Opinion Columns & Blogs

C-section deliveries are convenient, expensive – and overused

In the sitcom world of childbirth, mother-to-be tells father-to-be, “It’s time!” Father-to-be panics, fumbles over the packed suitcase and together they rush to the hospital. There, after hours of sweating and pushing and swearing, the blessed event occurs and the bouncing baby is delivered by a weary mother as a proud father looks on.

Of course, in the pragmatic world of modern medicine, physicians and patients alike find such old-fashioned notions incompatible with busy schedules. Hence, elective inductions and scheduled Caesarean sections have been increasing at a dramatic rate over the last 15 years.

Nowadays, more than one in three babies in the United States is born by C-section. This rate is more than double what the World Health Organization and Centers for Disease Control recommend. In fact, the most common surgical procedure in the country is C-section.

Rising incidence of maternal obesity, multiple births and hypertension are among some of the factors contributing to the increase. However, even when assessing women without any of these conditions, unnecessary C-sections are still taking place with alarming frequency.

If maternal and infant health outcomes were also on the rise, one might justify the upsurge. However, the United States now ranks last among industrialized nations for maternal mortality and second to last in infant mortality.

A C-section is a major abdominal surgery and the associated risks are significant. Infection, hemorrhage, injury to other organs, reactions to medications, premature births and fetal breathing problems are just some of them.

But C-sections are convenient and profitable. So profitable, in fact, that a recent investigation of California birthing records discovered that women are about 17 percent more likely to have a surgical birth at a for-profit hospital than at a nonprofit hospital. A Caesarean section can bring in up to twice the revenue of a vaginal delivery.

Washington is following the trend. Over 30 percent of births are by Caesarean section in our state. In 2009, in an effort to curb the increase in unnecessary surgical births, Washington Medicaid adopted a policy to pay hospitals the same amount for an uncomplicated C-section as for a complicated vaginal birth. Before this policy, Medicaid was paying approximate $5,000 more for a Caesarean than a vaginal birth. Private insurance pays an even higher rate.

Two years ago when my children were born, I was disturbed by the casual attitude toward C-sections. I was pregnant with multiple children and the pervasive attitude was that these children would certainly be born surgically. I was determined that they would not be. In the end, I became so sick that I acquiesced to the on-call physician’s insistence to perform a C-section. Consequently, I suffered post-surgical complications that were painful and frightening.

This summer, Portland hospitals agreed to a new policy. Beginning Sept. 1, all 17 Portland-area hospitals will refuse elective induction and C-section births before 39 weeks gestation. Of course, medically necessary inductions and surgeries will still be performed. Physicians and patients may find themselves inconvenienced, but the financial and long-term health consequences will surely benefit.

When used appropriately, a Caesarean section can save a woman’s life or the life of her child. However, the unnecessary overuse of the procedure contributes to increased complications for both the mother and the baby. Additionally, they are expensive. And in a health care environment where skyrocketing costs are such a cause for concern, the fiscal effect can’t be ignored.

Educating women about the reality of C-sections and removing some of the incentives for physicians and hospitals to perform them will go a long way in slowing an alarming and dangerous trend.

Kris Coyner is an activist for immigration justice and civil rights. She and her partner are raising 1-year-old triplet daughters near Shelton. A member of The Olympian’s Diversity Panel, she can be reached at kriscoyner@gmail.com.

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