Is 24% the correct goal for c-section rates?

The Pediatric Insider

© 2017 Roy Benaroch, MD

Yesterday I wrote about a recent Consumer Reports article about c-sections and how to avoid them by choosing a hospital with a low c-section rate. I’m not convinced that’s the best way to choose a hospital.

In their piece, Consumer Reports quoted an overall “goal” for c-section rates of 23.9%, as determined by the US Department of Health and Human Services’ Office of Disease Prevention and Health Promotion (That’s right, the USDHHSODPHP. Yes there will be a quiz.) I was kind of flip in my dismissal of that number – I may have said something about it being “made up” or “pulled from the USDHHSODPHP’s nethers” – because to my knowledge there’s no data supporting an exact c-section rate that’s ideal for maternal and baby health.

In the spirit of pretending to be a journalist, I looked into that number a bit further. And it turns out I was right. It really was pulled out of USDHHSODPHP’s nethers.

Here’s where it comes from, see for yourself: MICH-7.1, a goal to “reduce cesarean births among low-risk women with no prior cesarean births.” They took the 2007 rate –estimated at 26.5% — and reduced it by a target of 10%. Not 11% or 5% or 15%, but 10%, because that’s a nice number. And that’s it. Our current official goal rate of 23.9% is exactly where we were, reduced by a nice round percentage.

The number has nothing to do with healthy babies or moms – they didn’t even try to figure out what c-section rate results in the best health outcomes. Or even the lowest cost, or the best patient satisfaction, or anything like that. It’s just an arbitrary number that could as easily been set higher or lower. I mean, if a 10% reduction is good, why not 15%? Or 41.5%?

Why this matters: women are trying to make good decisions for their own health and the health of their babies. Arbitrarily telling them that c-sections are bad and that hospitals that do fewer of them are good is, well, silly and paternalistic and insulting. We can admit that we really don’t know the perfect percentage for a c-section rate, which means it’s OK that it’s not the same at every hospital. Whether you get a c-section should depend on your health, your baby’s health, and a frank and honest discussion with your OB or midwife about the risks and benefits of a vaginal or c-section delivery. Let’s leave the USDGGSODPHP out of it.

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5 Comments on “Is 24% the correct goal for c-section rates?”

  1. Cara Says:

    Being that c-sections saved both of my kids lives (my son was in major distress very early into labor, and my daughter hadn’t dropped when my water broke – she was double cord wrapped around her neck), I think information like this is bullshit. Why not look at hospitals with the best health outcomes for both mothers and babies? (Not including home-births transferred to hospitals in the numbers).

    You know what happened a lot before c-sections? Still births. Not that these don’t still happen, but at greatly reduced rates. Oh, dying in childbirth was also much more common.

    I am SO incredibly grateful for the medical technology that has given me two healthy, thriving children. Pregnancy and birth are risky for both mother and child. When things go well, medical intervention isn’t necessary – but FAR too often they don’t go well, and you want people on-hand ready to act in these scenarios instead of hesitating because it will impact the number of c-sections the hospital reports.

    I’m furious about this. This and the baby-friendly hospital initiative that has lead to babies failing to thrive, but that’s a whole other topic…

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  2. Desiree C Perazzo Says:

    Thank you for writing about this. I had a really hard time accepting my CS (although in hindsight, it was a medical necessity and am now grateful), and although I think there might be some Doctors that do unnecessary ones, there are probably more that are just trying to be safe for Mom and Baby. I doubt that there is a real “measure” of how many there needs to be.. I say there just needs to be as many as medically necessary to ensure mom and baby safety.

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  3. Heidi Says:

    My question is the “ideal” rate for what? A small local hospital that sends all it’s complicated deliveries to the nearest University teaching hospital; the place that is more likely to have Maternal/Fetal medicine specialists and be able to handle higher risk deliveries? The community hospital that does not have an anesthesiologist at the hospital 24/7 so they don’t schedule very many C-sections? The huge University hospital that has the Level III NICU and the neo-natal department that can handle micro-premies? Who do you think is going to have the higher C-section rate?

    How do you decide whose C-section was “un-necessary” ? If your OB sees late decels and your baby’s heart beat is not recovering after each contraction and your OB recommends a C-section, chances are you will have a screaming, healthy baby with good Apgars…does that mean the CS was un-necessary or does it mean you would have had a blue, cyanotic baby that had to be resuscitated and while they seem OK you aren’t going to know if they have any deficits from oxygen deprivation for quite a while…

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  4. Erin Says:

    Heidi, that’s exactly what I was saying in the first post! There are tons of hospitals in the US that would be those community hospitals- in rural/outstate areas especially. Do they get the awards for hitting the goal because they don’t have the resources to have lots of c-sections? The goal is soo arbitrary, especially in a profession which bases itself on science!

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  5. Thank you, I’m in the UK and we seem to have a similar focus on CS rate rather than what is best for the individual. It’s usually the outdated WHO 15% that gets quoted.
    I’m currently recovering for my 3rd CS and it’s been rough, I would love to be up and about again after A straightforward vaginal birth but of course you can’t simply choose that option and garuntee it will work out.

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