Rate of Unnecessary C-Sections Far Lower Than Thought

This December article by Serena Gordon of HealthDay News is a fascinating glimpse at what might be closer to the truth about cesarean delivery rates in the U.S: That the term 'unnecessary' may be being overused and based on inaccurate data.

Gordon reports that current estimates put the figure of unnecessary cesareans at nearly 60%, while the real number may be as low as 4%. Why the huge difference?

Mainly because of inaccuracies cited on birth certificates. When government experts analyzed birth certificates and hospital discharge data, they found the actual number of [unnecessary cesarean] deliveries was closer to 4%. The study author, Emily Kahn, an epidemiologist with the U.S. Centers for Disease Control and Prevention's division of reproductive health, explains that "You can't use the birth certificate alone to determine whether or not a woman is at risk for primary caesarean delivery."

"...The CDC researchers sifted through data on 565,767 births from women who were considered at low risk for needing a C-section. The women were all 37 weeks' to 41 weeks' pregnant when they went into labor and had singleton pregnancies. All of the women delivered in Georgia hospitals between 1999 and 2004. More than 70,000 of these women ended up having a Caesarean delivery, and almost 41,000 were listed on the birth certificate as having no risk factors. Yet, in the hospital discharge data, nearly 90 percent of these women had a risk factor listed. Overall, 58.3 percent of birth certificates suggested no risk factors. But when the researchers pooled the data and combined both birth certificate data and hospital discharge data, they found the rate of Caesareans with no reported risk factors at just 3.9 percent."

Doctors don't touch birth certificates
..."Kahn said there are several possible reasons for this discrepancy. One is that the main purpose of a birth certificate is simply to record the birth. Birth certificates aren't completed by physicians, but instead rely on worksheets filled out by the mother. And, she said, hospital discharge data is used to bill the insurance companies and doctors must be very detailed on these reports to get paid, which might make them more accurate. "Doctors don't touch birth certificates," said Dr. Miriam Greene, an obstetrician at New York University Langone Medical Center and author of the book Frankly Pregnant. "The person who writes up the birth certificate might not be knowledgeable about all the risk factors for C-section, and they see the baby is fine and may think there was no issue."

My view - U.S. birth data collation is unhelpful
The story above illustrates one disadvantage with the reliance on birth certificates for analyzing cesarean delivery occurence in the U.S., but I have long talked about another area for improvement. That is, separating the number of elective/planned cesarean deliveries and the number of emergency cesarean deliveries. Many European countries already separate these types of cesarean deliveries, and this has helped to inform research into the differences in risks between the two.

Even better would be to separate 'planned cesarean deliveries in healthy women with no medial indication' (since we now know they DO exist), as this would help us to compile actual outcome data of this group without waiting for agreement to a controversial clinical trial comparing planned vaginal and cesarean deliveries in healthy women.

On a positive note, the U.S. does separate primary and repeat cesarean deliveries, which has been useful for researching health risk outcomes in multiple deliveries. It now just needs to go a few steps further in order to ensure clarity and accuracy in its cesarean data collation.