U.S. Doctors May Be Too Eager to Perform C-Sections

The Joint Commission, an organization that sets healthcare standards and accredits healthcare institutions, has found the rates of cesarean deliveries to be high in many U.S. hospitals. Although the procedure is often medically necessary, high rates show hospitals could be overusing the surgery. Unnecessary C-sections pose health risks to mothers and their babies.

The High Rates of Unnecessary C-Sections

According to the Centers for Disease Control and Prevention (CDC), 31.7% of all births in the United States in 2019 were C-section births. Since 1985, the World Health Organization (WHO) has considered the appropriate limit for delivery by C-section to be 10% to 15% of all deliveries. However, the cesarean delivery rates in the United States have been in the 30% to 32% range for a decade.
C-sections are usually necessary many times, but not at a rate of 30%. High rates usually indicate many C-section procedures being performed unnecessarily.

Hospitals have shown significant, unwarranted variation in their rates of C-sections performed. One study identified a tenfold variation in cesarean rates at the hospital level. Some hospitals have high rates of up to 60%. Unfortunately, the variation occurs without an improved outcome for mothers and babies. Large variations without a difference in outcome are considered to point more toward quality of care issues.

The Risks of C-Sections

A C-section or Cesarean delivery is a surgical procedure whereby an incision is made in the mother’s abdomen and uterus to remove a baby. The doctor may recommend this form of delivery because of existing complications prior to labor. In certain cases, the need for the procedure may become evident only after labor has started.

C-section deliveries may be required if labor is not progressing, the placenta has a problem, the baby is in an abnormal position or distress, or other health issues.

Cesarean delivery can cause several problems to the health and safety of mothers and babies. Babies can develop breathing problems or sustain injuries during the surgical procedure. Mothers can experience issues like:

Hemorrhage
Severe reaction to anesthesia
Infection
Blood clots

Increased complication risk in subsequent pregnancies

A 2019 observational study found women who underwent C-sections to be 80% more likely to develop complications than those who went through vaginal births. Women aged over 35 who delivered by C-sections were about three times more likely to develop severe complications.

A C-section that is truly necessary logically carries less risk to the mothers and babies than vaginal birth because of the complications involved. However, an unnecessary C-section poses a greater health risk to mothers and babies.

Women who sustain injuries in unnecessary or botched C-sections or have their babies harmed can sue healthcare providers for medical negligence. There have been cases of doctors pressuring mothers into undergoing the surgical procedure to save time.

Lacerations to organs, infections at wound sites, and excessive blood loss are some of the injuries that birth injury attorneys see in the botched C-section cases they handle. In one case in which a man sued a hospital for medical negligence, a woman was left with severe brain damage after undergoing a C-section. When a doctor performs a C-section that is risky and unnecessary, he or she can be liable for medical malpractice.

Reducing Unnecessary C-Sections

Research has shown that hospitals can reduce cesarean rates safely without increasing neonatal complications. Some of the measures that for quite some time have been advocated for to help minimize C-section rates are standardizing the interpretation of fetal monitoring and proper labor and delivery management. Hospitals would start being more similar if they adhered to consistent guidelines.
Studies have shown interventions targeting healthcare professionals to reduce unnecessary C-sections safely. For instance, implementing strict clinical practice guidelines and making second opinions for indications for C-sections mandatory have been found to reduce the rates.

The Joint Commission decided to begin publicly reporting on hospitals with high C-section birth rates. Reporting the C-section rates is aimed at decreasing the number of unnecessary procedures.
The American College of Obstetricians and Gynecologists (ACOG) has released guidelines and recommendations for reducing C-section rates. The organization recommends healthcare providers and teams work toward safely reducing unnecessary C-sections through science-based resources developed by experts, such as patient safety toolkits and bundles.

ACOG says that regional and national organizations can spearhead setting an agenda concerning the prevention of high rates. However, that will have to be prioritized at different levels of health care systems, hospitals, and practices and will need a culture change. ACOG, together with the Society for Maternal-Fetal Medicine (SMFM), says the need for C-section deliveries can be reduced by increasing access to nonmedical interventions like continuous labor support.

By having fewer times when women need C-sections, cases of botched surgeries and the injuries that result will reduce. If mothers or their babies have sustained injuries because of complications caused by a C-section, they can seek guidance on their legal options from a birth injury attorney.