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C-sections on the rise, though they're not usually best option for mom or baby

Published: Saturday, May 10 2014 4:00 a.m. MDT

The U.S. has higher infant mortality rates than most developed countries. A trend toward scheduled labor and C-sections could be one reason why, according to Premier health care alliance CEO Susan DeVore.

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Consumer Reports says too many babies are entering the world through cesarean rather than natural delivery. And the odds of it happening are higher in some hospitals than others, even in the same cities.

Consumer Reports looked at 1,500 hospitals in 22 states, ranking each on the number of C-sections performed there, based on hospital billing records.

"The authors found the number of procedures performed vary wildly — even at hospitals in the same town," said CNN's Jen Christensen.

"Unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one. Overall, 66 percent of the hospitals in our Ratings earned our lowest or second-lowest score, while only 12 percent got either of our top two marks," Consumer Reports noted.

The analysis, in addition to rating hospitals in each state for the proportion of babies who are delivered by C-section, also offers ratings based on other measures. Not all hospitals have been ranked, and the C-section rating "does not include women who had a prior C-section or who had multiple babies in that delivery, delivered pre-term, had a delivery where the baby was in an abnormal position (for example, feet first or face up) or a delivery where the baby died."

According to background information provided by Consumer Reports under the title "What hospitals don't want you to know about C-sections," "While some C-sections are absolutely necessary for the health of the mother or baby, the high C-section rates in our low-scoring hospitals are 'unsupportable by professional guidelines and studies of birth outcomes,' said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco, who reviewed our data."

Wrote Tina Rosenberg for the New York Times Opinionator blog: "Sometimes C-sections are necessary. Most are probably not. They are done (very rarely) for the convenience of the mother or, far more commonly, for the convenience of the doctor. But this practice isn’t benign. Having a C-section puts a woman at increased risk for hysterectomy, hemorrhage, infection and deep vein thrombosis, and the risk rises with each subsequent C-section. They are also more expensive. The California Maternal Quality Care Collaborative, a group that works to improve birth outcomes, said commercial insurers pay 60 percent more for a C-section than a vaginal delivery — and this is the most commonly performed surgery in America."

The American College of Obstetricians and Gynecologists has said that unnecessary C-sections raise the cost and increase the risk of medical complications. The group in 2000 noted failure to reduce C-section rates to its targets and issued guidance to help hospitals and doctors determine when C-section is appropriate. It set a new target of reducing C-sections to 15.5 percent of births by 2010. That benchmark wasn't met, either.

ACOG notes that "as with any surgery, there are risks and complications to consider. Your hospital stay may be longer than with vaginal birth. Also, the more cesarean births a woman has, the greater her risk for some medical problems and problems with future pregnancies. This may not be a good option for women who want to have more children."

Rosenberg wrote that "hospitals with low rates of C-section have no difference in outcomes for babies, and better outcomes for mothers."

Risk rises with each subsequent C-section a woman has, according to both the report and ACOG.

"Consumer Reports finds the rate is high in many hospitals even for low-risk deliveries: women who haven't had a C-section before, don't deliver prematurely and are pregnant with a single baby who is properly positioned," said West Palm Beach, Florida's, WFTS.

"There are situations when a C-section is the safest option," Consumer Reports medical adviser Dr. Orly Avitzur told the station. "But the vast majority of women who anticipate a low-risk delivery should expect to have a natural birth."

"In Texas, for instance, 15 percent of births at El Paso's University Medical Center are C-sections; four miles away, at Sierra Medical Center, the rate is more than double that at 37 percent," the CNN piece said.

"The Denver Health Medical Center earned Consumer Report's highest rating for low rate of C-sections. Doctors delivered 8 percent of babies by C-section; at Denver's Presbyterian-St. Luke's Medical Center, by comparison, 20 percent of the low-risk deliveries were C-sections," according to the article.

"The variation is what gets you, that really is the thing," Doris Peter, director of Consumer Reports' Health Ratings Center, told CNN. "If you compare peer hospitals in urban areas that treat the same kind of patients — meaning they share similar socioeconomic issues — to have wildly different rates suggests that there is a problem here."

Email: lois@deseretnews.com, Twitter: Loisco

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