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« The Most Important Thing | Over the Curtain »
Tuesday
Apr062010

U.S. Cesarean Rate Rises for Twelfth Consecutive Year to 32.3 Percent

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Reader Comments (14)

Darn! I was really hoping we might one of these years see the peak, and see the numbers start going back down :-(

April 6, 2010 | Unregistered CommenterJennifer

I always find the 1990s dip interesting, since that was during the time VBACs were promoted and ended when the single negative VBAC article came out in NEJM.

April 6, 2010 | Unregistered CommenterKK

The numbers aren't going to start going down anytime soon. It is disgusting, and sad.
Until we as women band together and start telling OB/GYN's to go F OFF and use midwives
for our care, we won't see a change.

April 6, 2010 | Unregistered CommenterDanielle

ditto KK

April 6, 2010 | Unregistered CommenterWhoz Your Doula

ditto @ Danielle

April 6, 2010 | Unregistered CommenterWhoz Your Doula

I don't know, Danielle. The numbers are slowing their increase. I would think this is some cause for celebration, as we likely aren't looking at national averages in the 40% range any time soon. Also, with rates like NJ and Florida's out there, there are other places that have to have really low rates to ballance that out down to the 32% range nationally. Which means that some places are doing it right. We may well have seen the peak, and next year it will go down. I am keeping my optimism high here. No, it isn't what we would like to see, but it is much better than it has been.

April 6, 2010 | Unregistered CommenterLadydilee

Hi Jill,
I don't know if this is the appropriate place for this but I'm wondering if you could address a question I have about hospital C-section rates. From the most recent numbers I found, the hospital I am currently signed up with through my HMO has a 34% c-section rate. I asked my ob/gyn about this at my first appointment and she tried to reassure me by telling me that that was the national average and seemed surprised that I was concerned. When I told her that 1 out of 3 still sounded like a lot to me, she qualified the rate by saying that the primary c-section rate there is 15% and the rest of the numbers come from repeat c-sections. Do those sound like reasonable numbers or should I still be nervous about going there (right now I am)?
Thanks!

April 7, 2010 | Unregistered CommenterSteph

I tried to look at this for Ohio. CDC says that 148,850 babies were born in Ohio in 2008* and that the overall C-section rate was 29.8% in 2007** (so let's assume it was similar for 2008), meaning that about 45,357 babies were delivered by C-section that year. Ohio listed the primary C-section rate for low-risk first-time mothers as 27.1% (13,517 of 49,879) in 2008, so the other 31,840 C-sections would have to come from high risk pregnancies or repeats. If that holds true in other places, I can see how your doctor might be correct that repeats are driving up the rate.

*http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_19.htm#table1

**http://www.cdc.gov/nchs/data/databriefs/db35.htm#cesarean_by_state

April 7, 2010 | Unregistered CommenterKK

Hey, it's me again, the nosy ob. The section rate is climbing for both the right and mainly wrong reasons. We are saving smaller and smaller babies, now routinely saving the "micropremies". We are intervening more often for malformations and certainly the rash of IVF triplets and higher are driving this. There are many reasons for the climb that make sense - for primary sections. There are far fewer for the repeats, and they are now more often MD driven then not. I have seen a disturbing trend in that the newer practicioners seem to go for the section faster than us old farts. For the QA committee at one of our larger hospitals I have recently reveiwed the last years section rate broken down by doctor. I asked the committee secretary to look at the data in different ways. I was very suprized that a bizarre trend emerged that was counter to my thoughts. The highest rates by far (as high as 45%) was for the actively practicing female Obs in the largest all female group. The second highest group was younger solo male obs and the third highest was for the female obs in mixed gender groups (up to 9.8% higher then the next highest male in the group). The single lowest section rate was of a solo female ob and the highest was of also a solo female. As I can tell of, the 31 obs on staff at this hospital reveiwed were all actively practicing and did general ob/gyn. I also found out that not a single group, male, female or mixed, offered vbacs at ALL. What do I draw from this unscientific reveiw? I have no friggin' clue. Should I suddenly grow a uterus and impregnate myself I am going to Jills house.

April 7, 2010 | Unregistered CommenterOb

OB, you should come to my house anyway even if you don't sprout a uterus.

I'm reading a book right now from 1985 that is oddly prophetic. Barbara Katz Rothman studied the effects of prenatal testing, the concept of the blue-ribbon baby and societal expectations of "preventative" medicine and wrote about it in The Tentative Pregnancy.

So, you touched something I haven't been willing to touch with a ten foot pole. It's pretty well established that docs fresh out of their residency often have absurdly high cesarean rates. One MFM specialist in Georgia estimated that the new crop is about 75% likely to section. But the whole male OB/female OB section rate thing? I’ve heard that over and over.

April 8, 2010 | Registered CommenterJill
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