Cesarean Rates by State, 2008

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By Jill—Unnecesarean

Percent of babies born by cesarean delivery, each state: preliminary 2008 

1	New Jersey	38.7
2	Louisiana	38.0
3	Florida	37.6
4	Mississippi	37.1
5	West Virginia	35.5
6	Connecticut	35.1
7	Kentucky	35.0
8	Alabama	34.9
9	Arkansas	34.6
10T	New York	34.5
10T	Texas	34.5
12T	Oklahoma	34.2
12T	South Carolina	34.2
14	Massachusetts	34.1
15	Virginia	34.0
16T	Nevada	33.8
16T	Tennessee	33.8
18	Rhode Island	33.3
19	Delaware	33.2
20	Maryland	33.1
21	Georgia	32.9
22	California	32.6
23	New Hampshire	31.9
24	Michigan	31.5
25	Missouri	31.1
26	Nebraska	31.0
27T	Illinois	30.9
27T	Pennsylvania	30.9
29	North Carolina	30.8
30	Ohio	30.6
31	Maine	30.4
32	Kansas	30.1
33	Indiana	30.0
34	Washington	29.4
35	Iowa	29.3
36	Montana	29.2
37	Oregon	28.9
38	North Dakota	28.1
39	Vermont	27.2
40	Arizona	27.1
41	Wyoming	27.0
42	Hawaii	26.8
43	South Dakota	26.6
44	Minnesota	26.4
45	Colorado	25.9
46	Wisconsin	25.2
47	Idaho	24.4
48	New Mexico	22.9
49	Alaska	22.6
50	Utah	22.0

United States: 32.3

SOURCE: CDC National Center for Health Statistics

Comments

[KK]

What's amazing is not just that the numbers are so high in general, but the fact that Utah's rate is 22% while New Jersey's rate is almost 39%. I can't imagine that patient factors account for most of that difference, so it must be related to labor management (birth setting, interventions, access to VBAC, midwives, etc.), right?

[JMT]

*Glances at Public Health Hat on faraway shelf*
*Picks up nearby Excel nerd hat and places on head*

compared to 2007 (from here: www.theunnecesarean.com/blog/2010/2/13/cesarean-delivery-rates-by-state-2007.html)

Biggest absolute drop in rate: New Mexico - down 0.4 percentage points from 2007 (relative change of -1.7%)
Biggest absolute rise in rate: Louisiana - up 2.1 percentage points from 2007 (relative change of 5.85%)
States experiencing no change or a drop in rate: 9 total (NM ND MT UT AR IA AK MD SD) (of these, only Arkansas and Maryland had rates over 30% to start with)
States experiencing a rise in rate: 41 total (Arizona is notable for having a low-ish overall rate but a big rise from 07-08)

[Rebekah]

Cracked had an article about 5 overused/overhyped medical procedures, and C-Sections came up on their list. If the frat-boys at Cracked think c-sections happen to often, maybe other people ought to listen too.

http://www.cracked.com/article_18840_5-common-medical-procedures-that-secretly-arent-worth-it.html

[Vicki]

Hi, how does that match with the maternal and infant mortality rates? Seeing them side by side, with other countries for comparison would be an eye opener...

[Melissa]

I need advice! I was FORCED to have a repeat C-Section. Literally FORCED! The hospital denied me pain medication (my contractions were 2 minutes apart, water broken, 3 cm dilated) when I arrived. I was told the doctor on call "does not do VBAC's" (who's doin' the pushing here Mister????) and that they would not give me pain meds because I was going to have a C-section. They refused to call my midwife or even let ME call her. I argued with the nurse and the doctor, gritting my teeth during contractions, while they repeatedly waived a consent form in my face and told me I was wrong. I refuse to sign, they threatened to "treat me as hostile" (I was led to believe that they were going to put me in restraints), I finally couldn't bear the pain any longer, called them fascists and put a giant M on the consent line (that was all I could manage in my state and through my tears). They broke several laws in my opinion, but I can not seem to find anyone who will point me in the right direction for advice. I "signed" that form under duress and because it was the only way I could get them to get it out of my face while I was having contractions!! I am furious! Someone please help!!

[Jill]

Melissa, I'm e-mailing you.

[KK]

Consumer Reports also called cesareans "overused" back in 2007 (although I wish they hadn't mentioned speeding up labor):

"CESAREAN SECTIONS. They cost almost $7,000, about 55 percent more than a natural delivery, and constituted a record high of 30.2 percent of births in 2005. Most are performed because labor is progressing too slowly. But several less-invasive approaches might be enough to speed up labor."

http://www.consumerreports.org/health/doctors-hospitals/medical-ripoffs/10-overused-tests-and-treatments/medical-ripoffs-ten-over_1.htm

[Candice]

:gag: I HATE that I was apart of this statistic. I still mourn that birth to this day. It could have been better. The next HBAC is going to prove it.

