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Examining the High Rate of C-Sections

BY AMANDA FLAUM and MELISSA WELCH, M.D, M.P.H. – Today, nearly 1 in 3 women give birth by cesarean sections (C-section) in the United States. This is quite the jump from 1965 when C-section birth rate was first measured at 4.5 percent, and is much higher than the federal government’s target rate of 23.9 percent.  Too many women are having major abdominal surgery when it can be avoided.

Last week, Leapfrog Group released statewide and hospital-level statistics on C-section rates in the United States and found that more than 60 percent of hospitals surveyed have excessive rates of C-sections. Out of the 33 states surveyed, California is in the middle of the pack with 25.7 percent of births by C-section. While this is closer to the target rate, there is still work to be done.

C-sections are appropriate and potentially life-saving when the health of the mother or baby is at risk.  It is the use of C-section in circumstances where there is no medical risk to the mother or child that requires us to take pause.

When compared with traditional births, C-sections increase low-risk women’s chances of rare, but potentially life-threatening problems, such as hemorrhage, blood clots and bowel obstructions. For babies, C-sections can also cause immediate breathing difficulties and an increased risk of developing asthma and diabetes as a child.

Covered California has taken a keen interest in this public health issue, working  with health plans to encourage providers to avoid C-sections when not medically necessary and educate pregnant women on the risks and benefits of surgical birth. Blue Shield of California’s Prenatal Program includes personalized nurse coaching and a 24/7 hotline to educate expecting mothers and discourage early elective C-sections.

Getting to the optimal C-section rate is a matter of promoting the use of natural birth as the standard of practice, while using surgery only when medically necessary to reduce harm to the mother and baby.

By voluntarily reporting their C-section rate to the Leapfrog Hospital Survey, hospitals are showing dedication towards transparency, which is an important first step in lowering their rate.

Amanda Flaum is vice president of medical care solutions and Melissa Welch, M.D., M.P.H., is vice president of clinical quality and markets support at Blue Shield of California


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