The United States is one of the richest nations in the world and has the largest government spending budget. With all of the resources that the United States possesses in medicinal advancements, it is not surprising to many that healthcare is the second largest sector of government spending. However, what is surprising to many people is that out of the $1.05 trillion spent in the healthcare industry, 20 percent is wasted. This wastage is particularly salient in the field of obstetrics, where hospitals often elect to performance unnecessary C-sections for monetary gain. The inflation of C-section rates beyond what is medically indicated is startling, research shows that “1 in 3 babies are delivered by Caesarean section (C-section), despite medical indications suggesting that C-section rates should be 15% at most.” The United States, however, has allowed a little bit of leeway room and has set the national target for C-section rates at 23.9 percent.
Interestingly enough, in 2017, Consumer Reports conducted a study looking at over 1300 hospitals in the United States and their C-section rates. Over 56 percent of the U.S. hospitals in the study were over the national target rate of 23.9 percent. This shockingly high rate indicates that a huge improvement needs to be made nationally.
C-sections are 30-50 percent more expensive than vaginal births, contributing to the increasingly high cost dedicated to obstetrics including pregnancy, childbirth, and newborn infant care. In addition to being more expensive, C-sections are a major surgical procedure that pose greater risks and complications to both the mother and baby when performed without a specific medical reason. C-sections should be the preferred method of delivery only in instances when a women cannot give birth vaginally because there are very little to no benefits in doing so. Research shows that increasing rates of C-sections has done little to lower infant mortality; the overuse C-section by hospitals is done purely for monetary gain, convenience, and insulation from liability by hospitals–at the risk exposing mother and child to unnecessary injury.
Because a C-section can be performed within 45 minutes to two hours, most physicians prefer to perform a shorter procedure than a vaginal birth that can last up to 24 hours. Additionally, if there are instances where a hospital is understaffed or there are a large number of expectant mothers, a physician’s convenience can take priority over a woman’s preference.
C-sections can also serve to protect hospitals from lawsuits. In order to avoid legal complications, many physicians maintain a belief that C-sections are a “safer choice” when any doubt about a vaginal birth arises. For this reason, physicians prefer to take precautionary measures so that in case a legal situation arises it is much easier to argue that they “did all they could’ when performing an alternative measure of a C-section as opposed to a regular vaginal birth. However, there are much too many instances in which physicians jump to the conclusion of a C-section without carefully assessing the mother’s condition. C-sections are an extremely unsafe procedure to perform when there is no medical reason and although every case may not lead to extreme complications, C-sections result in longer recovery time, permanent scarring, and a 90 percent chance a woman will have to have another C-section to give birth again.
In order to convince expectant mothers to comply with a C-section for the purposes of monetary gain, convenience, and insulation from liability by the hospital, physicians often utilize a number of coercion tactics. A common technique is a blanket consent form that is presented to the woman before admission into the hospital. This form usually states that a woman is required to have a C-section if at any point the physician thinks it is necessary. If she refuses to sign it, the doctor can refuse to admit her. Another technique physicians or hospital administration utilize is the threatening an expectant mother with a lawsuit or threatening her with Child Protective Services. Additionally, physicians can label a patient “non-compliant” if she denies a C-section against their suggestion. Moreover, the use of multiple doctors to “bully” a patient into having a C-section is another highly popular and effective method of coercion.
Although there are many steps that women themselves can take to reduce the amount of unnecessary C-sections being performed, according to Dr. Doris Peter, director of the Consumer Reports Health Ratings Center, “reducing C-section risks for women is ultimately the responsibility of hospitals and providers”. It is in the hands of hospitals and physicians to ensure that they not only provide the best care to their patients, but also place their patient’s needs above their preference and convenience.
The first step in achieving this goal is educating physicians, hospital administrators, and policy makers on the importance of reaching the target rate of 23.9 percent. It is important for people in a position of power to realize that they can use their resources to make changes for the better. Hospitals in the past have both internally and externally posted C-section rates for each physician, serving as motivation for each physician to decrease his or her rate and keep them aware of their need to improve. In addition to being responsible for consistently updating C-section rates and data, hospital policy makers and physicians must establish limits and consequences to ensure everyone is on the same page when it comes to decreasing C-section rates.
The increase in C-section rates has not only become a problem medically, but it has also become a problem both legally and economically. The responsibility to decrease theses rates lie in the hands of physicians, hospital administrators, and hospital policymakers. Physicians must advocate for their patients and continually place the needs of patients above their own. Additionally, administrators and policymakers play an equally important role in this change to improve and should look towards other successful hospitals as examples.
While it is very likely that it can take years or decades for the United States to reach the national target, change is definitely possible. With new practices being implemented, many hospitals in the United States have been able to lower their C-section rate. Thus, it is evident that with education, perseverance, and consistency, all hospitals have the power to lower their rate.