C-section rates on the rise

By Dr. Ananya Mandal, MDSep 12 2010

According to a California Watch analysis, profit making hospitals across the state are performing Cesarean sections at higher rates than non-profit hospitals. The analysis compiled a database of state birthing records and showed that women were at least 17 percent more likely to have a Cesarean section at a for-profit hospital than at a non-profit or public hospital from 2005 to 2007.

A surgical birth can bring in twice the revenue of a vaginal delivery. The survey also showed that some hospitals appear to be performing more C-sections for non-medical reasons like the doctor’s schedule and availability. The differences were seen among 253 hospitals in California.

Pregnant women with low-risk pregnancies had a 10 percent chance of giving birth by C-section at the public Santa Clara Valley Medical Center, for example, whereas low-risk pregnancies at the for-profit Los Angeles Community Hospital ended in a surgical birth nearly 50% of the time.

Desiree Andrews, president of the International Cesarean Awareness Network, a nonprofit group that promotes C-sections only in cases of medical need said, “This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate.” Hospital officials refuted. Leslie Kelsay, a spokeswoman for Good Samaritan Hospital in San Jose said, “Decision-making about C-section versus vaginal birth is between a doctor and the patient, and our goal is to support that decision-making process with evidence-based practices.” This hospital had the highest cesarean rate for low-risk pregnancies in Santa Clara County at 22 percent.

According to Gene Declercq, professor of community health sciences at the Boston University School of Public Health these figures ring true. He said, “It's a lot easier if you can do all your births between seven and 10 in the morning and know exactly how many operating rooms and beds you need.” Vaginal births on the other hand are unpredictable he said. In 2008, more than 180,000 C-sections were performed in California. Sometimes the patients feel a pressure to deliver by C-section rather than being offered a choice between vaginal and surgical delivery.

Experts have failed to pin point the reason behind this trend apart from profits. In California, hospitals can increase their revenues by 82 percent on average by performing a C-section instead of a vaginal birth, according to a 2007 analysis by the Pacific Business Group on Health.

Pam Udy, president of the International Cesarean Awareness Network (ICAN) said, “Half or more of cesareans are avoidable and over-using major surgery on otherwise healthy women and babies is taking a toll.” She said unnecessary C-section can include risks like, babies being born premature, having a lower birth weight, lacerations, and respiratory problems. Mothers may also be at risk of infection, hemorrhage, longer hospitalization time, mistakes during surgery, placental abnormalities for a future pregnancy, the possibility of future stillbirths, even death.

Richard N. Waldman, MD, president of the American College of Obstetricians and Gynecologists (ACOG) speaking on VBAC (Vaginal birth after Caesarean section) said, “Given the onerous medical liability climate for OB-GYN, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether…Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC.” July this year the ACOG released revised guidelines on VBACs stating that “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”