Highlight : Variation in C-Section Rates

Overview

Cesarean births (commonly called C-sections) are when doctors cut through a mother’s abdominal wall muscle and the uterus to deliver a baby. When medically necessary, such as during a complicated birth, a C-section can help save the life of mother and/or baby. However, nearly one-third of all babies in the U.S. are born via C-section, and this is well above what most experts consider medically necessary.

A C-section is major surgery and carries significant risks for both mother and baby. The mother may get an infection, lose blood and require a transfusion, or develop blood clots. While death is rare, mothers are more likely to die during a C-section than during vaginal birth. The baby may be affected by the anesthesia required for the surgery and may be injured during it.

The problems are not confined to the surgery itself. C-sections generally require longer recovery time than vaginal deliveries. Women who have a C-section may also face challenges breastfeeding. In addition to the incision sometimes making nursing uncomfortable, pain medications that the mother may be taking can have an effect on breast milk. Furthermore, C-sections are also much more expensive than a vaginal birth.

Key Findings

This report looked at the percent of all deliveries that were by C-section, relying on claims data from July 1, 2015 to June 30, 2016. As the chart below indicates, the results show that Yakima has a consistently lower C-section rate for both commercially- and Medicaid-insured women.

 

 

 

Statewide, the C-section rate for women ages 20-44 of all insurance types is 24.8%, below the national average of 32%.

While Washington’s average is below the national average, the World Health Organization states that the ideal rate for C-sections is between 10-15%, while some studies show optimal C-section rates may be as high as 19%. Regardless, Washington state still has room to improve. Lowering the C-section rate will improve quality outcomes for mothers and babies, as well as decrease the cost of deliveries.

Action Steps

These action steps are adapted from the Bree Collaborative’s Obstetric Care Recommendations to address high variation in the use of procedures like C-sections.

• For parents, learn the risks of C-sections and if your doctor suggests the procedure, make sure to ask why they are recommending it and what your options are for inducing labor.
• For providers, provide patient education and promote shared decision-making on maternity care options and risks of C-sections.
• For purchasers, work in conjunction with your health plans or third party administrator to make benefit design changes that support evidence-based care and reward better outcomes.
• For health plans, collaborate with other health plans in Washington to create a quality incentive program, using the same quality criteria.

Different Regions, Different Care

As part of its Different Regions, Different Care report, the Alliance is publishing highlights showing that rates of medical treatments and procedures vary greatly depending on where you live in Washington state. While the data don’t provide an explanation, the variation may be because of greater health burdens or provider practice patterns. But by making such variation transparent, we hope to further the conversation to improve care for all Washingtonians.

 

Footnote

In the chart above, it is possible that a region may have a higher score (better, average) than another region even though the rate (percentage) is higher than that of the other region. This occurs in situations where the population used to rate the region is small, resulting in a very wide confidence interval used to assign the better, average, or worse score.