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Important Research – The Health Affairs Article

It is one thing for birth advocates to lament the state of maternity care in the U.S. (and many other countries around the world). It is another thing when health policy experts start questioning the status quo. In an article in the March 2013 edition of Health Affairs, researchers examined the variation in cesarean rates for over 800,000 births at 593 hospitals across the country. They excluded hospitals with less than 100 births per year, but otherwise examined a wide variety of hospitals: teaching, non-teaching, rural, urban, large, and small. Acknowledging that some differences in cesarean rates may be due to risk factors in the patient population, they examined both overall cesarean rates and the cesarean rate for low-risk women. They were surprised to find a ten-fold variation in overall cesarean rates among hospitals from 7.1 percent to 69.9 percent. Expecting to find a much smaller variation in low-risk cesarean rates, they were astonished to find a fifteen- fold difference from 2.4 percent to 36.5 percent. Such findings lead to tough questions and the inevitable conclusion that much of the variation is likely due to obstetric care practice patterns.

Not only does cesarean delivery increase risks for both mother and baby, but unnecessary cesarean surgery has a huge impact on our healthcare budget. Government money pays for almost half of the births in the U.S.; indeed, in 2009, state Medicaid programs paid over 3 billion dollars for cesarean surgery. Clearly, it is time to focus attention on maternity care practices that not only improve outcomes for mothers and babies, but also cost less. Childbirth educators are in an ideal position to work with other team members in the hospital to develop policies to promote and support normal, physiological birth; and to educate parents on how to plan for normal birth and avoid unnecessary interventions which lead to unnecessary cesarean surgery.

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