HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Thursday, January 27, 2011

Rates for Elective C-Sections Soar In Some Areas Ignoring Best Practices and Creating Surgical Signatures

A new study reports that the rates of elective c-section surgeries for no valid medical reason have soared to upwards of 40% in some hospitals in some areas, ignoring the risks associated with this choice to the mother and baby. According to the WSJ,

[s]ome 773 hospitals voluntarily provided the group with information on early elective deliveries. Rates varied widely, even within a single community — rates in Boston ranged from almost zero to 27%, Leapfrog says. (The group’s target rate this year is 5%, down from 12% last year.)

This pattern of early elective C-sections performed for no medical reason creates 'surgical signatures' indicating that the probability that a pregnant woman will undergo labor in the normal course or will have a C-section is not related to medical need but is related to geographic location or hospital choice.

These stats come courtesy of the Leapfrog Group — a coalition of health-benefit purchasers aiming to improve health-care safety, quality and affordability — which today put out a new report calling on expectant moms to request the rates of early elective delivery from hospitals in their area.

The group, along with Childbirth Connection (a not-for-profit focused on maternity-care quality) and the March of Dimes is trying to educate women about the importance of those last few weeks of pregnancy for the baby’s development, and about the risks to both moms and babies if delivery is induced or scheduled early without a valid medical reason. Those might include a mother developing hypertension or her water breaking without labor beginning. Here’s Childbirth Connection’s review of the evidence on labor induction.

Leapfrog says early elective deliveries cost the U.S. health-care system almost $1 billion a year.

“Some of these data will be quite disturbing,” said Leah Binder, Leapfrog’s CEO, on a phone call with reporters. “The hospitals that reported have at least committed themselves to transparency.” Many hospitals declined to report data.

As we wrote a while back, Utah’s Intermountain Health tapped its electronic medical records to show its physicians data on the health consequences of early elective deliveries, including higher rates of intensive care and ventilator use. Intermountain also developed guidelines to discourage early elective deliveries and tracked cases that didn’t adhere to the guidelines.

Within six months of starting the program, the rate of elective early delivery fell to less than 10% from 28%, and after six years “continues to be less than 3%,” according to a study published in 2009.

Maternity-care bonus: Will New Guidelines Let More Women Try Labor After a C-Section?

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