C-Section Rates Up Across NYC, Average Near 31% Manhattan Shows Sharpest Incease, Staten Island Has Highest Rate

Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology;  Pediatrics / Children's Health
Article Date: 15 Aug 2008 - 0:00 PDT

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New York City's cesarean section rate has increased by 24% over the past six years to an average of nearly 31%, and rates are on the rise at nearly every single city hospital, according to new data released by Choices in Childbirth, a New York-based nonprofit that works to enable women to make fully informed maternity decisions. Most city hospitals are not addressing the potential causes of the increase in c-section rates.

The new data includes a breakdown of c-section rates at every hospital in all five boroughs, demonstrating the change from 2000 to 2006, and is included in the new 2008-09 edition of Choices in Childbirth's annual New York Guide to a Healthy Birth. In Manhattan, the c-section rate increased by 29%, to an average rate of 30%; in Staten Island, it increased by 20% to an average rate of 34%; in Queens, it increased by 27% to an average rate of 33%; in Brooklyn, it increased by 26% to an average rate of 32%; and in the Bronx, it increased by 28% to an average rate of 26%. This follows statewide trends, where the rates of obstetrical interventions (including c-sections, inductions, episiotomies, epidurals, and other routine practices) are continuing to climb despite the release of multiple studies indicating the need for moderation.

The U.S. c-section rate for 2006 is 31%, an increase of 41% since 2000. This reflects a steady increase every year of the past decade-and New York's rising rates offer a microcosm of the national trend. The World Health Organization recommends that the c-section rate for industrialized nations should not exceed 15%. A safe range, as determined by WHO experts, is 10-15%-well below New York City's average rate.

"Certainly there are times when a c-section offers women, their families and healthcare providers a necessary and lifesaving birthing solution," said Elan McAllister, president and co-founder of Choices in Childbirth. "However this alarming citywide increase underscores how c-section has become a method of convenience rather than necessity, even though it can present tremendous risks for an expecting mother. Just as alarming, our city's hospitals have no strategy to reduce the rate. We urge families and the medical community to remember that the highest level of medical intervention is not always required, and is not necessarily the safest option for the mother and child."

Cesarean section is a major surgical procedure that increases the likelihood of many risks for mothers and babies in comparison with vaginal birth. The c-section rate in New York City is on the rise for a number of reasons, which may include medical care that does not offer the informed choice of vaginal birth, increasingly casual attitudes towards surgery and c-section surgery, limited awareness of the risks associated with c-section, and provider fears of malpractice and lawsuit.

"I'm really concerned that the c-section rate continues to rise at so many of our city's hospitals," said New York City Public Advocate Betsy Gotbaum. "We're making some positive strides, as New York's hospitals are finally complying with the legal requirement to release this data. However, there's much more work to be done to ensure that women receive the best and most medically appropriate care, and that hospitals take strong steps towards reducing the c-section rate. Information is essential - especially when you're dealing with the health of mothers and children. This is why I have introduced legislation which will require the city to create an online database to allow mothers to find hospital information quickly and easily, and help them make safe, informed decisions."

Two myths prevail about the increase in c-section rates. First, that more women are requesting the procedure. However, a national survey by Childbirth Connection found just one incidence in 1,600 of a planned c-section, for no underlying medical reason. The second myth, that the increase in c-section rate is a reflection of the increase in childbirth among older women who may have more frequent complications, is similarly unfounded. Cesarean section rates are going up for all groups of birthing women, regardless of age, the number of babies they are having, socio-economic status, health problems, race/ethnicity, or other criteria. "The American healthcare system is increasingly dependent upon medical interventions to address what is, most often, a normal and safe physiological process - natural childbirth - and this new data shows that New York City is mapping to the trend," said Rebecca Benghiat, executive director of the New Space for Women's Health, a new women's birth and health center in New York City. "Quite often, women are not fully informed of the risks associated with commonly performed obstetrical interventions, nor do they know there are options beyond hospital birth. However, as New York City women are becoming more aware of the state of standard maternity care in this city, we have seen an incredible increase in demand for services outside of the hospital."

"We should be concerned about the long-term risks of having so many women in the United States undergo major abdominal surgery, particularly those who do so when they are young," said Wendy Brooks Barr, MD, MPH, MSCE, research and co-maternity care director, Beth Israel Residency in Urban Family Medicine, Institute for Family Health, and assistant professor of Family and Social Medicine, Albert Einstein College of Medicine, Yeshiva University. "I urge my colleagues and peers across the city to be open to innovative means of changing how maternity care is delivered in New York, and to help develop solutions that work towards reducing the c-section rate."

For a copy of the new Choices in Childbirth 2008-09 New York City Guide to a Health Birth, to access 2000-2006 cesarean section statistics and to view the rates of other obstetrical interventions for hospitals in the New York Metro area, please visit http://www.choicesinchildbirth.org.

About Choices in Childbirth

At Choices in Childbirth, our mission is to improve maternity care by providing the public, especially childbearing women and their families, with the information necessary to make fully informed decisions relating to how, where, and with whom they will give birth.

Choices in Childbirth

About The New Space for Women's Health, a project of Friends of the Birth Center

The New Space for Women's Health grew out of the community of the Elizabeth Seton Childbearing Center, which, challenged by insurance demands and increasing costs, closed in 2003. Once open, the center will create an environment where midwives, mental health professionals, family educators and a community of other professionals will provide more than 20,000 women and families each year with prenatal and postpartum care, childbirth education, gynecological services, social work, and psychological care in a welcoming and environmentally sustainable setting.

The New Space for Women's Health

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