A Consumer Reports analysis of over 1,500 hospitals in 22 U.S. states suggests that some hospitals do a much better job than others at helping mothers avoid unnecessary C-sections.
Consumer Reports' Ratings are the largest one-stop shop for consumers to compare hospitals on C-section rates. The Ratings show dramatic variation in the percentage of women who have their babies delivered through a surgical incision using a cesarean section or C-section—even between hospitals in the same community.
For example, Consumer Reports found that more than half of pregnant women anticipating a low-risk delivery—that is, women who haven't had a C-section before, don't deliver prematurely, and are pregnant with a single baby who is properly positioned—at Los Angeles Community Hospital undergo a C-section. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim in nearby Anaheim, it's about 11 percent.
Or consider El Paso, Texas. At Sierra Medical Center, 37 percent of low-risk deliveries are C-sections; four miles away at University Medical Center of El Paso the rate is about 15 percent. It's a similar story in Denver, Colorado. Highly rated Denver Health Medical Center had a C-section rate of about 8 percent; while nearby Presbyterian-St. Luke's Medical Center got low marks for a rate of about 20 percent.
In fact, Consumer Reports found that startling scenario playing out over and over in communities large and small across the U.S.
Where an expectant mother chooses to deliver her baby should not determine how she gives birth, experts say. The high C-section rates in Consumer Reports' low-rated hospitals are "unsupportable by all professional guidelines and outcome studies," said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco.
Consumer Reports found that a hospital's C-section rate can be hard to find and is almost never widely publicized.
"We think it's time those hidden numbers are brought to light," said John Santa, M.D., medical director of Consumer Reports Health. "How you deliver your baby should be determined by the safest delivery method, not which hospital you choose."
The full report and C-section ratings for the 1,500 covered hospitals can be found at www.ConsumerReports.org.
Excess C-sections drive up healthcare costs and risk
C-sections can be expedient and profitable for doctors and hospitals. Both employer-based insurance plans and Medicaid pay about 50 percent more for C-sections than vaginal births.
More importantly, C-sections that aren't medically necessary carry extra risk for both moms and babies. C-sections are the second most commonly performed surgical procedure in this country and, overall, are very safe. Nonetheless, it is still a major abdominal procedure and like all surgery, carries important risks. In addition, women who've had surgical deliveries take longer to recover and are about twice as likely as those who deliver vaginally to report pain as a major problem within the first two months after the birth.
Regardless of the mode of birth, life-threatening complications are extremely rare. But compared with women giving birth vaginally, healthy, low-risk women undergoing their first C-section had a three times higher rate of serious complications, according to a 14-year analysis of more than 2 million women in Canada published in 2007. Vaginal delivery can also benefit babies. They are less likely to have breathing problems and more apt to breastfeed, perhaps because it's easier to get breastfeeding going when mom is not recovering from surgery.
"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," said Carol Sakala, Ph.D., director of Childbirth Connection programs at the National Partnership for Women & Families.
Tips for Expectant Parents
One of the first things expecting families should do is to check quality measures for their hospital. These latest Consumer Reports' Ratings are a great place to start. They are based on C-section rates for mothers who anticipate low-risk deliveries, that is, women who haven't had a C-section before, don't deliver prematurely, and are pregnant with a single baby who is properly positioned. While certain complications may require doctors to intervene surgically, experts say most of the women in this low-risk category should be able to safely deliver vaginally. If your hospital is not listed, check your states' public health website. They may list other measures, such as the percentage of all deliveries that are C-sections. You should also talk with your health care provider to see if his or her practice tracks the number of C-sections they do and discuss their philosophy on supporting vaginal birth.
For additional steps you can take before and during pregnancy to help ensure the best possible outcomes, see Consumer Reports' report What to Reject When You're Expecting at www.ConsumerReports.org.