Women who give birth at for-profit hospitals in the state of California have a 17% higher chance of undergoing a C-section (cesarean section) than at nonprofit hospitals, according to a California Watch analysis, which compiled a database from state birthing records. The authors add that a C-section can bring in much more revenue than a vaginal birth.

California Watch believes some hospitals may be carrying out C-sections for other than medical reasons. Such factors as staffing schedules in the maternity ward and a doctor’s patient numbers appear to be influencing factors on decisions regarding delivery recommendations, according to interviews with health professionals.

The authors explain that more women are having cesarean sections across the state for several reasons:

  • There are more obese mothers
  • The numbers of older pregnant women has risen
  • Doctors’ and hospitals’ fear of lawsuits
  • C-sections are becoming more culturally acceptable

The authors decided to investigate why some hospitals are performing higher rates of C-sections than others, instead of examining the above-mentioned trends.

Of the 253 Californian hospitals in California, the database revealed considerable differences in C-section rates. A woman with a low-risk pregnancy..

  • ..had a 9% chance of undergoing a C-section at the non-profit Kaiser Permanente Redwood City Medical Center.
  • ..had a 47% chance of undergoing a C-section at the for-profit Los Angeles Community Hospital.

The Los Angeles Community Hospital’s C-section rate was 59% when mothers who needed to have C-sections for medical reasons was factored in.

The report revealed that in some areas, two hospitals that served virtually the same population had significantly different rates.

Many people have expressed concern about C-section rates, wondering whether commercial and/or non-medical considerations were influencing decisions and recommendations.

The authors wrote:

The numbers provide ammunition to those who have long suspected that unnecessary C-sections are performed to help pad the bottom line.

Desirre Andrews, president of the International Cesarean Awareness Network, said:

This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate.

Dr. Jeanne Conry, California district chairwoman of the American Congress of Obstetricians and Gynecologists, is quoted at California Watch web site as saying that they take this information extremely seriously – the differences in C-section rates is “really a cause for concern.” The analysis revealed that C-section rates were higher for mothers of all ethnic and socioeconomic groups, which challenges the common assumption that C-sections are more common among well off mothers.

The authors wrote:

There was no correlation between C-section rates and the percentage of a hospital’s business from low-income or indigent patients receiving Medi-Cal, the state’s Medicaid program.

C-section rates were found to be higher in Southern California compared to the north of the state.

Four of the five Californian hospitals with the highest cesarean section rates were for-profit ones in poorer parts of Los Angeles Country.

California Watch says its analysis is the first independent one of C-section rates at 253 hospitals reporting birth statistics to state health authorities from 2005 to the end of 2007. It is also the first to reveal that for-profit hospitals have higher C-section rates than other hospitals in the state. The authors add that studies abroad have come up with similar findings.

“DATA: C-section rates vary in low-risk situations”
“How the C-section story came together”
California Watch

Written by Christian Nordqvist