[Augusta]

Sad to see that the lowest one is still 22%. As another poster commented, I'd be very interested to see the neonatal mortality rates for each state side-by-side.

[Dana]

The NJ cesarean rate is not exactly accurate. They obtain their number by taking an average cesarean rate for almost all the hospitals. They exclude hospitals without a maternity unit (these hospitals usually get a couple births for various reasons so some of them technically have a 0% cesarean rate or a 100% cesarean rate). If they actually looked at the raw numbers and calculated the total number of cesareans based on the total number of births, the cesarean rate was actually 39.4% in 2008.

[Heidi]

I believe the reason the rate is lowest in Utah is because one hospital chain, Intermountain Health Care, owns nearly every big hospital in the state. Doctors can't go anywhere else so the hospitals don't have to keep them happy. Because of this, they can implement whatever policies they want. Their induction policy, for instance, is that there are NO elective inductions before 39 weeks, and the doctors have no choice but to go along with it. In other places, however, where the hospitals are competing, they will do whatever just to keep doctors happy--including inducing at 37 and 38 weeks--otherwise they'll lose business.

It's a simple rule that obviously makes a big difference. Why can't our lawmakers recognize that and do something about it in other states?

[Debi]

Thirding the desire to see the neonatal mortality rates by state side by side for comparison.

[C.Pratt]

Fourthing the neonatal mortality rates if at all possible...

[Rebecca S]

Is it possible that 3 Wolf Moon shirts are more popular in Utah? Can you put those stats side by side please?

[Dreamy]

Anecdotally, it seems like the poor and the rich get the most unnecessary C/S. The rich because they go to the "best" (most technology-dependent) hospitals (and don't get me wrong-- many of those really are the "best" for pathological issues-- just not for birth). And the poor because they go to the most overwhelmed hospitals and get treated by doctors who are less-well-trained on average-- not to mention the racism and classism that pushes them along the assembly line...

It is no surprise to me that Mississippi is so high up-- it's the "blackest" state in the US. Similarly, it's no surprise to me that New Jersey and Connecticut, full of folks who work in NYC, are so high up.

If anyone could point me to ANY stats from DC, I would appreciate it. I haven't been able to find any-- District-wide or by hospital. Given that MD and VA are both in the top 20, and DC, like most big cities, has that rich/poor thing going on, I'd assume the percentage is very high, perhaps higher even than NJ.

[Knitted in the Womb]

I pulled the neonatal mortality data (deaths up to 6 days of age) from the CDC Wonder data set...the most recent data they have there is from 2005. I doubt the rankings of the various states have changed THAT much in 3 years as far as cesarean rate or neonatal mortality. I used all births from 32 weeks and later.

Anyway...to the naked eye, there does not appear to be any correlation...I just get a cloud of data points when I graph them. I ran a correlation calculation on the data, and got a correlation coefficient of -0.17, which means that there is a SLIGHT tendency for a higher cesarean rate to be related to a LOWER neonatal mortality rate (a correlation coefficient of -1 would mean that higher cesarean rate was always related to lower neonatal mortality, a correlation coefficient of 0 means no relation, and a correlation coefficient of 1 would mean a lower cesarean rate always means lower neonatal mortality).

[Vicki]

Thanks @ Dreamy... That doesn't look like a very good correlation to me, and could easily have been chance... What is the number needed to treat, does the tool you used give that?

OK, now, since the CS rate has increased since 2005, we'd need the complete 2005 data set to work this properly, or the complete recent data. A correlation of 2005 mortality and 2010 CS rates can't really be used to suggest safety is the reason for the rising CS rate, or the suggestion will always be that the correlation is due to chance and confounded by mismatched data sets. We are talking about such high numbers of sections, and such relatively small numbers of babies and mothers who die, the stats have to be from the same cohort.

What I'd like to see is:
CS rate
Maternal Mortality
Maternal Morbidity
Neonatal Mortality
Neonatal Morbidity
SCBU/ICU admissions

I think these figures are available for the UK, I wonder if they are collected and published for the US...

[Fogedaboudid]

Oh my good grief, approaching 40% of the women in several states are given vaginal bypass surgery instead of delivering their newborns normally?? And they think this CANNOT affect the neonatal or maternal mortality rates, I'm sure?

I dissected the rates from 2006. Left is c/s rates, right is neonatal mortality.

