The number of U.S. women who choose to deliver their infants by caesarean section even when the procedure is not medically indicated is increasing, according to a study released by HealthGrades, a health care quality ratings, information and advisory services firm, USA Today reports. For the study -- which is the first to "try to quantify the controversial phenomenon" of patient-choice c-sections -- Samantha Collier, vice president of medical affairs for HealthGrades, and colleagues analyzed hospital discharge data from 18 states for 1999 through 2001 (Rubin, USA Today, 7/21/03). Researchers looked at birth data from Arizona, California, Florida, Iowa, Massachusetts, Maryland, Maine, North Carolina, New Jersey, Nevada, New York, Pennsylvania, Texas, Utah, Virginia, Vermont, Washington and Wisconsin (HealthGrades release, 7/21/03). According to the data, 24.4% -- or one million -- of all deliveries in 2001 were c-sections, and approximately 63,000 of those c-sections were not medically indicated. HealthGrades found that during the three years studied more than 22% of first-time, planned c-sections were a result of patient choice, representing 1.72% of deliveries to women without a prior c-section (USA Today, 7/21/03). In addition, the annual patient-choice c-section rate for all deliveries rose almost 30% -- from 1.56% in 1999 to 1.87% in 2001 (Delfiner, New York Post, 7/22/03). New York, Florida and Texas had the highest patient-choice c-section rates in 2001, compared with Wisconsin, Utah and Washington, which had the lowest rates. Only two states -- Maine and Maryland -- showed a drop in patient-choice c-section rates between 1999 and 2001.
"There is a clear trend of women choosing c-sections over vaginal births at an increasing rate," Collier said. She added, "Some obstetricians see c-section deliveries as a treatment choice and support giving women the right to choose a c-section delivery. ... There are other obstetricians who believe that doing a c-section without any medical indication is tantamount to malpractice, based on the risks associated with major surgery." Although c-section deliveries carry more risks for women and fetuses than vaginal deliveries, some studies have suggested that women who deliver vaginally are at an increased risk of urinary incontinence and sexual dysfunction. "While there are thinking people on both sides of this issue, everyone agrees that the rate of 'patient choice' c-sections is rising," Collier said (HealthGrades release, 7/21/03). HealthGrades released the study in conjunction with its 2003 Hospital Quality Ratings for Obstetric Services for nearly 2,000 hospitals. The information is available on HealthGrades' Web site, according to USA Today (USA Today, 7/21/03).