It has long been understood that the c-section rate in the U.S. is too high. At 32 percent of all births, it is double the ideal target set by the World Health Organization.
Cesareans are the most common surgery in the U.S., and they are not without complications for both mother and child. Yet a recent study found that the need for a reduced rate is more complicated than simply performing fewer c-sections overall. In fact, the researchers found that many could benefit from more c-sections, not fewer.
“[Previous work] seems to forget there are good reasons for c-sections, and sometimes both the mom and baby would be better with a c-section.” W. Bentley MacLeod, Columbia University professor of economics, said in an interview on NPR.
The rate of c-sections in low-risk pregnancies is too high, and the rate of c-sections in high-risk pregnancies is too low.
His study, co-authored by Janet Currie of Princeton in the Journal of Labor Economics, looked at every live birth in the state of New Jersey from 1997 to 2006. They analyzed the health of the mother prior to giving birth, the type of delivery and the medical outcomes for both mother and baby.
What they found was that the c-section rate was much too high for low-risk mothers—and too low for high-risk mothers. Doctors with the best outcomes didn’t necessarily have the lowest rates of c-sections overall, but they had what the researchers called “smart” c-section rates. In other words, the doctors with the best outcomes were the most skilled at diagnosing high-risk pregnancies and performed c-sections in those cases, while supporting vaginal births in the case of low-risk births.
The researchers told NPR that smart rates, specifically higher rates for high-risk pregnancies, resulted in nearly 3,000 fewer infant deaths.
The researchers said they are concerned that mothers who are not trained to evaluate their own risk are seeking out hospitals and doctors with the lowest c-section rates. For the best health outcomes, they say their study shows that women need doctors with the best diagnostic skills, not the lowest rates for cesareans.
The data is compelling. The rate of c-sections in low-risk pregnancies is too high, and the rate of c-sections in high-risk pregnancies is too low.
MacLeod said he wants to encourage mothers not to treat a c-section like a consumer product.
The researchers said they hope to encourage a system that puts more emphasis on teaching doctors to distinguish between high- and low-risk pregnancies and labors and to make better decisions on an individual basis. They recommend thoughtful, systematic investigations when the medical outcome is not ideal, and also coordination at the highest levels to insure that all Ob-gyns receive up-to-date training.
The study concluded that, “[P]oor diagnosticians can be identified using administrative data and that improving decision making improves birth outcomes by reducing [c]-section rates at the bottom of the risk distribution and increasing them at the top of the distribution.”
MacLeod said he wants to encourage mothers not to treat a c-section like a consumer product. Having a well-trained doctor that she trusts is more important than having one who works at a hospital with a low c-section rate. Ultimately, the goal shouldn’t be less c-sections across the board, but better outcomes for mother and baby anywhere.