Public Health
The rate of Caesarian sections has skyrocketed in recent decades in the United States, placing it far ahead of other industrialized nations.
Historical overview of C-section rates in the U.S.
Breakdown of C-section rates by race and access to insurance
Why is this a public health issue?
Higher morbidity and mortality rate for C-sections.
Poor and minority women (and their families) affected at greater rates.
One of the costs driving up healthcare in the United States.
Medical and behavioral issues.
Does the medical establishment benefit from increased C-sections?
What behaviors on the part of physicians and other medical professionals push up C-section rates?
How do fears of malpractice lawsuits weigh in this issue?
What behaviors on the part of patients push up C-section rates?
How does obesity factor in to C-section rates?
How does pregnancy education affect C-section rates?
How does prenatal care affect C-section rates?
What is the cultural attitude toward C-sections that has made this a silent problem and how can this be changed?
The American Way of Birth
Americans like to believe that our system of healthcare is one of the best in the world. Indeed, one of the refrains of the recent debate about healthcare in the United States was that as a nation we have the best healthcare in the world. Setting aside the larger questions that such a claim raises, when one looks at the medical care given to women during pregnancy and labor, it is hard not to believe that a range of improvements could be made to this particular corner of American medical care. The rates of Caesarian sections in the United States are quite high compared to the rates in other modern industrialized countries. Moreover, the rate of C-section deliveries has been rising in recent years and disproportionately affects different populations of women.
Given that C-sections can pose a higher level of risk for mothers than is true for women who give birth without surgical intervention, that infants also face potential risks with surgery and its associated drugs, and that C-sections are much more costly than are vaginal deliveries, the high rate of C-sections must be considered a public health issue. This paper examines why the rate of C-sections is so high in the United States, looking at both possible demographic causes for the increase in C-sections (such as an increase in mean maternal age and an increase in maternal obesity) as well as aspects of the ways in which medicine is practiced (such as physicians acting in ways to reduce potential liability rather than in the clear best interests of their patients). Not only do C-sections have important personal consequences for the women who undergo them, but given the financial cost of C-sections makes this procedure of especial concern as the American health system as a whole is analyzed for ways in which better healthcare can be provided at the same time that costs are being reduced.
History of C-Section Rates in the United States
A just-released survey of C-section rates in the United States found that in the period between 2002 and 2009, rates for this surgery rose about 27% in the United States, with over a third of all American women delivering by Caesarian rather than non-surgically (Nordqvist, 2011). Even more striking, the rate of C-section has increased by 50% since 1996. Rates were higher in some parts of the country than in others, with the states of Texas, New Jersey, and Florida -- distinct both geographically and culturally -- having the highest rates of Caesarians. In these states, women had almost a four-in-ten chance of having a C-section (Nordqvist, 2011).
This survey of 5000 hospitals across the United States offered a number of possible reasons for the increase in C-section rates. These include the following (after Nordqvist):
C-sections are often seen as being more "convenient" by both medical professionals and mothers, especially when the mothers have older children to take care of.
The average age at which American mothers is giving birth is going up, and higher Caesarian-section rates are positively correlated with increased age. While this correlation is well established, why it should be the case is far less clear. Far more than many other medical procedures, C-sections are linked to cultural factors rather than purely medical ones. (This does not mean that cultural beliefs and values do not affect other medical procedures or that C-sections are performed without any regard to medical conditions.) Older mothers may need surgical intervention during labor for a number of...
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