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Study: C-section rates vary widely by hospital

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Delivery of a child by cesarean section is a fairly common practice in the United States — much more common than it should be, some medical experts believe.

A recent study on childbirth indicates that the chances of a woman having a cesarean section could depend less on her condition than on the hospital where the childbirth occurs.

The study, led by researchers at the University of Minnesota and the Harvard School of Public Health, found that cesarean deliveries made up nearly 33 percent of all deliveries in 2011 and accounted for more than 1.3 million births, according to a University of Minnesota press release. But the study also found that cesarean rates varied between 19 and 48 percent across U.S. hospitals. And the reasons for that variation cannot be explained by the medical condition of the mother.

Lead author Katy Kozhimannil, an assistant professor in the division of health policy at the University of Minnesota’s School of Public Health, told KSTP News the findings are significant.

"The hospital or the location when you give birth really matters for the type of care you may receive," Kozhimannil said. It's important to ask questions of your provider and of potential different birth settings ... about their use of cesarean delivery."

While previous studies have shown that cesarean rates vary significantly across the U.S., Kozhimannil said they didn’t explain what was behind the variation.

“We can’t answer the million-dollar question, which is: What is causing this variability?” Kozhimannil told the Star Tribune.

WHO says U.S. has the third-highest rate of 'unnecessary C-sections'

Traditionally, C-sections are most often used to deliver a baby when there are pregnancy complications and a vaginal birth is considered too risky. Doctors deliver the baby by making incisions in the mother’s abdomen and uterus.

Medical News Today reports that C-sections are the most common inpatient surgery in the country. U.S. cesarean rates increased from 20 to 32 percent between 1996 and 2009 but have stabilized since then, according to Science Daily.

But because it is a major surgical procedure, C-sections can carry a higher risk of complications for both mother and child. USA Today reports that the death rate is more than three times higher among mothers who undergo C-sections than it is among women who have vaginal births.

The rise in U.S. cesarean rates over the past few decades has caused concern among medical experts and health groups, and some believe the increase is being driven by unnecessary C-sections.

A 2010 report by the World Health Organization noted that the U.S. had the third highest number of unnecessary C-sections after China and Brazil. A 2013 survey of mothers by the group Childbirth Connection found that nearly 25 percent of the respondents said they had experienced pressure from a health professional to have a C-section.

Carol Sakala, director of programs for Childbirth Connection, said in an interview that “attitudes about cesarean are becoming quite casual, and some caregivers are comfortable moving to a cesarean section before trying other measures that are less invasive.”

Kozhimannil told the Star Tribune that cesareans pay hospitals and doctors around 50 percent more than vaginal births, and suggested that could have an impact on hospital policies.

In February, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine issued new guidelines aimed at reducing the national cesarean rate.

“The rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes,” the groups wrote in a press release.

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