Posted tagged ‘c-sections’

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

May 17, 2017

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.