The C-Section rate is an important criteria in selecting an obstetrician. Neither the decision to do the procedure nor the choice of doctor are trivial, but they are related.
The C-Section is the most common surgery performed in the US. The primary factor determining whether this procedure is performed is the doctor and hospital the woman chooses, and not medical need.(7) The rate of Cesarean births was 4.5% when first measured in 1965; it was over 32% in 2014. As of 2014, Louisiana and New Jersey led the US in the highest rate of C-Sections — over 38%.(7)
The increase in C-Sections hasn’t made childbirth safer for either pregnant women or the newborn. The rate of maternal death in childbirth has doubled since 1985, from 7.4 to 17.8 per 100,000 births.(9) However, there is a question about how much of this increase is real or do to changes in government reporting.(6)
The rate of newborn mortality in the US is slightly worse than the rate in Bosnia. According to the CIA World Factbook, the US rate is 5.87 per 1,000 births (2015 estimate). There are more than 50 countries with lower rates of newborn mortality, including Canada, all European countries, all Commonwealth countries, Singapore, Taiwan and South Korea.
A survey of new mothers in 2011-12 found several reasons for the increased use of C-Sections, including
- Physician or hospital unwillingness to inform the patient about options
- Hospital and doctor efficiency
- Limited awareness of surgical risk
- Blind faith in medical professionals
- Doctors’ unwillingness to attend births in the middle of the night (4).
However, unnecessary C-Sections are expensive for insurers, resulting is a push not to do them.
In one case part of which I witnessed, a physician decided to delay a C-Section in the hope of a vaginal birth on a woman with a previous history of miscarriage. That decision was catastrophic. The placenta tore, the fetus died and the mother almost bled out.
Ultimately, the decision to do a C-Section should be based on medical prudence, and not on insurance, the doctor’s quality of life or hospital income.
What does birth cost?
Cost estimates vary wildly, depending on whether they focus on out-of-pocket expenses for the new parents or the total charge including what insurance pays, as well as by state. (2)
How much the new parents pay depends on the kind of health insurance they have as well as any supplemental insurance.
What you can do?
If you are a loved one are involved in selecting an obstetrician, you need to quiz the doctor on how he/she makes decisions about doing these procedures. If the doctor shows a clear preference for surgery in most cases, or expresses concern about insurance and costs, you need to find a different doctor. The guiding consideration needs to be the woman’s medical condition and history, period.
Any “automatic” decision is probably wrong. Even a carefully considered decision could be wrong. There’s nothing trivial about these choices.
(1) Almendrala, Anna. “U.S. C-Section Rate Is Double What WHO Recommends,” Huffpost Parents. http://www.huffingtonpost.com/2015/04/14/c-section-rate-recommendation_n_7058954.html
(2)”Average Charges for Giving Birth: State Charts.” Transforming Maternity Care. http://transform.childbirthconnection.org/resources/datacenter/chargeschart/statecharges/
(3) CDC. “Births — Method of Delivery.” http://www.cdc.gov/nchs/fastats/delivery.htm
(4) ChildbirthConnection.org. “Cesarean Section.” http://www.childbirthconnection.org/article.asp?ck=10456
(5) Haelle, Tara. “Your Biggest C-Section Risk May Be Your Hospital,” Consumer Reports. 13 April 2016. http://www.consumerreports.org/doctors-hospitals/your-biggest-c-section-risk-may-be-your-hospital/
(6) Maron, Dina. “Has Maternal Mortality Really Doubled in the U.S.?” Scientific American. 8 June 2015. http://www.scientificamerican.com/article/has-maternal-mortality-really-doubled-in-the-u-s/
(7) “10 states with the highest C-section rates,” Fox News. 9 July 2014. http://www.foxnews.com/health/2014/07/09/10-states-with-highest-c-section-rates.html
(8) Rappleye, Emily. “The most common surgery in the world is often unnecessary — and this physician is out to fix it,” Becker’s Hospital Review. 16 May, 2016. http://www.beckershospitalreview.com/hospital-management-administration/the-most-common-surgery-in-the-world-is-often-unnecessary-and-this-physician-is-out-to-fix-it.html
(9) Wallace, Kelly. “Why is the maternal mortality rate going up in the United States?” CNN. 11 Dec. 2015. http://www.cnn.com/2015/12/01/health/maternal-mortality-rate-u-s-increasing-why/