Six States See Dramatic Rise in C-Sections
March 24, 2010
New York Times
By Denise Grady
The Caesarean section rate in the United States reached 32 percent in 2007, the country’s highest rate ever, health officials are reporting.
The rate has been climbing steadily since 1996, setting records year after year, and Caesarean section has become the most common operation in American hospitals. About 1.4 million Caesareans were performed in 2007, the latest year for which figures are available.
The increases — documented in a report published Tuesday — have caused debate and concern for years. When needed, a Caesarean can save the mother and her child from injury or death, but most experts doubt that one in three women need surgery to give birth. Critics say the operation is being performed too often, needlessly exposing women and babies to the risks of major surgery. The ideal rate is not known, but the World Health Organization and health agencies in the United States have suggested 15 percent.
The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”
Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.
The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit. The report states, “In addition to health and safety risks for mothers and newborns, hospital charges for a Caesarean delivery are almost double those for a vaginal delivery, imposing significant costs.”
Fay Menacker, an author of the report and a statistician at the National Center for Health Statistics, which published the report, said, “There’s been an increase for women of all ages and racial and ethnic groups, and all states.”
The highest rates of Caesarean births were in New Jersey (38.3 percent) and Florida (37.2 percent), and the lowest were in Utah (22.2 percent) and Alaska (22.6 percent).
The report notes that the rate in the United States is higher than those in most other industrialized countries. But rates have soared to 40 percent in some developing countries in Latin America, and the rates in Puerto Rico and China are approaching 50 percent. A report by the World Health Organization published earlier this year in The Lancet, a medical journal, said hospitals in China might be doing unnecessary operations to make money.
There is no single reason for the continuing increase in the United States. Rising multiple births because of fertility treatments have a role, because they often require Caesareans. But, the report notes, Caesarean rates for singletons increased substantially more than those for multiples. Another factor is that more older women are giving birth nowadays, and they are more likely to have Caesareans — but women under 25 had the greatest increases in Caesareans from 2000 to 2007.
Nonmedical issues are also involved. Obstetricians, fearful of being sued if there is harm to a baby after a normal labor and delivery, are quicker than they used to be to perform a Caesarean.