The CDC recently released its preliminary data on 2013 U.S. births. Among the findings: a very, very slight decline in the cesarean birth rate — 32.7 percent in 2013, down from 32.8 percent of all births in 2012.
Reporting past trends, the CDC explains that the cesarean rate increased dramatically (by about 60 percent) between 1996 and 2009, when it reached a peak of 32.9 percent. In 2010, it declined to 32.8 percent, but then stayed at that level for the next two years.
The 2013 decline was seen only in non-Hispanic white women. Rates were unchanged from 2012 to 2013 for black women, who have an even higher c-section rate — 35.9 percent — and Hispanic women, who have a slightly lower rate of 32.2 percent. The CDC does note that this is the first time in more than a decade that the rate for Hispanic women has not increased.
Cesarean rates have become a topic of much interest because of the dramatic increase over the past two decades and hospital and doctor policies that make it difficult to have a vaginal birth after a first cesarean. While it’s not clear what the best target is for the cesarean rates, there is a lot of agreement that the surgery is likely overused. Healthy People 2020 includes a target of 23.9 percent of births among low-risk (full-term, singleton, and vertex presentation) women in order to get a 10% reduction in these first time cesareans.
For most low-risk pregnancies, cesarean delivery poses a greater risk of maternal complications and death than vaginal birth, and the risk of certain complications such as placental abnormalities is thought to increase with each cesarean.
Recently, Consumer Reports issued ratings of more than 1,500 hospitals in 22 states based on their cesarean rates for deliveries that are considered low-risk. A delivery was considered low-risk if the woman hadn’t had a c-section before, didn’t deliver prematurely, and was pregnant with a single, properly positioned baby. Consumer Reports did not take into account other factors that may increase the risk of cesarean, including heart problems, pregnancy-related high blood pressure, obesity, or other chronic diseases.
Consumer Reports found wide variations between hospitals, ranging from 4 to 57 percent of low-risk deliveries. The “better” or “worse” designations are available for free for included hospitals in the 22 states, but a subscription is needed to view the complete hospital rating data, including percent of cesareans. However, the hospital accreditation agency, the Joint Commission, is now requiring hospitals to report their rates, so much more complete data may be available in the future.
So, what can you do with the “better” or “worse” rating, if your state is one of those Consumer Reports considered? While many other factors go into what makes a safe, high-quality hospital, the rankings may inspire you to ask questions of your provider about his or her approach to births and what they will “allow” — such as whether your local hospital will allow vaginal births after cesarean, for example.