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C-sections: Just. the facts .

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early one in three women gives birth by c-section today in the U.S., which is more than 5 times as many as in 1970. As the most commonly performed surgery in the country, the c-section keeps mothers and babies alive who might suffer injury or death without it. Yet when the procedure is overused, more women and babies are placed at risk of complications, both long-term and short-term, including emergency hysterectomy, blood clots, wound infection, abnormal placenta location in subsequent pregnancies and increased respiratory problems in newborns. The latest research shows that the rise of the c-section, or cesarean section, cannot be solely attributed to medical necessity or patients requesting them. A 2014 analysis by Consumer Reports found that women today tend to be older and heavier going into pregnancy, which might result in more medically

if you can find them.

necessary c-sections, but the medical experts they interviewed attribute the increase to inducing labor for patient or provider convenience and decreased interest in normal birth. Consumer Reports also identified extreme variation in c-section rates, echoing the findings published in the journal Health Affairs in 2013, which showed a ten-fold variation in c-section rates in the U.S. This is why current research looks at how rates vary between hospitals rather than the rise in the overall rate nationally. The Joint Commission measure now used in hospitals with over 1,100 births per year examines the most variable portion of c-section rates—those occurring to full-term pregnancies in first-time moms because, according to the Joint Commission specifications manual, “[h]ospitals with CS rates at 15-20% have infant outcomes that are just as good and better maternal outcomes.” They also note that that physician factors, rather than patient characteristics or obstetric diagnoses, account for the difference in rates within a hospital. Ideally, people seeking maternity care would have access to information, such as c-section rates, of hospitals in their area to help them decide where to give birth, especially if they would strongly prefer to give birth vaginally. Some states are transparent with hospital data—New York and Massachusetts even have a law specifically stating that maternity care data must be made publicly available! Other states, including Arkansas and Kansas, have a law prohibiting the release of hospitallevel data to the public. How to find a provider or facility with an appropriate c-section rate if your state doesn’t report them:

30 September 2014

The time to research a place of birth, costs of giving birth and provider practice style is as soon as possible! When shopping around for a care provider, find out at which hospitals they have privileges. This information is typically available on health insurance in-network search directories. The provider’s administrative staff should be able to answer your questions over the phone about insurance, where the provider or group attends births, whether they routinely attend VBAC (vaginal birth after cesarean) and what their c-section rate is, though it isn’t uncommon for patients to hear

Profile for Peekaboo

September 2014  

September 2014