Pregnant women and their doctors all want the same thing – a healthy pregnancy and a safe birth, resulting in a healthy mom and baby. Cesarean deliveries, or C-sections, performed at the right time and under the right clinical circumstances can be essential to preserving the health of the mother and/or her baby. But C-sections also carry health risks for both mom and baby, from surgical infections and blood clots to problems from blood transfusions. Still, about one out of three births in the U.S. is by Cesarean delivery. And experts agree that too often and for a variety of reasons C-sections are performed even when the pregnancy and delivery are low risk, or not medically necessary.
C-section rates have been declining modestly in the past few years, thanks in part to recent initiatives by the medical community and other organizations promoting health care quality. But there is still much variation from hospital to hospital, town to town. So what is an expectant mom to do?
Experts agree that too often and for a variety of reasons C-sections are performed even when the pregnancy and delivery are low risk, or not medically necessary.
Choosing the right doctor and hospital
“Women need to know that even in the same town, hospitals and the doctors can have different approaches and very different rates of Cesarean delivery,” said Joanne Armstrong, M.D., Aetna senior medical director and head of women’s health. “Women need information on hospital safety and quality so they can make informed choices.” This includes choosing a doctor and hospital that are committed to doing C-sections only when medically necessary and preventing elective deliveries until a woman has carried her pregnancy at least a full 39 weeks.
“Understanding the non-medical factors that can result in an unwanted C-section can empower women to actively participate in their delivery decision making and perhaps prevent a C-section,” Armstrong said. “Where you choose to have your baby can make a big difference in how your birth is managed and what kind of birth you have.”
How can you find out which hospitals in your area may be doing C-sections when they’re not needed? You can start by consulting C-section results gathered annually by the Leapfrog Group. Leapfrog asks hospitals nationwide what their C-section rates were for pregnancies that were unlikely to need surgical intervention during labor—specifically, first-time pregnancies that had reached the 37th week or pregnancy or beyond, with a single baby in the head-down (vertex) position. Not all hospitals disclose their C-section rates, but many do. Women also can check if any data is available through their health plan. And of course, they can ask the doctor’s practice and hospital directly about their C-section rates.
C-section rates over the past two decades have risen much faster than risk factors alone would warrant.
Working to reduce unnecessary C-sections
The C-section is the most common surgery in the U.S. today, performed 1.2 million times a year.
There are more pregnancies today with risk factors that could lead to a C-section, including obesity and older moms. However, with the exception of the past few years, C-section rates over the past two decades have risen much faster than these factors alone would warrant, Armstrong said. The increase also is related to discretionary decisions made by doctors and patients, including to electively induce labor before the pregnancy is ready, or opt for a C-section after a few hours of labor when there are no other risk factors.
The U.S. Department of Health and Human Services, Healthy People 2020 has a goal to safely reduce unnecessary C-sections in low-risk pregnancies. This is supported by medical societies as well as groups focused on health care quality, such as The Leapfrog Group and the March of Dimes. Aetna has joined these groups in an effort to support safe childbirth.
Currently, there is no agreement on the “right” Cesarean delivery rate for the country, but experts agree that the rate of Cesarean delivery in the country can be safely lowered.
“To help doctors and hospitals safely and effectively perform Cesarean deliveries only when necessary, the health care community needs to clearly decide: which are the low-risk pregnancies and births that should not need Cesarean delivery, and which are high-risk and may well need Cesarean delivery?” Armstrong said.
Fortunately, many doctors, hospitals and academic societies are committed to identifying and reducing the causes of variation and safely lowering the Cesarean delivery rate. With additional information and agreement on the factors that define low-risk and high-risk Cesarean delivery, doctors and hospitals will be able to assess how they are doing in this important population health issue and then hopefully, Armstrong says, they will take action.