No pressure! You’re only making your first big decision as a parent—selecting the right practitioner and the right hospital for your baby’s birth. Perhaps your primary care doctor has recommended an obstetrician. Perhaps you want to go with the OB/GYN practice your friends have used, or the midwife who delivered your sister’s baby last year. Maybe you love your regular gynecologist, and she’s also an obstetrician, so you plan to stick with her and the hospital where she has privileges.
Or maybe you’re more comfortable making the decision based on statistics, like the percentage of cesarean births at your hospital of choice compared with cesarean rates at other hospitals in the region. If you’re lucky, you’ll even be able to find cesarean rates for a specific obstetrician.
What is a normal C-section rate?
The overall cesarean rate in the United States was 32.8% in 2012, a dramatic increase from the 5% overall rate in 1970 and more than twice the World Health Organization’s recommended rate of 15%. The WHO goes on to say that higher cesarean rates “have not shown additional benefit for the mother or the baby,” and can actually be harmful.
In the United States, some studies have shown that women of color and low-income women are more likely to have cesareans, while higher rates of education and other forms of privilege help some women avoid unnecessary cesareans. But there is conflicting evidence that “overuse of medical procedures often occurs when providers are sure of payment,” which could lead to higher rates of medically unnecessary cesareans among higher-income women and white women, according to a 2012 article by sociologists at the University of Arizona.
Keep in mind that some cesarean births are requested by the mother, but there are still a lot of women undergoing major abdominal surgery whether they like it or not. Sometimes cesareans are medically necessary. There may be problems with the placenta, or the baby’s head may be too large to pass through the mother’s pelvis, for example. But many cesareans could be avoided. The causes of unnecessary cesareans are hotly debated, but some think the culprits are often common interventions such as inducing labor, or administering an epidural without also giving the drug pitocin to stimulate contractions.
The Department of Health and Human Services has set a goal of reducing cesarean rates for low-risk women by 10% by 2020, but in the meantime, it’s every woman for herself.
Fortunately, it’s relatively easy to find cesarean statistics on your state, and from there you can look for a hospital at the low end of the range.
Although there are various for-profit sites that aggregate cesarean statistics by hospital, you’re better off going right to the source. State health departments routinely track the number of cesarean births performed at each hospital and make this data available to the public online. For example, California’s Office of Statewide Health Planning and Development provides statistics on the number of total births performed at each hospital and how many of them were cesarean births. If you’re a second-time mom who’s hoping for a vaginal birth after having had a cesarean, many state sites also provide information on Vaginal Birth After Cesarean, or VBAC.
Intimidated by enormous PDF files on government websites? Hospitals that provide maternity care field questions on this all the time. Ask your doctor or the administrator of the hospital’s maternity ward for statistics, and speak to your doctor about her approach.
What is best for you and your baby?
This is what it really comes down to. Do you trust your doctor to make the best decision for you and your baby? Do you trust the hospital to support your doctor in making the right call? It can be difficult to get the cesarean rate for a specific doctor, but some states do maintain fine-grained data, such as this database that tracks cesarean rates for doctors in Virginia.
But statistics will only get you so far. Your research is really just preparation for the important conversation you’ll have with your doctor. Ask her whether she performs cesareans herself, or whether cesareans are performed by a backup physician. Ask her how she decides if a cesarean is necessary.
You might be hoping for a vaginal birth, but you’re not interested in heroics and you’re comfortable with the idea of a cesarean if it’s warranted. In that case, you don’t want a doctor who will delay a cesarean until the last possible moment. Maybe you’re worried about the effects of general anesthesia on the baby, so you want a doctor who will perform a cesarean with just an epidural. Or maybe you want to avoid a longer stay in the hospital after giving birth, so you want a doctor who will do everything she can to help you deliver vaginally.
Don’t neglect the statistics, but don’t stop there, either. Ultimately you’re looking for a setting and a birth attendant who will give you the maximum chance of bringing your baby into the world safely and with minimum stress.
Mother and baby image via Shutterstock.