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C-Sections Cubby

Los Angeles Times Examines Popularity of C-Sections in U.S.

National Partnership for Women & Families
May 18, 2009

The Los Angeles Times on Sunday examined how caesarean sections have become the most commonly performed operation in the U.S., despite the fact that they are more expensive than vaginal births and place women at a higher risk for complications. Such complications include possible infections, blood clots, increases in premature births and the need for newborns to undergo intensive care. Even if c-sections result in no complications, they still require longer hospital stays, the Times reports.

Some experts say that c-sections could be maintaining popularity because of media coverage of celebrities who have had the procedure. In addition, some say that physicians are responsible for the procedure's popularity because they sometimes do not make women fully aware of the potential consequences and promote c-sections for convenience.

According to the Times, c-sections are performed in 31% of births in the U.S., an increase from 4.5% in 1965. Despite government's stated goal of reducing the rate of c-sections, the U.S. has set a new record each year over the past 10 years. The c-section rate in the U.S. is higher than in most developed nations, while the U.S. now fares worse than many other developed countries on performance indicators such as infant mortality and low birthweight.

In addition, spending on uncomplicated c-sections costs about $4,500 on average -- nearly twice as much as comparable vaginal births -- and about $13,000 for privately insured women. According to a 2008 report by the Childbirth Connection, pregnancy is the most expensive condition for both private insurers and Medicaid beneficiaries. The report states, "The financial toll of maternity care on private (insurers)/employers and Medicare/taxpayers is especially large." It adds, "Maternity care thus plays a considerable role in escalating health care costs, which increasingly threaten the financial stability of families, employers and federal and state budgets." According to the Times, these costs and outcomes are a major reason why childbirth "often is held up in health care reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good."

In an effort to address the issue of high c-section rates, the Institute for Healthcare Improvement's Strategic Partners program trains hospitals to enforce a set of guidelines, such as the careful use of oxytocin and a ban on elective deliveries before 39 weeks' gestation. The program was established four years ago, and since then, 60 hospitals have signed up to participate. Program director Frank Federico said, "It's a culture change." He added, "It used to be that we spent more time defending the 39-week rule. Lately, there's no question about that. It's, 'How can we improve the process to support that?'" (Girion, Los Angeles Times, 5/17).

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