well-being of the mother or the baby.

Nevertheless, the women's health organizations reported, “For most pregnancies, which are low-risk, cesarean delivery appears to pose greater risk of maternal morbidity and mortality than vaginal delivery.”

A 14-year analysis of more than 2 million women in Canada found that C-sections in low-risk women raised the likelihood for severe bleeding, blood clots, heart attack, kidney failure and major infections. Babies born vaginally also may be less likely to develop asthma or allergies, or suffer from obesity, according to research cited by Consumer Reports.

“Unless there is a definitive need for a C-section, vaginal birth has major benefits for moms and babies, both in the short term and throughout the course of their lives,” Carol Sakala, director of Childbirth Connection Programs at the National Partnership for Women & Families, said in a release.

Because of the variance in rates across similar institutions, the study did not find a clear answer as to why some hospitals have high rates of C-sections and others have low rates. However, they did identify certain potential motivating factors, including the convenience and control of scheduling a birth and the associated finances. Medicaid and private insurers pay approximately 50% more for C-sections than they do for vaginal births. It is estimated that if the number of C-sections performed in the U.S. were reduced by half, it would save the country about $5 billion in annual healthcare costs.

Follow Rachel Landen on Twitter: @MHrlanden