People are shocked—SHOCKED!—at the news in a recent study that spells out one of the glaring reasons why our Cesarean section rate is so ridiculously high. According to a new study conducted by the University of Minnesota's School of Public Health and published in the journal Health Affairs, C-section rates vary tenfold throughout the United States—ranging from 7.1 percent to 69.9 percent. Researchers worked with data from 593 U.S. hospitals on births in 2009. They found that even in low-risk pregnancies, where women were unlikely to need surgical deliveries, C-section rates varied fifteenfold from 2.4 percent to 36.5 percent.
What the heck is going on here? After scrutinizing the data, researchers are spilling the beans on stuff a lot of us in-the-business have known all along—some doctors and midwives are “cutters” and some, not so much. Some know how to practice obstetrics without making the OR their go-to resource and some don’t. Some were trained to respect physiologic labor and some were trained to anticipate complications and be proactive. Some feel far more comfortable in a controlled surgical setting and some are comfortable with vaginal birth.
The reason why there’s so much variation is not about the patient and her risk level, it’s about the doctor or midwife, his or her preferences, skill set and comfort level. It’s about the culture of care in certain hospitals and regions, not the standard of care. Sure, some patients just plain need C-sections, but not 69.9 percent of them. Not even 33 percent of them (the current C-section rate in the U.S.). When you’re looking at numbers like that, it becomes pretty clear that this isn’t about high-risk patients. It’s about something else entirely.
In addition to all those pesky health complications that are associated with C-sections (for both mother and baby) that I’ve been writing about for so long, overuse of C-sections is draining valuable health care dollars. Accoring to federal statistics C-sections are the No. 1 surgical procedure performed on women in the U.S. The costs of a C-section are reimbursed at significantly higher rates than a vaginal birth. They require patients stay in the hospital and utilize more goods and services, which are all billable. The cost of all these surgeries is just as ridiculous as the C-section rate itself. The good news of the study mentioned above is that officials seem to agree that in large part because of the bottom line, it’s time to really start looking for a better delivery system. Duh!
Here’s an answer to the question of what kind of delivery system we need to reduce the C-section rate while guaranteeing good outcomes (medical-legal speak for healthy, happy, satisfied patients). Another study was released last month that looked at the health and financial outcomes associated with utilizing birth centers (staffed by certified nurse midwives and obstetricians, associated with hospitals, but located off-site or in a hospital unit separate from the traditional maternity ward). The focus of these birth centers was on physiologic birth—you know…delivering the old fashioned way with the expectation that most moms-to-be and births are problem-free, but with ready access to emergency care in case they’re not.
It should come as no surprise that birth center outcomes were fabulous and resulted in primarily vaginal births and only a 6 percent C-section rate. What’s also fabulous is the dramatic cost reduction associated with all these safe, happy vaginal births as opposed to all those C-sections.
What kind of numbers are we talking? In 2008, hospitalization for pregnancy, birth, and care of the newborn resulted in total hospital charges of $97.4 billion, making it the single largest contributor as a health condition to the national hospital bill. Medicaid and other government-sponsored insurance programs currently fund about 42.9 percent of all birth in the United States. That means our tax dollars are paying billions of dollars for surgeries many women don’t need or want.
We’re in a national budget crisis here people. We can’t afford to keep messing around in the OR when we don’t really need to. What’s the solution? It’s time to make individual providers and hospitals accountable for their obstetric practices. It’s time to put a higher value on vaginal birth than C-section and, it appears, it’s time to have certified nurse midwives and doctors with low C-section rates re-train providers with high C-section rates. And it’s time to open birth centers all over the country so more women have access to the high-quality health care they deserve.
Jeanne Faulkner, R.N., lives in Portland, Ore., with her husband and children. And co-author of, The Complete Illustrated Birthing Companion: A Step-by-Step Guide to Creating the Best Birthing Plan for a Safe, Less Painful, and Successful Delivery for You and Your Baby. Got a question for Jeanne? Email it to firstname.lastname@example.org and it may be answered in a future blog post.
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