What Every Expectant Parent Should Know about Hospital C-section Rates

For this post, we spoke with Julian N. Robinson, MD, chief of obstetrics in the Department of Obstetrics and Gynecology, about C-section rates.

Planning for the birth of a child can be a wonderful time. It can also be filled with questions and concerns.

You’re probably thinking about the quality and safety of the care you and your baby will receive during and after delivery. You may have heard about a recent Consumer Reports study suggesting that a women’s risk of a cesarean section, or C-section, depends on the hospital she chooses.

In certain situations, a C-section is the safest option for both mother and baby. For example, when the baby is positioned side-to-side in the belly or the placenta is covering the cervix, or if the baby’s heart rate drops during labor. But C-sections, like any surgery, come with risks, such as infections.

To lower or eliminate these risks, hospitals should strive to perform C-sections only when medically necessary. However, how often a hospital performs this procedure depends on several factors, including risk to mother and baby, patient choice and clinician recommendations. In addition, hospitals with strong high-risk obstetrics programs and those caring for women who haven’t received optimal prenatal care are more likely to have higher C-section rates.

In recent years, patient choice and clinical recommendations have played a bigger role in influencing C-section rates at some hospitals. For example, some patients may think a planned C-section will alleviate stress about when the baby will arrive or whether her health care provider will be available for the delivery. Although a C-section is often recommended for women with high-risk pregnancies, our goal at BWH is for women to have a vaginal delivery when possible.

Because of these factors, you won’t be able to discern from a hospital’s C-section rate how many were medically necessary and how many were not. The national benchmark for low-risk pregnancies is 23.9 percent of births by C-section. At BWH, we fall just below the national target, with 23.2 percent of births by C-section. BWH delivers more babies than any other hospital in Massachusetts and specializes in high-risk pregnancies. If the hospital you are considering has a high C-section rate that doesn’t make it a bad place to give birth, for all the reasons detailed above, but you should ask for more information and talk with your obstetrician about the safest birth plan for you and your baby.

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