C-Section Rates Vary Drastically Among U.S. Hospitals

Caesareans are the most common operation performed in the U.S., but according to a new study, the rates at which the procedure is performed varies widely—ranging from 7 percent of all deliveries to 70 percent of all deliveries—depending on the hospital. And it apparently has to do with the quality of care.

The study, published in the journal Health Affairs, was based on the federal data of over 800,000 births at 593 U.S. hospitals in 2009. Oddly, the rates for low-risk pregnancies (single births, carried to term, not breech, performed on mothers who had never had a C-section before) varied even more, from 2 percent to 36 percent. Researchers at the University of Minnesota in Minneapolis and the University of British Columbia in Vancouver, who authored the study, said that the variation in rates could not be explained by hospital size, geographic location, or the “too posh to push” trend in which mothers request the procedure for convenience.

Instead, researchers found that the variations in rates have to do with how the individual hospitals are run, how they manage women’s labor, how they admit patients, and how their clinicians are paid. Katy B. Kozhimannil, an assistant professor of health policy and management at the University of Minnesota School of Public Health and one of the authors of the study said, “It begs a closer look at how we structure and finance childbirth in the United States.”

The study suggested that “including better coordinating maternity care, collecting and measuring more data, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting” would reduce the variations in the procedures.