C-sections at a high in the United States
According to the National Center for Health Statistics, Caesarean sections as a means to deliver babies in the United States has reached a record high, accounting for 1.2 million, or 29.1%, of deliveries in 2004.
What is interesting to me is that for all the reasons cited in the news articles that I read (and I realize that they all generally come from the same source, AP, Reuters etc) and even on the NCHS Web site, there was no mention of economic factors as a reason why the number of C-sections might be rising. This article from the Citizens for Midwifery breaks down very clearly exactly what might be going on in decision-making about maternity care these days. The long and short of it, as it relates to this current issue, is that “there is no question that planned Caesarean sections are more profitable for both the obstetrician (in most states OBs are reimbursed more for a cesarean section than for a vaginal birth) and the hospital (more technology, drugs, lab work etc can all be billed).” The cost for a vaginal birth in hospital ranges from $4 300- $16 000 and a C-section from $9 300- $26 000 (including a four-day stay in hospital).
I would imagine that as cuts are made to some programs, and doctors and hospitals find it harder and harder to get reimbursed for procedures that used to be covered, they will search for other ways to fill the gaps and I see this increase in the number of C-sections as one way that providers have managed to do this.
November 21st, 2005 at 4:49 pm
Yeah, there have been several articles in the British Medical Journal describing C-section trends globally. One study found a correlation between increased C-sections and private health insurers in Chili (as opposed to public health insurance and system). As we know, our health care system in the US is increasingly privatized. Along with C-sections i would guess the use of epidurals in vaginal pregnancies has a similar relation, although I don’t know this for a fact. The same journal (BMJ) published an article in 1998 about American women on welfare being denied epidurals during labor because they could not pay for them. This is of course extreme, but indicative of a larger question of whose rights are more important (patient or doctor) in a system that serves neither very well?
November 21st, 2005 at 10:17 pm
I’m remembering a discussion in my maternal and child health class about the increasing rate of C-sections. The basic gist involved hospital managers tracking the number of C-sections performed each month and trying to get the number down. C-sections were seen as negative indicators but exactly what factors were believed to contribute to their increased frequency I can’t remember. Any of the MDs in my class want to enlighten us? It’s a lot closer to home for you.
At the same time that many hospitals are profit driven, the increased stress and complication that surrounds a C-section wouldn’t seem worth it. Maybe human hospitals are less chaotic, but in the small animal (cat and dog) veterinary hosiptal that I’m in now, the less invasive, less complicated procedure is always preferable. Would I rather do an abdominal ultrasound with a liver biopsy or send the dog to for an abdominal exploratory surgery with biopsies? The abdominal explore would make more money but it’s a pain in the butt - from anesthetic induction to surgery to recovery will take a couple hours. The ultrasound is less invasive, faster and far less stressful. I’m not saying that Maud isn’t right -I’d believe that some doctors would push scheduled C-sections for extra pay, but a lot of docs would pick fewer hours and fewer messy, bloody surgeries over more money.
What blows my mind is that more and more women are requesting scheduled C-sections. I just can’t quite imagine it.
November 23rd, 2005 at 8:42 am
When Sinclair Lewis wrote Arrowsmith, the pulitzer-prize winning novel about a doctor in the 1920’s, the OB’s were the oddballs of the medical school class, and ranked low on the prestige scale. One of the ways prestige has been enhanced has been through medicalizing birth and offering up surgical birth.
But maintain a historical perspective: infant mortality was barely on the charts until the middle of the 20th century after maternal mortality came under control. Now, mny OB’s are motivated by a keen desire to reduce birth injuries and infant mortality. But as Margo points out, emphasizing voluntary c-sections to increase income or to avoid pain for the mother may have gotten out of control. Look carefully at the socio-economics, too, many newcomers to this country have bigger babies because of improved nutrition, and they truly won’t fit.
In the 1970’s many OB’s were offering c-sections as a route to “better babies” — because of reduced injuries associated with forceps. A side benefit, as one OB said to me — not my wife — when discussing cesarean with us was “Plus, her vagina will be tighter.”
The best scenario has women (midwiives) taking care of women in pre-natal care, and doctors on call for high risk deliveries. NB: The AMA launched a big anti-midwife campaign in the 1920’s (it may have been among the last of the witch hunts)when childbirth was seen as the gateway to lifelong family practice.
November 24th, 2005 at 7:32 pm
I would think that OBs (and women) would like to schedule C-sections because:
1) they have become so routine, quick and scars are pretty small these days, from what I hear.
2) the OB pencils it into his/her schedule and there’s very little inconvenience for that person.
As I understand it, unless you have a “high risk” or complicated birth, you end up with a random resident and maybe an attending on-call that you don’t know when you go into labor. A scheduled C-section is guaranteed cash for the OB.
This probably appeals to women more since they have spent most of the pregnancy with their own doctor. I don’t think that it’s necessarily a lack of trust in someone who is less qualified or has less experience. Perhaps as Americans we are just allowing women to spend too much of their pregnancy with someone who won’t/shouldn’t be there when the baby is born?
Also worrying about the rise in C-sections is the fact that some hospitals are now “banning” vaginal births after C-sections. This means that if a woman has the procedure without needing it the first time, depending on the hospital closest to her, she may not be able to deliver naturally again? Doesn’t seem fair.