Why Caesarean Section Rates Are Rising in the US

By ANNIE ATURA

April 1, 2010

This past week illuminated yet another instance of the health care system’s unsavory influence on women’s health decisions: on Tuesday, the National Center for Health Statistics released a report detailing the inappropriate increase in Caesarean sections over the past decade, due in no small part to hospital policy. The New York Times has reported that medical corporations’ fear of malpractice suits has encouraged these lengthy – and expensive – procedures, despite evidence that suggests that Caesarean sections often favor the baby’s health at the expense of its mother’s. The increase has affected all racial and ethnic groups, in all ages of mothers, in every state.

The latest report from the National Center for Health Statistics (http://www.cdc.gov/nchs/data/databriefs/db35.pdf) found that in 2007 (the most recent year data is available), 32% of babies were delivered via Caesarean section. That statistic is a high-water mark for surgical deliveries in the United States, and makes C-sections the most common surgical procedure performed in American hospitals. The report found that the highest rates of Caesarean births occurred in New Jersey and Florida, and the lowest in Utah and Alaska.

We often consider surgical births to be less painful or dangerous than vaginal births, and in many cases C-sections do indeed save mothers and babies alike. But according to the World Health Organization, about half of the C-sections currently performed in the United States are inappropriate. The organization has estimated that surgery is proper in only about 15% of deliveries.

The spike in C-sections has been spurred in no small part by the fear that the uteruses of mothers who have already undergone a Caesarean will rupture under the pressure of a vaginal birth, particularly around the seam of the incision. Fewer than 10% of mothers who have previously had a C-section deliver vaginally, and their surgeries account for 40% of the total of C-sections in the United States. Some hospitals even mandate C-sections for such women. Yet a panel convened by the National Institutes of Health found earlier this month that such barriers were unjustified by medical concerns, and suggested that hospitals publish their rates of vaginal births so that women would know the institution’s policy on mandated C-sections. Women could then weigh the risk of a ruptured uterus against an increased likelihood of complications.

Some blame the unprecedented popularity of surgery on the increasing median age of pregnancy, or on the likelihood of a mother having already undergone a Caesarean. Surprisingly, however, the largest proportional increase in surgical births has been found in mothers under the age of 25. C-sections can subject these younger women to a litany of future problems, including ruptures during future pregnancies and an increased risk of abnormalities in the placenta, which leads to hemorrhaging and potential hysterectomy. Complications occur more frequently during surgery than during vaginal births, and women who undergo surgery during delivery are more likely to remain in the hospital with such complications. In problem cases, C-sections may make it difficult or impossible for women to choose to have large families.

Why, then, do doctors choose to operate twice as often as they should? Cynics will notice that C-sections generally cost twice as much as vaginal births. The World Health Organization has been quick point out that the profitability of C-sections may be the cause of the ridiculously high rate of surgical birth in China, where half of mothers undergo surgery. The same logic may apply here in the States.

The increase might also be attributed to a fear of malpractice lawsuits; the scientific journal Obstetrics and Gynecology published a study last month that found that 29% of its polled members reported performing more C-sections to avoid being sued when a vaginal birth went wrong. 8% of OB/GYNs had chosen to stop delivering babies, and a third of that portion said they had done so because of liability issues.

In other cases, inductions are at fault – mothers induced into labor (i.e. given drugs that prematurely begin the process of labor) are more likely to have C-sections. Obstetricians have reported the advent of “social inductions,” when mothers effectively chose their date of labor for reasons unrelated to their health. This poses a whole new set of issues; women may feel pressure to subject themselves to unnecessary risk in order to deliver on weekends or in the presence of family.

In the debate over the effect that politics and insurers have on women’s access to abortion, we might also cast a critical eye on institutional impacts on women’s health decisions at large. In the case of Caesareans, both a reform in policy and a raise in awareness are in order. Women may not realize the more questionable aspects of this surgical procedure, which is currently performed at twice the recommended rate – and which is growing more popular still.

Annie Atura is a junior in Yale College. She is a staff writer for Broad Recognition.