Every day, an estimated 10,000 babies are born in the US. One-third of those babies are born via cesarean births. This number has increased significantly over time, and numerous scientific community members believe that the numbers are far higher than necessary. The increases in c-section birth rates aren’t translating to healthier babies or mothers. While it’s impossible to know the required rate of cesarean sections with accurate precision, it’s closer to 10 to 15 percent.
Why Are So Many Unnecessary C-Sections Being Performed?
This very question is one that both doctors and patients are concerned with. However, the answer is by no means a straightforward one. While a majority of people agree that the mother and baby come through the delivery process safe and sound, doctors are typically paid a significant amount more for c-sections than vaginal births.
Such a financial increase may have everything to do with the rate of non-indicated cesarean sections in the United States.
C-sections are lifesaving when they’re necessary. Some situations involve cesarean sections being a preference, and some are mandatory. Cases involving conditions such as placenta previa (when going into labor, will precipitate life-threatening cord prolapse or hemorrhage) can cause the baby's death.
In many situations, cesarean sections aren’t the preferred method of delivery. Expert consensus and evidence are relatively consistent with the message that, on average, c-sections come with more risks than vaginal births. These risks include excessive blood loss, high risk of infection, increased chances of blood clots, and complications with future pregnancies. The worst threat is death.
There are many c-sections that are performed in a clinical gray area where the actual necessity isn’t apparent. The complexity revolving around c-section decision-making isn’t the problem. The trouble is that the ideals of doctors and patients making objectives and informed decisions together are difficult to come by.
The doctors and patients aren’t the only ones involved in this challenging decision, nor do they make it in a vacuum. Many births in the United States take place in hospitals. Interestingly enough, hospitals add pressures that can change birth choices.
Many hospitals tend to be risk-averse. They’ve developed systems that intend to improve patient safety; however, this can result in pressure to have a cesarean section instead of letting natural labor continue.
Studies found that c-sections, especially first-time cesareans, tend to spike around morning, lunchtime, and the end of the night. This could be interpreted as an induced demand by doctors responding to schedule pressures.
Another reason for the United States' higher c-section rates is that doctors are often paid more for cesarean births than they are vaginal delivery. Some c-section rates are about 15 percent higher, on average. Why? Prevailing logic says a c-section is a major surgery, and that in itself reflects the more significant potential for complexity.
However, this exact logic rests upon a crude generalization. While vaginal births can be more straightforward, they can also be complicated and time-consuming. Regardless, payments are fixed, reflecting the mode of delivery instead of the difficulty.
The fact remains the United States' existing system creates financial incentives for doctors to perform c-sections, which makes a difference in the clinical gray areas.
Studies have shown that the more money physicians get paid for cesarean births relative to vaginal delivery, the higher the cesarean rates. When these differentials get reduced, you’ll see c-section rates decrease.
There are several truths behind the increasing rates of unnecessary C-sections. It’s not only about the pay rates being higher. However, medical care is complex, and labor management is bound to face myriad pressures;. At the same time, we might not be able to relieve all of the pressures, but we might be able to change one of them.