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C-Section Rate in U.S. Climbs to All-Time High: Report

By Steven Reinberg
HealthDay Reporter

TUESDAY, July 19 (HealthDay News) -- Between 2002 and 2009, the number of cesarean deliveries rose significantly, from 27 percent of births to 34 percent, finds a new report based on information from 19 U.S. states.

"C-sections are rising, and there needs to be a little bit more scrutiny from the person who is having the C-section as well as doctors and hospitals," said report author Dr. Divya Cantor, the senior physician consultant for HealthGrades, the organization that put together the report.

HealthGrades is a source for physician information and hospital quality outcomes.

The jump in C-sections is a national trend, according to Cantor. "Doctors need to better understand when a C-section is called for," she said. "Patients need to have a better understanding of C-sections and not go into it blindly."

Commenting on the report, Dr. Alan Fleischman, medical director of the March of Dimes, said that the findings in the report are "not surprising, but they are quite dramatic."

"We at the March of Dimes have great concerns not just about the rate, but about what's driving it," he said.

According to the report, some of the reasons the number of cesarean deliveries are on the rise include:

  • Convenience in delivery timing for the doctor or the mother.
  • Women giving birth later in life, which raises the risk of complications during pregnancy and delivery.
  • An increase in maternal risk factors, such as obesity and diabetes.
  • Increase in multiple births, sometimes due to the increase in fertility treatments.
  • Increased willingness of doctors to perform C-sections.
  • Pregnant women's lack of understanding of the potentially serious complications of C-sections.
  • Pregnant women requesting C-sections.
  • Fear of malpractice for not doing a C-section.
  • Common labor practices, such as inducing labor or using epidural drugs.

"Many women and many babies have benefited from a cesarean when the fetus is sick," Fleischman said. "But in fact, there is very little an obstetrician can do after 34 weeks of gestation other than deliver a baby," he said.

Fleischman thinks too many babies are delivered early to minimize risk, in part because the outcomes of infants delivered after 34 weeks are good. "But not as good as [a full-term birth]," he said.

"Cesarean section should be done at the right time and for the right reason," he insisted. "Some cesarean sections are being done too early and not for the right reason. Convenience for the woman or her doctor isn't the right reason."

Cesarean delivery can be dangerous for the mother, Fleischman added. Complications can include blood clots, excessive bleeding, infection, longer recovery time and injury to the bladder, uterus or bowel, according to the report. The risk of complications is even higher in obese women, where a cesarean is a major operation, Fleischman noted.

In addition, infants born before term can also experience problems, Fleischman said, warning that there is an increased risk of complications such as breathing difficulties and even death.

Women need to understand how important it is for a delivery to go to term, Fleischman pointed out. "Fetuses are not just getting fatter in the last month," he said. "They are actually growing and developing. Their lungs and brains and kidneys are developing," he stated.

The findings are published in a report titled HealthGrades 2011 Obstetrics & Gynecology in American Hospitals.

Other highlights in the report include:

  • 7 percent of women having babies in hospitals had a complication. If all hospitals performed at the level of the best-rated hospitals, 32 percent of these complications (141,869) might have been avoided.
  • 9 percent of women undergoing gynecologic surgery had a complication. If all hospitals performed at the level of the best hospitals, 35 percent of these complications (30,675) might have been prevented.
  • Although hysterectomies are the most common gynecological procedure performed, representing 79 percent of procedures, the number has decreased since 2002, by 31 percent.
  • Of the 19 states included in the report, the highest rates of C-section deliveries were in Florida (38.6 percent) and New Jersey (38 percent). The lowest rate was in Utah (22.4 percent).

More information

For more information on cesarean section delivery, visit the U.S. National Library of Medicine.

SOURCES: Divya Cantor, M.D., M.B.A., senior physician consultant, HealthGrades; Alan Fleischman, M.D., medical director, March of Dimes, White Plains, N.Y.; July 19, 2011, report, HealthGrades 2011 Obstetrics & Gynecology in American Hospitals

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