NewJersey 37.4 3.91
2 Florida 36.1 4.75
3 Louisiana 35.4 6.12
4 Mississippi 35.4 6.60
5 West Virginia 35.2 3.87
6 Kentucky 34.5 4.43
7 Connecticut 34.1 4.76
8 Alabama 33.4 5.77
9 Oklahoma 33.3 4.41
10 Arkansas 33.2 4.93
11 Massachusetts 33.2 3.60
12 Texas 33.2 3.97
13 South Carolina 32.9 5.53
14 New York 32.6 3.79
15 Tennessee 32.4 5.81
16 Virginia 32.4 4.91
17 Nevada 32.3 4.17
18 Maryland 32.2 5.78
19 California 31.3 3.48
20 Georgia 31.3 5.29
21 Rhode Island 31.1 5.01
22 Delaware 30.7 6.01
23 DC 30.6 7.04
24 Missouri 30.2 4.90
25 Maine 29.9 4.24
26 New Hampshire 29.9 3.96
27 North Carolina 29.9 5.56
28 Michigan 29.8 5.18
29 Pennsylvania 29.7 5.47
30 Illinois 29.6 4.90
31 Kansas 29.3 4.27
32 Ohio 29.3 5.21
33 Indiana 29 4.94
34 Nebraska 28.8 3.52
35 Washington 28.4 2.99
36 Oregon 28.2 3.70
37 Montana 28 2.64
38 North Dakota 27.8 3.60
39 Iowa 27.7 3.25
40 South Dakota 27 3.61
41 Wyoming 26.3 4.43
42 Vermont 26 3.07
43 Arizona 25.6 4.35
44 Hawaii 25.6 4.43
45 Minnesota 25.4 3.28
46 Colorado 25.3 4.37
47 Wisconsin 24.6 4.30
48 New Mexico 23.3 3.64
49 Alaska 23 3.73
50 Idaho 22.8 4.63
51 Utah 21.5 3.53

I graphed it too.

What is interesting, and not included in this ( linked here : http://www.mchb.hrsa.gov/chusa08/state/pages/406inm.html) Is the black rates vs. white.

Please excuse the caps : my keyboard wasn't working that day and wouldn't let me turn off the caps, and I don't feel like re-writing all of this.

IT WOULD SEEM TO ME, THAT ONCE YOU DROP THE C/S RATE BELOW 29 IN 2006, YOU ALSO SEE LOWER NEONATAL MORTALITY (LIVE BIRTH, MOST BABIES DIE WITHIN THE FIRST 3 DAYS, BUT IT IS UP TO 28 DAYS) , IT DOESN'T GO ABOVE 4.63/1000 LIVE BIRTHS (DEAR OLD UTAH IF YOU ELIMINATE IT, THE DEATH RATE NEXT HIGHEST IS 4.37 WHICH IS BELOW THE NATIONAL AVERAGE (4.45). WHEREAS ABOVE THE THE POINT OF 29% YOU START TO SEE NUMBERS AT MUCH MORE FREQUENTLY AT 5, 6, AND EVEN 7/1000 LIVE BIRTHS.

IT DOESN'T HAVE AN EXACT RATE TO DEATH RATIO RESULT. AND, UH, MOST OF THE STATES WITH THE LOWEST C/S NUMBERS - DO NOT HAVE BLACK WOMEN LISTED IN THEIR RESULTS. (ALASKA, MONTANA, HAWAII, IDAHO, IOWA, NEW MEXICO, NORTH DAKOTA, NEBRASKA, VERMONT, OREGON, AND WYOMING) AND NONE OF THOSE STATES BUT UTAH DO THEY GO OVER THE NATIONAL AVERAGE, FOR NEONATAL DEATH - THE STATES THAT HAVE HIGHER C/S RATES (>29) BUT LOWER MORTALITY RATES THAN WHAT SEEMS TO BE AVERAGE, ARE ALSO SOME STATES THAT DO NOT LIST BLACK RESULTS (THE ABOVE, AND MAINE, WEST VIRGINIA, NEW HAMPSHIRE, RHODE ISLAND ( THE ONLY VERY WHITE STATE NOT BELOW THE NATIONAL AVERAGE - AT 5). SOME OF THE ALL WHITE STATES ACTUALLY DIP BELOW THE WHITE NATIONAL AVERAGE. BUT THOSE STATES ARE GENERALLY ONES WITH LOWER C/S RATES.

A BIG CONFOUNDING FACTOR IS, SADLY, RACE.

KENTUCKY, OKLAHOMA, MASSACHUSETTES, TEXAS, NEW YORK, NEVADA, AND CALIFORNIA, ARE THE ONLY STATES WITH LOWER THAN AVERAGE NEONATAL DEATH RATES IN COMBINATION WITH THE HIGHER C/S RATES. TEXAS, NEW YORK, AND CALIFORNIA ARE THE ONLY STATES WITH VERY LOW MORTALITY THAT MATCHES UP CLOSER WITH THE WHITE STATES.

