First-Time Cesarean Rates Dipped in 2012: CDC
THURSDAY, Jan. 23, 2014 -- Efforts to curb cesarean birth rates in the United States might be working, with health officials reporting a 2 percent decline in the number of first-time surgical deliveries between 2009 and 2012.
Cesarean delivery rates in 19 states reporting to the U.S. Centers for Disease Control and Prevention averaged 21.9 percent in 2012, the CDC said in a report released Thursday. This represented a return to the rate last recorded for those states in 2006.
Report co-author Michelle Osterman, a statistician at the CDC's National Center for Health Statistics, said the turnaround was significant. "The rates had been going up every year, but in 2009 they either stabilized or started to come down," she said.
The real impact might be felt in the overall cesarean rate, Osterman said.
"Because primary cesareans are starting to decline, the overall cesarean rate will be impacted because there is only a 10 percent chance that a woman who has had a cesarean is going to have a vaginal birth afterward," she said. The overall rate has stabilized at about 33 percent of all births in the United States, Osterman said.
One expert said the report indicates slight progress.
"At least the rate stopped going up," said Dr. Mitchell Maiman, chairman of obstetrics and gynecology at Staten Island University Hospital in New York City. "After decades of climbing, there seems to be a hold to it. But we could do a lot better."
The risks to the mother and baby are much higher in a cesarean birth than in a vaginal birth, Maiman said.
"Once you have the first cesarean, you're overwhelmingly likely to have repeat cesareans," he said, noting the odds for complications and death rise dramatically with each additional C-section. "It's also worse for the baby as multiple studies have proven."
Risks to the mother include infection, excessive bleeding and blood clots traveling to the legs or lungs. Risks to the baby include injury during delivery, breathing problems and the potential need for intensive care.
"Vaginal delivery is the preferred method for having a baby," Maiman said. "Cesarean should only be resorted to when it's absolutely necessary."
Maiman said the cesarean rate is so high because doctors fear malpractice lawsuits.
"The pressure is on physician practices because it takes so much time and energy to stay with a patient for hours for a vaginal delivery, compared to the quickness of a cesarean," he said. "Most of the lawsuits are for the failure to do a cesarean in a timely fashion."
In a separate reporting region, the researchers found that in 28 states and New York City, the first-time cesarean rate dropped from 22.1 percent in 2009 to 21.5 percent in 2012.
Declines were reported in 16 of those 29 areas, while the remaining states' rates remained the same, according to the report.
Some areas reported dramatic declines. C-sections in Delaware, North Dakota, Oregon, New York State and New York City decreased by 5 percent to 10 percent from 2009 to 2012. In Utah, the rate fell by 15 percent.
Cesarean rates also varied depending on the stage of pregnancy. Each week from 37 weeks' gestation and beyond saw declines in C-sections, with the biggest drop at 38 weeks, when the baby is nearly ready to be born. Full term is usually considered 40 weeks.
The researchers said these findings cannot be generalized to the entire country, because the reporting states aren't a random sample of U.S. births.
Putting financial pressure on hospitals could reduce the cesarean rate further, Maiman said. "If you introduce financial incentives or disincentives to hospitals for overall cesarean rates, then they will pass that on to the physicians," he said.
Changes regarding medical malpractice laws could also make a major impact on the cesarean rate, he said.
For more information on cesarean delivery, visit the U.S. National Library of Medicine.
Posted: January 2014