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'Patient-choice' C-section rate rises 36%: HealthGrades study

More women choosing C-sections when no medical necessity exists - Florida, New York, New Jersey have highest rates;Nevada, Washington, Florida increase most

The number of pregnant women choosing to have a "patient-choice" Cesarean section (C-section) rose by 36.6 percent from 2001 to 2003, according to a study released today by HealthGrades, the leading provider of independent healthcare ratings. The study also finds wide variation from state to state in the rate of these types of C-sections, for which there is no medical necessity.

Complication rates from "patient-choice" C-sections are one factor in the ratings of maternity care at more than 1,500 hospitals, which HealthGrades posts free of charge for consumers at The ratings are designed to let women compare the quality of maternity care among local hospitals.

Dr. Samantha Collier, HealthGrades' vice president of medical affairs and the author of the study, said, "The controversy over 'patient-choice' C-sections continues in the medical community, with some doctors believing that patients should have the ability to choose a C-section if they prefer. Other doctors believe that patients can never fully understand the risks involved, and should never choose major surgery when it is not necessary. Despite the controversy, this much is clear: the 'patient-choice' C-section rate in America has accelerated in each of the three years HealthGrades has been conducting this study, so consumers are making their preferences known."

The rise of 36.6 percent in the nation's "patient-choice" C-section rate represents an increase from 1.9 percent to 2.6 percent of deliveries in the years 2001, 2002 and 2003 for women with no history of C-sections. The study covers deliveries in the 17 states that release this data. When extrapolated to the nation, the study shows that 267,340 "patient-choice" C-sections were performed over those three years. These 17 states represent approximately 58 percent of the nation's total population.

The study finds that the rate of "patient-choice" C-sections varies widely from state to state. Arizona had the smallest increase, with 15.7 percent, while Nevada had the largest increase of 56.7 percent. As in past HealthGrades studies, Florida, New York and New Jersey had the highest rates of "patient-choice" C-sections in the latest year studied, 2003. The rates and percentage increase of the rate from 2001 to 2003 are in the following table:

Percent Increase of "Patient-Choice" C-Sections by State(2001 ?2003)

State % Increase 2001 2003
National 36.56 1.87 2.55
Nevada 56.74 1.94 3.04
Washington 53.57 1.15 1.77
Florida 47.55 2.21 3.26
Maine 46.80 1.40 2.06
New Jersey 45.63 2.14 3.12
Massachusetts 45.00 1.86 2.70
Virginia 43.52 1.96 2.84
Wisconsin 42.54 1.04 1.48
California 40.29 1.58 2.21
Utah 35.46 1.06 1.44
Texas 33.13 2.15 2.86
Pennsylvania 31.55 1.81 2.39
North Carolina 31.41 1.89 2.48
Maryland 29.15 1.76 2.28
Iowa 28.20 1.56 2.00
New York 26.25 2.48 3.13
Arizona 15.66 1.57 1.81

"When we first did this study three years ago, we found that 'patient-choice' C-sections were increasing at a rate of 19 percent, between 1999 and 2001," continued Dr. Collier. "Now we are seeing the rate increase by 36.6 percent between 2001 and 2003, a dramatic acceleration that we believe is driven by heightened awareness of the option, increased support and advocacy, and women waiting until they are older to have their first child."

Since the release of HealthGrades' first study on this topic in 2003, the American College of Obstetricians and Gynecologists' Ethics Committee released an opinion supporting C-sections by patient choice "�so long as the patient is fully informed of the risks and benefits of this procedure over vaginal delivery."



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