Elective C-sections still rising in the U.S.

The number of medically unnecessary Cesarean sections has shot up in recent years in the U.S., with more and more women opting to forgo labor in favor of surgical delivery, according to new figures.

Between 2001 and 2003, the rate of so-called “patient-choice” C-sections climbed by nearly 37 percent in the 17 U.S. states covered in the new study. In certain states - including Nevada, Washington and Florida - the increase hovered around 50 percent.

The findings point to an acceleration in a trend first noted in a 2003 study by the same researchers, from HealthGrades, a Golden, Colorado-based company that evaluates healthcare quality.

A patient-choice C-section is defined as a first-time, pre-planned cesarean for which there is no medical need; it does not include women having a repeat C-section.

In 2003, Florida, New York, Nevada and New Jersey had the highest rates of these procedures, at slightly more than 3 percent of births to women with no previous C-section.

Though that percentage is small, it’s part of a “dramatic acceleration” in patient-choice C-sections in just a few years, Dr. Samantha Collier, vice president of medical affairs for HealthGrades, said in a statement.

The increase seen between 2001 and 2003 was about twice that found in the company’s original study, which showed a 19-percent rise in patient-choice cesareans between 1999 and 2001.

A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but anesthetized from the chest to the legs by epidural or spinal anesthesia. An incision is made across the abdomen just above the pubic area. The uterus is opened, the amniotic fluid is drained, and the baby is delivered.

Greater awareness of the option may be helping to fuel the increase, Dr. Jeff Goldstein, a senior physician consultant to HealthGrades, told Reuters Health. More doctors may be bringing it up to patients, but women may also be hearing more about it and broaching the topic themselves, he noted.

Whether the growth of these elective C-sections is a good or bad trend, however, is “still open to debate,” Goldstein said.

Some experts believe the surgery - which results in longer recovery times and hospital stays - should be performed only when medically necessary. It is major surgery, and while complication rates are low, the risks include hemorrhaging, infection and placental implantation problems in future pregnancies. There are also potential risks to the newborn, including accidental cuts during the surgery and breathing problems soon after birth.

But others point out that C-sections may lower the risk of pelvic organ prolapse - in which the bladder, uterus or bowel sink from their normal positions - and incontinence after delivery. If a woman is informed of the risks and benefits of both modes of delivery, advocates say, then she should be free to choose.

In addition, more women are having their first child at an older age, and an elective C-section may be a safer option for them, Goldstein said.

He pointed out that the American College of Obstetricians and Gynecologists has stated that there is “no single, correct response” to give to patients who ask about elective C-sections. The organization has also deemed patient-choice cesareans to be ethical, as long as women are fully informed of the risks and benefits of the surgery.

Whether a given insurance plan will cover the elective procedure is another question.

In this latest study, based on discharge data from 1,500 hospitals, HealthGrades found that rates of elective C-sections varied widely among states. Utah, Wisconsin and Washington state had the lowest rates in 2003, all below 2 percent of births - though Washington had one of the sharpest increases between 2001 and 2003, at more than 53 percent.

The reasons for the regional differences are not clear, according to Goldstein. But what is common to all states, he added, is that none has shown a decline in the procedure.

Provided by ArmMed Media
Revision date: June 21, 2011
Last revised: by Jorge P. Ribeiro, MD