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Hospital culture and C-section rates

Cesarean sections are a common procedure, but recent evidence suggests that the surgery is perhaps more common than it needs to be. In particular, what hospital Massachusetts mothers-to-be choose can be a determining factor in whether they receive surgical intervention during a low-risk delivery.

According to the Massachusetts Department of Public Health, 31.4 percent of births statewide occurred via cesarean section in 2015, the most recent year for which data are available. This percentage was slightly lower than the national average.

Given that nearly one third of Massachusetts births involve surgical intervention, new research by Consumer Reports into high C-section rates across the country is particularly relevant. This investigation drew on information from approximately 1,200 hospitals around the United States and focused on low-risk deliveries.

Ultimately, the numbers of C-sections performed per hospital varies widely, even among geographically adjacent health care facilities. Researchers believe this variance relates more to hospital culture than to patient demographics in part because increases in factors that may necessitate surgery—such as maternal age, multiple births and obesity—can account for only a small portion of the recent rise in C-section rates. Furthermore, mothers are extremely unlikely to request a C-section unless it is medically necessary.

In many cases, doctors may intervene when they judge that a labor is taking too long, but their assumptions about appropriate length of labor may be based on information that has not been updated in more than 50 years. Thus, a lack of current standards may contribute significantly to a culture of unnecessary surgical intervention in hospitals with high C-section rates. The report further found that among low-risk C-section deliveries, nearly half of the babies could have been delivered safely by vaginal birth.

Though there are certain factors that may make C-sections both necessary and lifesaving, such as birth complications and maternal health conditions, there is also good reason for hospitals to aim to decrease C-section rates. For example, among women who have low-risk pregnancies, C-sections contribute to longer recoveries and higher risks of serious labor complications compared to vaginal births. Furthermore, surgical intervention significantly increases the possibility that subsequent births will also occur by C-section. Last but not least, C-section delivery can be as much as 30 percent more expensive for the family than vaginal delivery.


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