Pregnant women put a lot of trust in their doctors and hospitals. But a Consumer Reports investigation of more than 1,500 hospitals in 22 states suggests that such trust may be misplaced. It found that in many hospitals, far too many babies enter this world through cesarean section.
While some C-sections are absolutely necessary for the health of the mother or baby, the high C-section rates in our low-scoring hospitals are “unsupportable by professional guidelines and studies of birth outcomes,” said Elliot Main, M.D., director of the California Maternal Quality Care Collaborative and former chairman of the department of obstetrics and gynecology at the California Pacific Medical Center in San Francisco, who reviewed our data.
Our Ratings reveal that C-section rates vary dramatically—even between neighboring hospitals. For example, almost 55 percent of pregnant women anticipating low-risk deliveries—that is, women who haven’t had a C-section before, don’t deliver prematurely, and are pregnant with a single baby who is properly positioned—nonetheless undergo a C-section at Los Angeles Community Hospital. But at California Hospital Medical Center, also in Los Angeles, the rate of C-sections for low-risk deliveries is 15 percent; at Western Medical Center Anaheim, 28 miles away, it’s about 11 percent.
Or consider El Paso, Texas. At Sierra Medical Center, 37 percent of low-risk deliveries are C-sections; four miles away at University Medical Center of El Paso the rate is about 15 percent. It’s a similar story in Colorado. Denver Health Medical Center earned a top score with a C-section rate of about 8 percent, while nearby Presbyterian-St. Luke’s Medical Center got low marks for a rate of about 20 percent.
We found this startling scenario playing out over and over in communities large and small across the U.S. Because a hospital’s C-section rate can be hard to find, it’s likely that most families are unaware of the huge differences in medical practice.
And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one. Overall, 66 percent of the hospitals in our Ratings earned our lowest or second-lowest score, while only 12 percent got either of our top two marks.
“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. “How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.”
Change is already afoot. Evidence on the fallout from too many C-sections has grown so alarming that numerous health organizations have made lowering rates a priority. In March 2014, two major women’s health organizations—the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM)—teamed to publish groundbreaking new practice guidelines aimed at preventing unnecessary cesarean births.
But hospitals can be bureaucratic institutions where the wheels of change move slowly.
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