March, 2010, Data Brief of the National Center for Health Statistics (NCHS) reported that nearly a third of cesarean sections in New York state may be performed unnecessarily, and a report released by Public Citizen this past Wednesday found that Long Island has among the state’s highest rates of cesarean sections.
The rapid rise in cesarean sections is due to the procedures being performed on women who had never had one before, as well as to a sharp decline in the rate of women who undergo a vaginal birth after a previous cesarean (VBAC). The Public Citizen report analyzes the rates of c-section by counties and hospitals in New York and sets forth suggestions for expecting parents to try to avoid an unnecessary c-section.
The NCHS paper describes major risks of undergoing a cesarean section: Cesarean delivery involves major abdominal surgery, and is associated with higher rates of surgical complications and maternal rehospitalization, as well as with complications requiring neonatal intensive care unit admission. In addition to health and safety risks for mothers and newborns, hospital charges for a cesarean delivery are almost double those for a vaginal delivery, imposing significant costs.
The key findings of the NCHS paper are: The cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States. From 1996 to 2007, the cesarean rate increased for mothers in all age and racial and Hispanic origin groups. The pace of the increase accelerated from 2000 to 2007. Cesarean rates also increased for infants at all gestational ages; from 1996 to 2006 preterm infants had the highest rates. Cesarean rates increased for births to mothers in all U.S. states, and by more than 70% in six states from 1996 to 2007.
The New York state hospital with the highest percentage of total C-sections was St. Anthony Community Hospital (Orange County) with 53.5 percent of deliveries by C-section. Auburn Memorial Hospital in Auburn had the lowest percentage of C-sections, with a rate of 16.6 percent. Among urban hospitals, the lowest rates were at North Central Bronx Hospital, with only 18.5 percent of deliveries done by C-section; St. Barnabas Hospital (Bronx), with 20.7 percent; Maimonides Medical Center (Brooklyn), with 20.9 percent; and New York Downtown Hospital, with 22.3 percent.
In contrast, other urban hospitals had very high C-section rates, such as University Hospital of Brooklyn (Brooklyn), with 40.2 percent; NewYork-Presbyterian at Weill Cornell Medical Center, with 39.2 percent; Lenox Hill Hospital, with 40.1 percent; and Long Island Jewish Medical Center, with 40.3 percent. Six of the eight hospitals in Westchester County also had rates exceeding 39.5 percent. The Public Citizen report includes suggestions to women as to how to avoid c-sections.
Public Citizen recommends that health departments and hospitals require all hospitals to offer the alternative of delivery by a licensed midwife, adopt peer review in all aspects of maternal and fetal care, require all ob/gyns to get a second opinion before deciding on a primary C-section, standardize care right before and after birth, and eliminate financial incentives for performing C-sections (physicians are paid more for performing C-sections, even though they may take less time to perform than vaginal deliveries). Specifically addressed to expecting parents, the report suggests:
- Talk to your doctor or midwife early about your preferences. Fully air any major discrepancies concerning your respective perceptions of risks and benefits.
- Find the overall, primary and VBAC rates in the hospitals and by their obstetricians you are considering using for your pregnancy. For hospitals, one can use the findings in the report and NYS Public Health Law section 2803 requires that every hospital and birth center provide each prospective maternity patient and the general public an informational leaflet with data on maternity care and insurance coverage. The hospital and birth center must also provide statistics on its maternity-related procedures. These include data on cesarean rates, successful VBACs, midwife-attended births, use of fetal monitoring, use of forceps and analgesia, anesthesia, births delivered vaginally, induced deliveries, use of augmentation of labor and episiotomies, availability of birthing rooms and facilities for rooming-in.
- Consider using a certified nurse-midwife or certified midwife. Findings in multiple studies show that the likelihood of induction, episiotomy, or a cesarean section is generally lower with midwife-attended deliveries than with obstetrician-attended deliveries.
- Consider using a doula – continuous labor support by an experienced woman – in conjunction with your doctor.
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