Your Pregnancy Matters

Why you should ask about your hospital’s C-section rate

C-section rates can vary widely from hospital to hospital, so ask about them when choosing an Ob/Gyn and a hospital at which to deliver.

Want to know if your obstetrician has any malpractice claims? The answer is just a few clicks away on the Texas Medical Board website. Curious about your hospital’s safety ratings? Check out Medicare’s Hospital Compare site. More than ever, the health information you seek is at your fingertips – or can be found by asking Siri.

So it’s not surprising that more people want to know about C-section rates – from their state down to their city, hospital, and doctor. Cesarean sections are the most common surgical procedures performed in the United States, with one in three babies delivered this way. While C-sections are generally considered safe, they are still major surgery and carry risks.

Consumer Reports has even begun to publish C-section rates at hospitals across the country. Their investigation – which focused on first-time mothers at low risk of needing a C-section – showed these rates can vary widely from state to state, and even from hospital to hospital within the same city. That’s why I recommend you look at C-section rates when choosing an Ob/Gyn and a hospital at which to deliver.

3 reasons to ask about C-section rates

First things first: There absolutely are cases in which a C-section is necessary for the health of mom and/or baby. If you have had a C-section, I don’t want to imply it was unnecessary. My daughters were delivered by C-section because they were both in a breech position – one of the many legitimate indications for a cesarean delivery.

However, the number of C-sections performed in the U.S. has risen dramatically over the years – from nearly 23 percent in 1990 to nearly 33 percent in 2013 – while maternal and infant mortality rates have not decreased. In an effort to help turn this trend around, the Department of Health and Human Services (HHS) has set a target C-section rate of 23.9 percent or less for women who should be at low risk for having this procedure to begin with.

The Centers for Disease Control and Prevention reported that the C-section rate for Texas for singleton births was 23.8 percent in 2012. According to Consumer Reports, University of Texas Southwestern Medical Center’s C-section rate for low-risk women – having their first baby (not twins), at term, with a baby that is head down – was between 23.9 percent and 27 percent. Our internal data suggests that our rate was 21 percent to 22 percent in 2015. While we are hovering around the HHS target rate, we still have work to do.

There may be reasons why some doctors or hospitals have higher C-section rates than others. For example, some doctors and hospitals are more equipped to deal with high-risk deliveries. It makes sense that places that take care of moms who have medical conditions or fetuses with congenital abnormalities that might necessitate delivery via C-section will have a higher than normal rate for cesarean delivery. Still, it’s important to understand what your hospital’s and doctor’s C-section rates are. Here are three reasons why:

  1. C-section is major surgery. Complications can include infection, increased bleeding, injuries to the bowel and bladder, and reaction to anesthesia. The recovery time for a C-section is also much longer than for a vaginal delivery.
  2. Having a C-section increases the chance of needing one in a later pregnancy. And the risks go up with each C-section. The placenta can end up abnormally low in the uterus (known as placenta previa), or it can grow into the scar from the previous C-section, which can lead to a higher chance of bleeding during pregnancy or delivery – or even needing a hysterectomy.
  3. C-sections cost nearly twice as much as vaginal deliveries. Even if you have good insurance, you likely will pay some co-insurance for a hospital stay. This can run into the thousands depending on the out-of-pocket maximum set by your plan. Insurance plans also are paying attention to the rising number of non-medically indicated C-sections. The California health insurance exchange, Covered California, recently announced it will exclude hospitals with C-section rates above 23.9 percent starting in 2019.

What we are doing to decrease C-section rates

There are many reasons for the increase in C-sections over the years, but a few include:

  • Doctors succumbing to an operative delivery out of habit or personal convenience.
  • Doctors performing C-sections to avoid potential lawsuits.
  • Technology and advanced tests raising more potential red flags.
  • Patients asking to schedule elective C-sections.

The American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) issued new guidelines in 2014 in an effort to help prevent unnecessary C-sections. A big part of this effort is allowing women with low-risk pregnancies to spend more time in the first stage of labor. The groups also encourage the use of operative vaginal delivery techniques, such as the use of forceps.

Along with following these guidelines, our clinic in Dallas is making a few additional efforts to reduce the number of C-sections we perform. First, we’re making sure our physicians know their C-section rate for low-risk patients. Some doctors just aren’t aware of how they compare to their colleagues and the national average.

Clements University Hospital also launched a Certified Nurse Midwife program in 2015. We utilize a laborist model of on-call coverage – meaning that there is always one member of the faculty in labor and delivery available to care for patients. Studies have shown that hospitals that employ midwives and utilize this type of call coverage report fewer C-sections than those that don’t. This can help avoid a situation in which a doctor wants to do a C-section in order to return to clinic or go home when a shift ends.

4 ways to help reduce your C-section risk

While we work on our end to reduce C-section rates, there are steps you can take as well.

  1. Ask about the C-section rate for your hospital and obstetrician, especially for low-risk patients. If you can’t find the information online and they won’t tell you, consider finding a new provider and hospital.
  2. Ask if your hospital employs midwives. You also may want to consider using a doula to provide additional physical and emotional support during delivery. Studies have shown that women who have extra support during labor are slightly less likely to have a C-section.
  3. Maintain a healthy lifestyle. Follow your Ob/Gyn’s recommendations for how much weight you should gain and exercise regularly. Also, be patient. You may be tempted to ask your doctor to induce labor if you go past your due date, but your body will let you know when it’s time to have your baby.
  4. Understand your insurance plan. If you do need a C-section, you’ll want to be prepared for what it might cost.

Reducing the number of medically unnecessary C-sections will require hard work, and it won’t happen overnight. But recognizing our C-section rates, and having patients ask us questions about it, will help us provide the safest, healthiest birth experience for all of our moms-to-be. 

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