Cesarean Birth Rate Falling in U.S., Researchers Say : Medicine: Percentage in California is also lower. Health group says many of the surgeries are unnecessary.
The Cesarean birth rate in California and the nation dropped slightly between 1989 and 1990, reversing a steady increase in the rate of surgical deliveries over the previous quarter-century, according to a report released Tuesday.
But despite the favorable trend, the study by the Washington-based Public Citizen’s Health Research Group said that the rate of Cesarean sections is still nearly twice as high as it should be.
“We are optimistic that this important turnaround signals the beginning of the end of this national epidemic,” said Dr. Sidney M. Wolfe, the director of the consumer advocate group and one of the authors of the report.
Wolfe, who has crusaded against “unnecessary Cesareans” for many years, charged that nearly 500,000 unwarranted surgeries are performed each year, at an estimated cost of $1.3 billion. These operations “are a major example of violence against women,” he said.
The national Cesarean rate--the percentage of all deliveries performed by C-section--increased from 4.5% in 1965 to 24.7% in 1988, according to federal statistics.
But between 1989 and 1990, the national rate declined, according to statistics cited in the report. Based on a sample of more than 2.5 million births each year, the rate decreased from 23% in 1989 to 22.7% in 1990. The 1989 and 1990 rates were based on a larger sample than previous years’ figures and thus are more reliable, according to the report.
California’s Cesarean section rate was 22.9% in 1989 and 21.4% in 1990--significant declines from the 24.5% recorded in 1986.
Samaritan Medical Center-San Clemente was No. 5 in the highest rates of Cesarean deliveries among hospitals in Los Angeles, Orange, San Diego and Ventura counties, according to the health group’s survey. Slightly over 37% of its 544 deliveries were Cesareans in 1989.
Three Orange County hospitals were on the opposite end. At Kaiser Foundation Hospital in Anaheim, 12.5% were Cesareans out of 4,574 deliveries, and UCI Medical Center in Orange had a rate of 16.3% among its 6,044 deliveries.
The study cites several explanations for the slight drop in the nation and the state. They range from the growth of consumer activist groups, such as the Syracuse, N.Y.-based International Cesarean Awareness Network, publicity about the high Cesarean rates at individual hospitals, greater attention to the issue among obstetricians, and educational programs for physicians at individual hospitals, such as Kaiser Permanente facilities in Southern California.
Another positive trend cited in the report is an increase in the percentage of vaginal births for women who have had children by Cesarean section. These cases, which account for more than one-third of all Cesareans, are the most common reason for the surgery.
Previously, the refusal of some obstetricians to consider a vaginal birth for such women fueled the growth of the surgeries. The national rate of vaginal birth after Cesareans increased from 12.6% in 1988 to 20.4% in 1990.
The report recommended that hospitals help to control the use of the surgeries through such steps as enforcing standards on their physicians and developing informational pamphlets for patients. It also supported the increased use of midwives.
Cesarean section is the most common major operation in the United States. During the surgery, the abdomen and uterus are cut open to deliver the baby. The operation is essential in some instances to the health of the mother or the fetus, such as when the fetus has an abnormal heartbeat or when a vaginal birth is considered unsafe.
In recent years, there has been widespread concern that the operation is performed too frequently. Vaginal births are less than half as expensive as surgical deliveries and the mother’s recuperation is quicker. Women often leave the hospital within 24 hours of a vaginal birth; after a Cesarean section, mothers may be hospitalized for three to four days.
Typical physician and hospital charges for a C-section are $7,186, compared to $4,334 for a vaginal birth. Only a handful of insurers, such as Blue Cross/Blue Shield programs in a few states, reimburse physicians at the same rate for both deliveries, the report said.
Many leading obstetricians consider a desirable Cesarean rate to be between 15% and 20%, but the report suggests that 12% to 14% would be the proper rate. These estimates are based on medical studies and expert opinions about the percentage of women who require the surgery when given state-of-the-art care.
Kate Ruddon, a spokeswoman for the Washington-based American College of Obstetrics and Gynecology, said the college agreed that C-section rates are “too high.”
But she said the organization, whose membership includes most practicing obstetricians, disagreed with the 12% goal cited in the report and the conclusion that nearly half of the operations are unnecessary. Ruddon said there were “too many variables” related to the types of patients at different hospitals to set a target national rate.
Using data collected from state health departments, the report includes Cesarean rates for 2,657 hospitals in 34 states, and overall figures for an additional 13 states and the District of Columbia. Many of the statistics had not been made public.
The report’s list of 104 hospitals with the highest Cesarean section rates--37% and above--included 10 hospitals in California.
Bakersfield Memorial Hospital topped the California list at 41.2%. Tim Langeliers, the hospital’s director of marketing, attributed the rate to a high percentage of high-risk births.
In California, 58 hospitals had Cesarean rates of 30% or more. Twenty-six hospitals, including Los Angeles County/USC Medical Center and UCLA Medical Center, had rates of 16% or less. Kaiser Foundation Hospitals had an overall rate of 18.3%.
Statewide rates in 1989 varied from a high of 31.7% in Nevada to a low of 15.2% in Alaska.
