July 25, 2011

C-section Rates Climbing In The US

Births from Cesarean-sections in the United States are at an all-time high, with more than one in three births attributed to the surgical delivery method, an increase of 25 percent over the past seven years, according to various media reports.

The study findings, conducted by HealthGrades, were based on data from 19 states and showed the C-sections rose up from 27 percent of all births in 2002 to 34 percent in 2009.

"C-sections are rising, and there needs to be a little bit more scrutiny from the person who is having the C-section as well as doctors and hospitals," report author Dr. Divya Cantor, the senior physician consultant for HealthGrades, the organization that put together the report, told HealthDay reporter Steven Reinberg.

The study noted that the states with the highest rates of Cesarean deliveries are Texas, New Jersey and Florida. The lowest rates came from Utah, Colorado and Wisconsin.

Experts say that C-section deliveries are most suitable when vaginal deliveries pose a health risk to the baby or the mother. But in some cases, they believe the increased rates could be attributed to convenience.

The jump in the delivery method is a national trend, said Cantor. "Doctors need to better understand when a C-section is called for," she said. "Patients need to have a better understanding of C-sections and not go into it blindly."

Dr. Alan Fleischman, medical director for the March of Dimes, said the findings in the report are "not surprising, but they are quite dramatic. "

"We at the March of Dimes have great concerns not just about the rate, but about what's driving it," Fleischman, who was not part of the study, told Reinberg.

The report attributes the increase in Cesarean deliveries to a number of reasons. These include convenience in delivery timing, pregnancy later in life that increases the risk of vaginal delivery, increase in maternal risk factors, increase in multiple births, increased willingness of doctors to perform the delivery method, pregnant women's lack of understanding of the complications possibly involved in having a C-section, fear of malpractice for not doing a C-section, and common labor practices, such as inducing labor or using epidural drugs.

"Many women and many babies have benefited from a cesarean when the fetus is sick," Fleischman told HealthDay. "But in fact, there is very little an obstetrician can do after 34 weeks of gestation other than deliver a baby."

He thinks too many babies are delivered early to minimize risk, in part because the outcomes of infants delivered after 34 weeks are good. "But not as good as (a full-term birth)," he cautioned.

"Cesarean section should be done at the right time and for the right reason," insisted Fleischman. "Some cesarean sections are being done too early and not for the right reason. Convenience for the woman or her doctor isn't the right reason."

He added that C-section delivery can be dangerous for the mother.

Complications can include blood clots, excessive bleeding, infection, longer recovery time and injury to the bladder, uterus or bowel, the report stated.

The risk of complications is even higher in obese women, where a cesarean is a major operation, Fleischman noted.

In addition, infants born before term can also experience problems, Fleischman said, warning that there is an increased risk of complications such as breathing difficulties and even death.

Fleischman explained that it is important for women to understand how important it is for a delivery to go to term. "Fetuses are not just getting fatter in the last month," he noted. "They are actually growing and developing. Their lungs and brains and kidneys are developing."

The findings of the study are published in the report titled HealthGrades 2011 Obstetrics & Gynecology in American Hospitals.

The study further found that 7 percent of women having babies in hospitals had a complication. If all hospitals performed at the level of the best-rated hospitals, 32 percent of these complications (141,869) might have been avoided.

It also found that 9 percent of women undergoing gynecologic surgery had a complication. If all hospitals performed at the level of the best hospitals, 35 percent of these complications (30,675) might have been prevented.

HealthGrades is an independent health care ratings organization with information on physicians, dentists and 5,000 hospitals in the nation.


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