Los Angeles Times examines increase in Caesarean births, related rise in risk, cost

May 19 2009

Caesarean sections -- which are performed in 31% of births, up from 4.5% in 1965 -- often are considered an unnecessary risk and "an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good," the Los Angeles Times reports.

According to the Times, c-sections can increase a woman's risk of complications, such as infection, blood clots and premature delivery. Even without complication, c-sections typically result in longer hospital stays and increased costs.

Expenses related to c-section births account for 45% of the more than $79 billion in annual hospital charges that childbirth incurs in the U.S. annually. The average uncomplicated c-section costs about $4,500, which is about twice the cost for vaginal births. C-sections cost about $13,000 for privately insured patients. According to a 2008 report by Childbirth Connection, "The financial toll of maternity care on private (insurers)/employers and Medicaid/taxpayers is especially large." It also said, "Maternity care thus plays a considerable role in escalating health care costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets."

Addressing the Increase

The Institute for Healthcare Improvement has launched its Strategic Partners program to address the surge in c-section births, the Times reports. Under the program, hospitals are trained to enforce a set of guidelines, such as a ban on elective deliveries before 39 weeks' gestation. In the program's four years, 60 hospitals have agreed to participate. According to Elliot Main, chief of obstetrics for Sutter Health, typical c-section births are a "profit center in hospitals, so there's not a lot of incentive to reduce them." However, program Director Frank Federico said, "It's a culture change," adding, "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?'" (Girion, Los Angeles Times, 5/17).