Consumer Reports: Your biggest C-section risk may be your hospital

FORT MYERS, Fla. (CONSUMER REPORTS) The most common major surgery performed in the U.S isn’t to remove an appendix or replace a knee. It’s to deliver babies by cesarean section, or C-section.

Roughly one out of every three babies born in this country—or about 1.3 million children each year—are delivered this way, instead of vaginally. Yet the vast majority of women prefer to deliver vaginally, according to a January 2017 study in the journal Birth.

So what’s going on?

While being overweight, diabetic, or older can make it more likely for a woman to have a C-section, the biggest risk factor is “the hospital a mother walks into to deliver her baby, and how busy it is,” says Neel Shah, M.D., an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, who has studied C-section rates in the U.S. and around the world.

A new Consumer Reports investigation of more than 1,300 hospitals across the U.S. echoes Shah’s findings. It reveals that C-section rates for low-risk deliveries in the U.S. vary dramatically from hospital to hospital, even between those located in the same communities.

When a C-Section Is Necessary

Sometimes, a C-section is absolutely necessary for a safe delivery, according to the American Congress of Obstetricians and Gynecologists (ACOG).

For example, an emergency C-section can be lifesaving if the placenta blocks the cervix, a condition called placenta previa. And it can sometimes make sense to schedule a C-section when, for example, the fetus isn’t properly positioned for birth. Cesareans can also be necessary if the mother has uncontrolled high blood pressure or diabetes, or when she is pregnant with twins, triplets, or other multiples.

But for most pregnancies, which are low-risk, C-sections are not necessary: Researchers estimate that almost half of the C-sections performed in the U.S. are not required. And performing a surgical birth can pose added risks to the mother and her child and also raise costs, research shows.

While many medical institutions across the U.S. are now taking steps to reduce unnecessary C-sections, women themselves can take steps to reduce their own risk of having one, including through their choice of hospital. A study in the journal Birth, for example, found that more than half of women said they would travel 20 miles farther to have their baby at a hospital with a C-section rate that was 20 percentage points lower.

“Women understand that the quality of care differs depending on the hospital they pick, and this study shows that it is possible for women, if properly armed with data, to vote with their feet and send a signal to the medical community by choosing—if possible—a hospital with a lower C-section rate,” explains Doris Peter, Ph.D., director of the Consumer Reports Health Ratings Center.

That said, some women may not have the option to choose a different hospital. (For more on what else you can do to reduce your risk of a C-section, see “How to Cut Your Odds of Having a C-Section.”) Reducing C-section risk for women is ultimately the responsibility of hospitals and providers, Peter says. And progress is being made in the medical community.

For example, ACOG and the Society for Maternal-Fetal Medicine (SMFM)—the nation’s two leading medical organizations that focus on childbirth—issued recommendations in 2014 aimed at safely reining in unnecessary C-sections. And new ACOG recommendations released earlier this year discourage the types of medical interventions in low-risk deliveries that can increase the risk of a C-section.

“No one is saying that C-sections are never necessary, and no woman should feel bad if they end up needing one,” says Elliott Main, M.D., the medical director of the California Maternal Quality Care Collaborative, a nonprofit organization that works to improve outcomes for mothers and babies. “The goal is to better support women in labor so that indications for C-sections do not develop,” he says.

The Danger of Unnecessary C-Sections

When C-sections aren’t medically indicated, they may be more likely to harm mothers and babies than to help them.

“As the cesarean rate went up from 1995 to 2007, we didn’t see a decrease in neonatal mortality in our country related to cesarean birth,” says Aaron B. Caughey, M.D., chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University School of Medicine in Portland and a lead author of the 2014 ACOG/SMFM recommendations. “In fact, if anything, we started to see an increase in maternal mortality.”

Harvard’s Shah points out that C-sections are major surgery, with all of the risks of any hospital procedure. “Unnecessary C-sections may be responsible for up to 20,000 major surgical complications a year, including everything from sepsis [a life-threatening complication of certain infections] to hemorrhage to organ injury,” he says. The challenge is identifying the ones that aren’t necessary and implementing measures to stop them from occurring.

Life-threatening complications are very rare whether babies are born vaginally or by C-section. But women with low-risk pregnancies undergoing their first C-section were three times more likely to die or suffer serious complications—such as blood clots, heart attack, and major infections—compared with women delivering vaginally, according to a 14-year analysis of more than 2 million women in Canada published in 2007 and cited by the ACOG guidelines.

Click here to find your hospital’s C-section rate.

Reporter:Lindsey Sablan
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