Too many cesareans?

In 1999-2001, 8% of deliveries at nearly 2,000 hospitals in 18 states were planned cesareans performed on women who had not gone into labor and had not previously had a cesarean; 22% of these operations involved women who had none of 12 clinical conditions that have been characterized as appropriate indications for cesarean delivery, (1) Analysts who compared the actual number of cesareans performed with the number expected for clinical reasons found that 24% of hospitals performed more than the expected number of procedures. This finding, they comment, may reflect a demand for cesareans done simply because women choose them--a practice whose appropriateness, risks, benefits and ethics have stirred much debate. On the other hand, 29% of hospitals performed fewer cesareans than expected--possibly, according to the analysts, in response to pressure from organizations that advocate lowered rates of cesarean delivery. The downside to underuse of the procedure may be poor maternal outcomes: Vaginal complications were significantly more prevalent in hospitals where unexpectedly few procedures were performed (14%) than in others (11-13%). Poor outcomes from underuse would be "counterproductive to the goals of a lowered national primary cesarean rate."

(1.) Health Grades, First time preplanned and "patient choice" cesarean section rates in the United States, Lakewood, CO: Health Grades, 2003.