Making Sense of Cesarean birth Rates
Cesarean, or C-section, rates are often in the news. Although regarded as one of the important measures of a hospital's performance, one study found that only 28% of its survey respondents used quality information to choose a hospital for their birth. Another study revealed that just over half of respondents didn't think their choice of hospital had any impact on whether or not they would have a cesarean birth.
Current public health efforts focus on reducing the overall number of medically unnecessary cesarean births among a specific population-- first-time moms with potentially "low-risk" births, meaning that they have a single, full-term baby in the head-down position. The cesarean birth rate in this population is called the NTSV cesarean birth rate.
Centers for Disease Control and Prevention data from 2016 show that 31.2% of all births were by cesarean and 25.7% of the NTSV population had cesarean births.
NTSV and Total Cesarean Rates, Untied States, 1993-2017
Available CDC data show that the NTSV cesarean birth rate was as high as 28.1% in the United States, reaching this peak in 2009.
Unfortunately, only 12.4% women with a history of a previous cesarean birth end up having a vaginal birth after cesarean, or VBAC, as many hospitals and doctors offering maternity services do not permit women with a history of cesarean birth to give birth vaginally at their facility. Multiple repeat cesarean births dramatically increase the risk of dangerous long-term complications, such as placenta accreta.
In 2016, 601,788 Women with a Previous C-section Had a Baby.
How Women with a Previous C-section Gave Birth in 2016
A 2013 University of Minnesota study identified 10-fold variation in hospital-level cesarean rates-- from 7 percent to 70 percent. The variation was more extreme in patients with lower-risk births. Rates of cesarean birth varied 15-fold in this population.
At present, the best sources of patient-facing information on hospital cesarean rates only feature data from less than half of hospitals with maternity services. Some state departments of health make these data available, but the type of cesarean birth measure varies from state-to-state, making understanding the concept of a cesarean rate confusing to the public.