THE ONLY WAY C/S RATE BEING MUCH HIGHER SEEMS TO DICTATE HIGHER NEONATAL MORTALITY IS IF YOU HAVE A VERY LOW OTHER RACE POPULATION IN COMBINATION WITH IT. OTHERWISE, IT APPEARS TO BE A FREE-FOR-ALL WITH REGARDS TO NEONATAL MORTALITY AND THE COINCIDING C/S RATES, WHICH MUST MEAN THEY'RE UNRELATED IN SOME INSTANCES.

THERE IS RHODE ISLAND WHICH SEEMS TO BE THE ZEBRA IN THE ROOM WITH HIGHER MORTALITY, LOTS OF WHITE PEOPLE, AND A MIDDLE OF THE ROAD C/S RATE.

HOWEVER....

THE ONLY STATES THAT THE TOTAL NEONATAL MORTALITY IS BELOW WHITE AVERAGE (3.72) ARE WASHINGTON (HAS BLACK INFO TOO, LOWER C/S RATE), VERMONT (LOWER C/S, NO BLACK), UTAH (LOWER C/S, NO BLACK), NORTH DAKOTA (LOWER C/S, NO BLACK), OREGON (LOWER C/S, NO BLACK), NORTH DAKOTA (LOWER C/S, NO BLACK), NEBRASKA (LOWER C/S, NO BLACK), MONTANA (LOWEST AT 2.64 AND LOWER C/S AND NO BLACK), IOWA (LOWER C/S, NO BLACK)... AND THEN..

CALIFORNIA WHICH IS THE ONLY STATE THAT IS BELOW THE WHITE AVERAGE AT 3.48 WITH A HIGH C/S RATE AND INCLUDES BLACKS. IT HAS A DENSE BLACK AND IMMIGRANT POPULATION. WHICH IS PUZZLING A TOUCH. THE BLACK NEONATAL MORTALITY RATE IS ACTUALLY FAIRLY HIGH IN CALIFORNIA.

NEW YORK, BY THE WAY, IS ALSO VERY - VERY CLOSE TO HAVING A NEONATAL MORTALITY RATE LOWER THAN WHITE AVERAGE AND YET MAINTAIN A RATHER HIGH C/S RATE. IT ALSO HAD A LOWISH BLACK MORTALITY RATE (5.89) COMPARED TO A LOT OF OTHER STATES (USUALLY 7-11). ACTUALLY, IT IS ACTUALLY SECOND LOWEST NEXT TO WASHINGTON (WHICH C/S'S A LOT LESS PEOPLE)

I AM THINKING - STATES LIKE CALI AND NEW YORK SPEND A LOT OF MONEY ON HEALTH CARE FOR THE PEOPLE WHO LIVE IN IT. I DON'T GET HOW CALI HAS SUCH LOW NEONATAL MORTALITY WITH SUCH A DENSE BLACK POPULATION AND A HIGHER MORTALITY FOR THEIR BLACK BABIES (8.2, OR, DOUBLE+ THE MORTALITY OF THE WHITE POPULATION). BUT THEN AGAIN THEY ALSO HAVE ONE OF THE LOWEST WHITE MORTALITY RATES IN THE COUNTRY.

BY THE WAY, THE NEONATAL MORTALITY RATE FOR 2006, FOR JUST THE WHITE POPULATION, IN OUR COUNTRY (3.72) IS VERY MUCH IN LINE WITH EUROPE.

THE NEONATAL MORTALITY FOR BLACKS WAS 8.82, WHICH IS DOUBLE + .. WHICH IS NOT SO CLOSE. THE ACTUAL IS STILL NOT THAT BAD THO. 4.45 IT COULD BE, IT SHOULD BE, MUCH BETTER.

There. I rambled about c/s and mortality rates. You can't really determine much based on c/s rates vs. mortality rates, though. You'd have to literally go in and dissect why those babies died. Maybe there are more preemies in some states, maybe it's a low funding issue, or maybe it's the doctors. I don't know. We can't know. But we can randomly dissect numbers and see how they SEEM to correlate, more for fun than anything else.

I think the correlations do equal some amount of causation.. especially when you look at who kills more people and who doesn't : re: states with high amounts of taxation and medical funding like Cali and NY do very well on mortality but still have high c/s rates? There must be some sort of causation going on with that. Maybe it's not just c/s's, I'm betting it's something to do with racism, sexism, and a lack of quality healthcare in other states.. as well.

I also think, there is no maternal information involved in that. And, it is from 2006. I'd be HIGHLY interested in 2009-2010 maternal morbidity/mortality, neonatal morbidity/mortality, etc. I don't think it's been compiled yet though.

I think they will pass a threshold at some point where they do more harm than good. I personally think we've already crossed it, but, the proofs in the numbers! (pun very intended.. and.. I'm horrible with numbers! Someone else do it, please!)

[Monika]

It's just an assumption, but perhaps Utah has a lower ERC rate because of people planning large families and doctors knowing that that many c-sections would be a serious risk?