To Cesarean or not to Cesarean

Jennifer Janowski

Consumer Reports recently published an article about the “lows” and “highs” of Cesarean Section (C-section) rates in the US.  http://consumerreports.org/cro/2014/05/what-hospitals-do-not-want-you-to-know-about-c-sections/index.htm   This is a topic I have been following with interest for years.   Not just because I have been working in the women’s health arena for the past 10 years and have had 3 children in the meantime.  I just think it’s interesting.  And when Consumer Reports talks about it, you know you’ve hit the mainstream.

The article in Consumer Reports is a well-rounded look at the risks of C-sections and some of the reasons the rates have increased so much in the last thirty to forty years.   It even calls out some hospitals that have done a terrific job of managing their primary C-section rate for low-risk deliveries, with the top 10 all well below the 15% rate that the World Health Organization (WHO) considers the upper limit.  Congrats to my hometown success story Columbia St. Mary’s and also Denver Health, Utah Valley, McKay-Dee, Intermountain, Monmouth  and the rest of the “top 10.”

The Centers for Disease Control and Prevention is another terrific resource for statistics on pretty much anything and recently published a study showing an ever-so-slight decline in the rates of primary C-sections in some states implementing a new birth certificate process from 2006 to 2012.   Not surprisingly, Utah, which had 3 hospitals in Consumer Reports’ “best” list, comes out ahead in this report as well, topping the report with the best primary, singleton rate at 12.5%  http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_01.pdf  

What neither of these reports discusses is the cost associated with C-sections.  WHO published a terrific document in 2010 that discusses just that.   http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf  WHO has long contended that the upper limit for C-section rates should not exceed 15%.   There are clearly areas that exceed that rate but also areas in the world that are considered under-served.   WHO’s conclusion is that the $2B of costs associated with excess C-sections could pay for the underserved regions nearly 5 times over and save $2B.

As a women’s health professional and consumer, I can attest to the impact on the pocketbook.   And with high deductible plans becoming increasingly common, the pricing transparency has to come next.    So, Consumer Reports—the next challenge is to report on how much hospitals pay for and insurers reimburse for C-sections!   In the meantime, I’ll be waiting and watching!


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