There’s no denying the C-section rate in America is high, but why? Well, according to Modern Healthcare, the likelihood of entering the world through the birth canal or by cesarean section is not based strictly on clinical factors. Other factors like insurance coverage and the hospital where the birth is occurring play a role in whether or not birth will be performed vaginally or by cesarean.
Just a quick glance at three different Michigan hospitals can show just how varied c-section rates really are. The three Michigan hospitals in question are DMC Harper-Hutzel hospitals in Detroit, Henry Ford West Bloomfield Hospital and McLaren Macomb in Mount Clemens. Of the three hospitals, nearly a “fifth of all babies born at DMC Harper-Hutzel hospitals in Detroit was delivered by C-section,” while a quarter of all babies born at Henry Ford West Bloomfield Hospital were delivered by C-section. At McLaren Macomb, more than one-third of all babies were born via C-section. According to data submitted to “the Leapfrog Group, an employer-backed quality and patient-safety group in Washington, D.C.,” across the three hospitals, the “rate of babies born by C-section varied by 15.3 percentage points!”
However, with all of this data, it still doesn’t explain why C-section rates were higher at McLaren Macomb than at Harper-Hutzel. Figuring out the why is key to lowering the country’s high C-section rate and all the healthcare spending that goes into them. The problem is, as Modern Healthcare pointed out, there’s a “dearth of information about how delivery decisions are made at each hospital.”
Every hospital is managed differently, meaning that every maternity ward is managed differently. One thing is for certain, though, money does play a role in the decision-making process. “Insurers pay more for C-sections than vaginal births, which take more time in hospitals that are often pressed for space.” Sure, sometimes C-sections are medically necessary, but oftentimes, according to Katy Kozhimannil, an associate professor at the University of Minnesota School of Public Health, “the system nudges hospitals and clinicians toward greater use of cesarean sections” because they are quicker and more profitable for the hospital. A typical C-section only takes about 30 minutes and “Medicaid and private insurers typically pay twice as much for a C-section.” For example, the Center for Healthcare Quality and Payment Reform estimates the average “commercial payment for vaginal births to be $5,809, compared with $11,193 for cesarean births.” That’s a huge price difference!
Another reason behind the country’s high rate of C-sections could be that many doctors “fear malpractice suits stemming from natural births,” despite the fact that C-sections are usually riskier than a vaginal birth.
No matter the reasons that lead to C-sections, something needs to be done to decrease the number being performed each year here in the U.S. According to Modern Healthcare, C-sections account for about one-third of U.S. births. That’s “double the rate the World Health Organization considers medically necessary.” U.S. C-section rates are even high among women “considered less likely to need the procedure,” estimated around 25.8%. So we’re literally performing C-sections on women who don’t need them all for convenience and to make an extra buck.
So what can realistically be done to curb America’s love affair with C-sections? For starters, hospitals can cut back on early elective deliveries via C-section. Additionally, “they can refuse to schedule C-sections or to pay for deliveries when labor is induced without medical necessity.” More states and hospitals can also undertake “payment reform to reduce financial incentives for C-sections” by making it so vaginal and cesarean deliveries cost the same.
As more and more people begin to learn about this particular problem, one can only hope changes and reforms occur and that hospitals go back to caring for their patients rather than how much money they can squeeze from them.