Cesarean Birth Rate Jumps Dramatically
Once rare, the number of cesarean deliveries, also known as c-sections, compared to natural births is now 33% and rising. This is happening despite the higher risk of medical complications for both mother and child. What’s surprising is that the most significant factors accounting for this are non-medical; and, contrary to popular opinion, mothers requesting c-sections play only a minor role in the dramatic increase. Because the cost of cesarean deliveries is significantly higher than natural births, we’re all affected since health insurance rates and taxes go up as a result. For the good of all, this has to change.
The national rate of cesarean births was just 4.5% in 1965. Today, it’s over 30%, The National Center for Health Statistics found, in a recent study, that surgical delivery of babies jumped 50% since 1996. This dramatic increase raises the risk of all the complications associated with c-sections: infection, surgical injury, blood clots, adhesion formation, serious problems in future pregnancies, and placental implantation issues among others. Babies not delivered naturally have a higher incidence of respiratory problems. Ominously, a committee investigating the increase of pregnancy related deaths over the last decade cited the increase in cesarean births as a major contributor. Given these odds would prospective mothers knowingly undergo a c-section without a good medical reason? If not, then what’s behind the dramatic increase?
One popular argument is simply that more women are requesting c-sections over a vaginal birth or that wealthy women in particular would want them. But studies investigating the increasing numbers of c-sections disprove this. Also, in hospitals located just miles from each other, the rate of c-sections over natural births varies widely, from 9% to 47%. In another study, of the 5 hospitals in California with the highest rate of C-sections, 4 are found in the poorest parts of Los Angeles County where African-Americans and Hispanic populations are among the highest in the state.
Evolving factors could account for more c-sections being medically warranted. These include more older women having babies, more multiple births because of in-vitro fertilization and higher obesity rates. However, higher numbers of cesarean births are occurring across all age groups, ethnicities, economic levels, and geographic areas. Moreover, it doesn’t explain why hospitals serving the same population have such a wide difference, 9% vs 47%, in percentage of cesarean births.
Several studies point to a surprising answer. After reviewing the data, the California Maternal Quality Care Collaborative sees this large disparity is due to staffing, management practices, and standards favoring c-sections in hospitals having the highest percentages. One practice, in particular, leads to c-sections. A large study published last year in the journal Obstetrics & Gynecology shows that fully 44% of women who expected normal delivery had their labor induced. A high percentage of these were done at the beginning or before labor began. Births by these women resulted in twice as many c-sections as those from normal labor. Furthermore, the study showed that significant numbers of c-section deliveries unrelated to inducement were initiated before labor was under way. Why would such a pattern of early inducements and c-sections take place?
To begin with, in contrast to cesarean deliveries, natural births are unpredictable, making them, often times, inconvenient. Even after labor has started, there are few clues indicating how long it will last. It could be just 30 minutes or many hours. Complications can come as a surprise as well. As a result, a hospital must be staffed and equipped and the doctor on hand to handle what ever happens, when ever it happens. In contrast C-sections are deliberative and more or less the same in most situations. They’re over in 15-30 minutes. Staffing and facilities and schedules can be more efficiently, and profitably, managed.
According to a California Watch study, hospitals can, indeed, be run more profitably by scheduling c-sections instead of natural births. Because surgery is involved and the patient and baby must remain under care longer, they can charge more. The Pacific Business Group on Health estimates that hospital revenue is increased 82% by each surgical delivery.
There’s a reason this phenomenal rise in c-sections started in 1996. It’s in 1996 that the federal government mandated that all employers in the U.S. offering health insurance benefits must include maternity coverage. In addition 22 states, including California require that all health insurance policies cover maternity costs. Medicaid, the health insurance for the poor now covers c-sections in most states, as well.
Because of the sudden affordability, cesarean deliveries have become more acceptable despite the risks. The cost of such a delivery is no longer part of the conversation and few people challenge a doctor or hospital’s judgment in the matter. The result today is that 1 in 3 births are surgical. We not only pay for this with higher health insurance costs, our state and federal taxes are also higher because of Medicaid covered c-sections. Incredibly, in California, one half of all births are covered by Medi-Cal. As a result, the number of increased cesarean births there cost California taxpayers an estimated $240 million in 2011 alone.
Although many parties are aware of this problem, few have offered substantive ideas other than education to change the continuing rise of cesarean births.