TOO MANY C-sections

June 28, 2016 at 12:00a.m.

FROM CONSUMER REPORTS

by the editors of Consumer Reports

The most common surgery performed in American hospitals isn’t on the heart or hips SEmD it’s a C-section. Roughly 1 of every 3 babies born in this country, or about 1.3 million children each year, are now delivered by cesarean section.

While a number of factors can increase the chance of having a C-section SEnD being older or heavier or having diabetes, for example SEnD the biggest risk “may simply be which hospital a mother walks into to deliver her baby,” says Dr. Neel Shah. Shah, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School, has studied C-section rates in this country and around the world.

That is supported by a new investigation of more than 1,200 hospitals across the country conducted by Consumer Reports. It found that C-section rates for low-risk deliveries among U.S. hospitals vary dramatically, even in the same communities and among similar institutions, and that in most hospitals, the rates are above national targets.

In many cases, cesarean sections are absolutely necessary. But there are times when they are not: Researchers estimate that almost half of the C-sections performed in the U.S. are done in situations when babies could be safely delivered vaginally instead. Performing a surgical birth when it isn’t necessary poses avoidable risks to the mother and child and needlessly raises costs, research shows.

Too Many C-Sections

Consumer Reports’ analysis focuses on first-time mothers-to-be who should be at low risk of needing a cesarean: pregnant women expecting just one child (not twins or other multiples) whose babies are delivering at full-term in the proper position, which means coming out head first.

The target C-section rate for those births, set by the Department of Health and Human Services, is 23.9 percent or less. That’s 10 percent less than the rate for such births in 2007, which the government uses as a baseline from which to improve.

Many experts say that the ideal C-section rate for those births is even lower. Yet nearly 6 in 10 of the hospitals Consumer Reports looked at had C-section rates above the national target for low-risk births. That means that 40 percent of hospitals already achieved this goal, which suggests that a rate of less than 24 percent is within reach for all hospitals.

The risk of having a C-section also varied depending on where women lived. In general, rates were higher in the Northeast and South, and lower in the West and Midwest.

Three states plus the District of Columbia had C-section rates of 30 percent or higher: Mississippi (31 percent), Kentucky (32 percent), Florida (32 percent) and D.C. (35 percent). Four states had rates below 18.5 percent: South Dakota (14 percent), Wyoming (17 percent), New Mexico (18 percent) and North Dakota (18 percent).

The variation in first-time, low-risk C-sections among individual hospitals is even more dramatic. For large hospitals, they ranged from 11 percent at Crouse Hospital in Syracuse, N.Y., to 53 percent at South Miami Hospital in Miami. Hialeah Hospital, outside of Miami, had the highest C-section rate of all hospitals, with more than 2 of every 3 low-risk babies delivered there by cesarean.

Consumer Reports found wide variation, even among hospitals in the same community. For example, 30 percent of low-risk deliveries at the University of Chicago Medical Center were by C-section, while at Northwestern Memorial Hospital, another teaching hospital just 10 miles away, only 17 percent were.

Patricia Villa, a spokeswoman for Hialeah Hospital, told Consumer Reports, “while there are many factors that impact a woman’s decision to have a cesarean section, we are focused on driving improvement in this area.” The University of Chicago Medical Center declined to comment.