May 21, 2009

The High Cost of C-Sections

Ever wonder what’s the most common surgery performed in the United States? If you guessed birth by cesarean section you’d be correct.

We often point to stories about the rising rate of c-sections, but this L.A. Times story is definitely worth reading at it offers a comprehensive look at both the health risks of unnecessary c-sections and the escalating health care costs.

The United States has the second highest rate of cesareans among Western industrialized countries — c-sections are performed in 31.1 percent of all births, up from 4.5 percent in 1965. Italy ranks first, with a stunning c-section rate of 39.4 percent.

Lisa Girion writes:

As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.

Because spending on the average uncomplicated cesarean for all patients runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. (Among privately insured patients, uncomplicated cesareans run about $13,000.) [...]

The problem, experts say, is that the cesarean — delivery via uterine incision — exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

Inducing childbirth — bringing on or hastening labor with the drug oxytocin — also is on the rise and is another source of growing concern. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own. Induction, studies show, also raises the risk of complications that lead to cesareans.

Despite all this intervention — and, many believe, because of it — childbirth in the U.S. doesn’t measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight.

And in at least two areas, the U.S. has lost ground after decades of improvement: The maternal death rate began to rise in 2002, and the typical American newborn is delivered at 39 weeks, down from the full 40. Public health experts view the trends with alarm.

Girion also notes that there are small but growing signs of change:

The Institute for Healthcare Improvement’s Strategic Partners program trains hospitals to implement a set of guidelines, such as the careful use of oxytocin, and a ban on elective deliveries before 39 weeks. In four years, 60 hospitals have signed on.

“It’s a culture change,” program director Frank Federico said. “We’re at a tipping point. … It used to be that we spent more time defending the 39-week rule. Lately, there’s no question about that. It’s, ‘How can we improve the process to support that?’ “

For more on preterm birth: Vivian W. Pinn, M.D., director of the Office of Research on Women’s Health, hosts a podcast, “Pinn Point on Women’s Health.” In the latest one, Pinn discusses healthy pregnancy and reducing the risk of preterm birth with Catherine Spong, M.D., of the Pregnancy & Perinatology Branch of the Eunice Kennedy Shriver National Institute on Child Health and Human Development (NICHD). Here’s the audio file and a transcript.


One Response to “The High Cost of C-Sections”

  1. MomTFH Says:

    Not only is the national cesarean rate horrid, but in my home city, Miami, where I will most likely train to be an ob/gyn, the cesarean rate is more than 50 percent. No, that is not a typo. More than half.

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