Another Reason You're More Likely To Have A Cesarean

Of all the complex factors that go into having a cesarean birth, one California report finds evidence that one influences than the rest: whether the hospital is non-profit and for profit. C-sections bring in up to twice the revenue.

The non-profit reporting group California Watch looked at state birthing records and saw that all things being equal, women were 17 percent more likely to have cesareans at for-profit hospitals. They cite a 2007 analysis by the Pacific Business Group on Health (including both business and non-profit participation), which says that in California, “hospitals can increase their revenue by 82 percent on average by performing a C-section instead of a vaginal birth.”

The rise in c-sections has been attributed to a greater percentage of obese mothers and older mothers, maternal preference, and limiting institutional and personal liability. The profit motive has also been a favorite reason of surgical birth’s critics, but up until now, research hasn’t focused on the angle of for-profit versus non-profit hospitals.

The cliche of a wealthy woman scheduling her cesarean for the convenience factor is disputed by the groups’ analysis, which found that “wealthier women are more likely to opt for a surgical birth….And there was no correlation between C-section rates and the percentage of a hospital’s business from low-income or indigent patients receiving Medi-Cal, the state’s Medicaid program.” In fact, four for-profit hospitals in parts of Los Angeles County with high African-American and Hispanic populations were in the top five of the entire state.

That said, one doctor quoted in the study defends his hospital’s high numbers of cesareans by saying, “I think, to a large extent, consumers want to have elective cesarean deliveries.” It’s precisely this mentality of birth as a consumer industry that critics argue can turn on the mother and pressure her into high-risk surgeries.

In fact, it’s clear that there are some structural reasons behind why you’re likelier to have a cesarean in one hospital versus another, and they actually don’t always have to do with being non-profit or for-profit, by the report’s own account. There is the fact that doctors are in a hurry:

[At one hospital], nurses have been written up for insubordination after asking doctors to give their patients more time or complaining to administrators about doctors rushing to perform C-sections, according to Nancy Carder, nursing practice representative for the California Nurses Association.

And that’s in part because of how their work is structured. A brief case study of two hospitals, both non-profit and very similar demographically, shows a sharp divergence in number of c-sections. The chairman of obstetrics says,

Valenzuela attributes his hospital’s low rate to doctors working in shifts. Shift workers have no financial incentive to hurry a delivery along: The doctor is paid the same and can end a shift regardless of whether he or she delivers 10 babies or simply monitors the early stages of labor. The system increases accountability, he said.

We can all agree, at least, that accountability is a good thing.

For-Profit Hospitals Performing More C-Sections [California Watch]
Are California’s For-Profit Hospitals Performing More C-Sections? [RH Reality Check]