HealthGrades Reveals C-section Rates Across America
The percentage of American women who end up having C-sections performed during delivery is increasing. What you should know about surgical trends, the most common delivery complications, and why where you have your baby can make a difference.
By Karen Boruff
According to the Healthgrades 2012 Trends in Women’s Health in American Hospitals report, the percentage of babies delivered via caesarean section (C-section) has reached an all-time high of 34%. While the C-section delivery rate is stable for the first time in eight years, the dramatic increase from 2002-2009 has been the subject of much controversy throughout the medical community. There is debate over the possible reasons for the rise and if it is a cause for concern, as the World Health Organization indicates that the rate of C-section births should be 10-15%. (Source: WHO)
While C-sections are most often performed when complications arise during labor, more mothers are electing to have a C-section when there is no medical reason to do so. Vaginal deliveries are not without risks and side effects, but a C-section is major surgery and as such, poses risks to both the mother and baby.
Common Reasons for a C-section
C-section deliveries may be planned or unplanned. An unplanned C-section is the result of complications during labor and can be a critical situation. Complications that may require the operation may include lack of progression during labor, a drop in fetal heart rate, or the placenta detaching from the uterine wall.
Induction of labor can also increase the risk for C-sections. Induction is when doctors use artificial means, such as the medication oxytocin (Pitocin), to initiate labor. Sometimes inductions are not successful and a C-section is necessary. Early inductions–39 weeks or earlier–may be performed because of complications with the pregnancy, but findings suggest that doctors may be trying to accommodate busy schedules and the mother’s desire to reach the end of the pregnancy more quickly (Source: NEJM).
While complications during childbirth increase the likelihood of having a C-section performed, not all C-sections are unplanned. Doctors will schedule a C-section because of health risks such as obesity, diabetes, or preeclampsia–high blood pressure during pregnancy. A C-section may also be called for if the baby is growing too large or is in a breech position. Other reasons include multiple births, increased age of the mother, and a larger-than-normal baby.
C-sections By Choice
Additionally, a growing number of women are opting for an elective C-section when there is no medical reason. The medical community is divided on elective C-sections, especially after the American College of Obstetricians and Gynecologists (ACOG) said physicians may ethically perform a C-section without a medical cause if it’s in the patient’s best interest.
But why would a woman choose to undergo major surgery if it isn’t necessary? Fear of the pain of childbirth, more control over the exact date and time of delivery, and avoiding the potentially damaging effects of vaginal delivery are common reasons. Critics of elective C-sections also state there may be pressure from physicians to schedule C-sections out of convenience. What factors are really important when making this decision?
Vaginal Birth After C-Section
Besides complications during labor or electing to have a C-section, another common reason for the surgery is prior history of C-sections. While the likelihood of needing one in subsequent pregnancies is high, it is not a given. Eighty percent of women who have had a C-section are candidates for vaginal birth after C-section (VBAC ), but less than 10% actually end up with a VBAC . (Source: AHRQ) The main reason for this is the risk of uterine rupture, which can have catastrophic effects to the mother and baby.
Stephanie Black wanted to try VBAC with her second baby. Her first pregnancy resulted in an unplanned C-section, but her doctor advised her early on she would be a good candidate. However, when the time came to start discussing a birth plan, she found it wasn’t so simple.
“My doctor said a VBAC was possible and she was willing to do it, but the hospital [Lodi Memorial Hospital] does not allow them due to insurance reasons, and she doesn’t deliver at UC Davis,” the mother of two said.
Black’s experience is not unique. Increasingly, mothers who opt to push for VBAC are facing strong opposition from the medical community.
Vaginal Versus C-section
There are pros and cons to both vaginal and C-section deliveries. Vaginal delivery is a natural process and offers numerous health benefits to the baby. The labor process helps clear fluid from the lungs and the baby may be exposed to beneficial bacteria in the mother, making them less likely to develop allergies. But if the labor isn’t progressing or the baby goes into distress because of complications with the cord or lack of oxygen, both mom and baby are at risk.
Vaginal delivery can lead to physical problems for the mother after birth. Damage to the pelvic floor, incontinence, and sexual dysfunction are common issues. Other common complications include severe lacerations–tissue tearing of the perineum–and excessive bleeding.
With a C-section section, you avoid some of the physical effects of vaginal childbirth and there is less pain during delivery. But a C-section introduces other risks, such as postpartum infections, wound complications, and problems with anesthesia. Although there is less risk for fetal distress, some studies show that there is an increased risk for asthma or other respiratory issues. The recovery from a C-section is also lengthier and more difficult, with pain, swelling, and restricted movement lasting weeks. Still, some mothers appreciate the relatively quick process of a C-section delivery, especially after a long and trying pregnancy.
- Vaginal and C-section deliveries offer both benefits and complications.
- A C-section is a major surgery and the risks should be carefully considered.
- The C-section rate in the United States is rising and physicians are looking at ways to safely curb the number of unnecessary procedures.
- Discuss your options and specific health needs with your physician.
Hospitals Providing Superior Care in Women’s Health
Among 176 hospitals designated as Women’s Health Excellence Award hospitals, the following hospitals were recognized as 5-star in all three HealthGrades care areas: women's health, maternity care, and gynecologic surgery. They are:
- Inova Alexandria Hospital: Alexandria, Virginia
- Kendall Regional Medical Center: Miami, Florida
- Martin Memorial Medical Center (including Martin Memorial Hospital South): Stuart, Florida
- Winthrop University Hospital: Mineola, New York
- Lancaster General Hospital: Lancaster, Pennsylvania
- Harlingen Medical Center: Harlingen, Texas
- Memorial Hermann Healthcare System Southwest: Houston, Texas
- Memorial Hermann Northwest Hospital: Houston, Texas
- Memorial Hermann Southeast Hospital: Houston, Texas
- Memorial Hermann The Woodlands Hospital: The Woodlands, Texas
* Distinction cannot be used without a Licensing Agreement from Health Grades, Inc.
Medical Reviewer: Brian McDonough, MD