The C-section rate in the U.S. is 33 percent, according to the Centers for Disease Control and Prevention. It would be logical to conclude, then, that expecting moms have a 1 in 3 chance of delivering that way, right? Well, it’s not really that cut and dry.
A revealing new study new finds that an expecting mom’s odds of having a Cesarean mostly depend on where she delivers: Some hospitals have a low 7.1 percent C-section rate, while others are as high as a whopping 70 percent. Even C-section rates for low-risk patients ranged from 2.4 percent to 36.5 percent.
To arrive at these surprising findings, researchers crunched numbers from hospital discharge data from 593 hospitals nationwide for the year 2009 (accounting for more than 800,000 babies). What the data does not show, however, is the why behind the C-sections. In the past, the spike was attributed to things like maternal obesity, multiple births and malpractice concerns.
"The variations we uncovered were striking in their magnitude, and were not explained by hospital size, geographic location or teaching status,” said lead author Katy Kozhimannil, an assistant professor in the University of Minnesota School of Public Health in a statement. “The scale of this variation signals potential quality issues that should be quite alarming to women, clinicians, hospitals and policymakers.”
So where are all the most C-sections being performed? New Jersey (38 percent rate) and Florida (37 percent rate). The fewest are done in Utah (22 percent) and Alaska (23 percent), according to a 2010 report in the New York Times. But overall, there’s no regional C-section trend.
What it seems to boil down to is your doctor and your hospital’s philosophy on the procedure. A 2011 survey in the journal Obstetrics and Gynecology, for example, found that 29 percent of OBs were doing more C-sections because of fear of lawsuits.
Then there’s the fact that many medical types frown upon vaginal birth after C-section, or VBAC. So once a woman has had one, she may be pushed to have another, whether she needs it or not. Repeat C-sections account for 40 percent of all of the procedures performed.
"This highlights an important issue — women lack access to clear, unbiased, publicly-reported data on hospital cesarean rates," Kozhimannil tells Parenting.com. "Some states have laws that require hospitals to report maternity-related measures and post them on government websites, and that kind of legislation is a good first step."
Want to avoid a C-section? Be pro-active with this advice from the American Pregnancy Association:
• Find out your hospital’s C-section rate and your OB’s philosophy on the procedure. If you’ve already had a C-section, find a provider who will support your trying for a vaginal birth.
• Hire a doula (really!). Women who have continuous support during labor are 23 percent less likely to need a C-section.
• Ask your OB if you can delay coming into the hospital when you first start labor. Women who labor longer in a hospital are more likely to receive a C-section.• Skip continuous electric fetal monitoring during labor, which has been shown to increase the C-section rate by 33 percent.