If We're Going to Reduce Maternal Mortality, We Have to Look at C-Sections

A new law signed late last year aims to help states investigate the causes of high rates of maternal mortality in this country—and today the New York Times makes the case for a critical look at the United States’s C-section rate. “Although cardiovascular problems account for the highest percentage of maternal deaths, complications linked to surgical deliveries are among the biggest factors,” reports the Times.

Last year, a Commonwealth Fund report surveying 11 high-income countries found that the highest rate of maternal mortality was in the U.S., with four deaths per 100,000 births. As the Times points out, the Centers for Disease Control and Prevention puts this estimate even higher: 18 deaths per 100,000 births. In fact, the maternal mortality rate in this country has more than doubled in the last two decades.

Good thing, then, that the Preventing Maternal Deaths Act, which has been heralded as landmark legislation, aims to bolster investigations into maternal death. But one thing we already know is that the C-section rate is another area where the U.S. gets low grades. The same Commonwealth Fund report found that in most high-income countries, mothers give birth “in the care of midwives in more relaxed environments,” reports to the Times. “Sweden has one of the lowest C-section rates, around 17.3 percent of all births, and one of the lowest rates of maternal mortality.”

Of course, C-sections can save lives, but not when they are done unnecessarily. A 2015 World Health Organization report found “that C-section rates higher than 10 percent were not associated with reductions in maternal and newborn deaths,” according to the Times. The C-section rate in the U.S. ranges from 7 percent to 70 percent, according to a 2015 study.

Research has shown that the greatest predictor of whether a woman has a C-section in the U.S. is not her health, the health of her baby, or even her particular doctor, according to the Times. It’s the hospital where she gives birth. As Neel Shah, an assistant professor at Harvard Medical School, told the Times, “Your biggest risk factor for the most common surgery is not your preferences or your medical risks, but which door you walk through.”