1 in 3 births: C-section rate increases, again
Data: CDC; Map: Axios VisualsThe rate of cesarean births in the U.S. has gone up, again.Why it matters: About one in three births in the U.S. are C-sections, according to new data, well above the 10-15% rate that the WHO considers "ideal."By the numbers: The national C-section delivery rate increased in 2023 to 32.4%, up from 32.1% in 2022, according to provisional CDC numbers.That's the highest rate since 2013, and the fourth annual increase after the rate generally declined 2009 - 2019, the CDC says.The rate of low-risk cesarean deliveries (mothers' first births of full-term, head-first singletons) increased from 26.3% in 2022 to 26.6% in 2023, the highest rate since 2013, per the CDCYes, but: An increase in C-sections doesn't necessarily mean the rate of unnecessary procedures has risen — there are other factors at play.Patients are sicker overall.With conditions like gestational diabetes and hypertensive disorders in pregnancy on the rise, there could be a greater need for C-sections, says Jane van Dis, OB-GYN and assistant professor at the University of Rochester.Van Dis says it's her hypothesis that the rise in those conditions is due to "environmental exposure," and she cites the increasing use of plastics.Repeat C-sections account for many procedures, even though the old "too posh to push" idea is not widely held."If you have already had a C-section, you will almost always be offered — and indeed the default is likely to be — a second," says Emily Oster, economist and author of "The Unexpected," her book about navigating pregnancy complications, due out April 30.Between the lines: Hospital politics might also come into play.For example, there are cases when doctors are more inclined to perform C-sections because that option would less likely lead to a medical malpractice lawsuit, Van Dis says.And health care system reimbursements for C-sections are generally higher than for vaginal births. "Financial incentives almost always play some role," Oster says.What they're saying: The "biggest consideration" with having a C-section is "future fertility," because of an increased risk of complications in later pregnancies, Oster tells Axios.Compared to a vaginal delivery, a C-section doesn't lead to a statistically different outcome for the baby, but it's a major abdominal surgery that tends to require a longer short-term recovery for the mother.Overall, a C-section "is an absolutely safe method of childbirth that should be available, and it should not be the first choice," Oster says.Vaginal deliveries also come with their own risks.And there are many situations — like in cases of breech birth, the presence of certain placenta problems, and severe preeclampsia — where a C-section should be performed, Van Dis says.What we're watching: Expanding access to doula care — as new legislation in New York does — could lower the rates of C-sections.A number of studies already suggest that the presence of doulas lowers the use of C-sections, Oster says.Doulas are there for psychological support during the often-overwhelming labor process, and to help with birth positions that could avoid the need for a C-section, Van Dis says."Doulas should be in every hospital … paid for," she adds.
Data: CDC; Map: Axios VisualsThe rate of cesarean births in the U.S. has gone up, again.Why it matters: About one in three births in the U.S. are C-sections, according to new data, well above the 10-15% rate that the WHO considers "ideal."By the numbers: The national C-section delivery rate increased in 2023 to 32.4%, up from 32.1% in 2022, according to provisional CDC numbers.That's the highest rate since 2013, and the fourth annual increase after the rate generally declined 2009 - 2019, the CDC says.The rate of low-risk cesarean deliveries (mothers' first births of full-term, head-first singletons) increased from 26.3% in 2022 to 26.6% in 2023, the highest rate since 2013, per the CDCYes, but: An increase in C-sections doesn't necessarily mean the rate of unnecessary procedures has risen — there are other factors at play.Patients are sicker overall.With conditions like gestational diabetes and hypertensive disorders in pregnancy on the rise, there could be a greater need for C-sections, says Jane van Dis, OB-GYN and assistant professor at the University of Rochester.Van Dis says it's her hypothesis that the rise in those conditions is due to "environmental exposure," and she cites the increasing use of plastics.Repeat C-sections account for many procedures, even though the old "too posh to push" idea is not widely held."If you have already had a C-section, you will almost always be offered — and indeed the default is likely to be — a second," says Emily Oster, economist and author of "The Unexpected," her book about navigating pregnancy complications, due out April 30.Between the lines: Hospital politics might also come into play.For example, there are cases when doctors are more inclined to perform C-sections because that option would less likely lead to a medical malpractice lawsuit, Van Dis says.And health care system reimbursements for C-sections are generally higher than for vaginal births. "Financial incentives almost always play some role," Oster says.What they're saying: The "biggest consideration" with having a C-section is "future fertility," because of an increased risk of complications in later pregnancies, Oster tells Axios.Compared to a vaginal delivery, a C-section doesn't lead to a statistically different outcome for the baby, but it's a major abdominal surgery that tends to require a longer short-term recovery for the mother.Overall, a C-section "is an absolutely safe method of childbirth that should be available, and it should not be the first choice," Oster says.Vaginal deliveries also come with their own risks.And there are many situations — like in cases of breech birth, the presence of certain placenta problems, and severe preeclampsia — where a C-section should be performed, Van Dis says.What we're watching: Expanding access to doula care — as new legislation in New York does — could lower the rates of C-sections.A number of studies already suggest that the presence of doulas lowers the use of C-sections, Oster says.Doulas are there for psychological support during the often-overwhelming labor process, and to help with birth positions that could avoid the need for a C-section, Van Dis says."Doulas should be in every hospital … paid for," she adds.
The rate of cesarean births in the U.S. has gone up, again.
Why it matters: About one in three births in the U.S. are C-sections, according to new data, well above the 10-15% rate that the WHO considers "ideal."
By the numbers: The national C-section delivery rate increased in 2023 to 32.4%, up from 32.1% in 2022, according to provisional CDC numbers.
- That's the highest rate since 2013, and the fourth annual increase after the rate generally declined 2009 - 2019, the CDC says.
- The rate of low-risk cesarean deliveries (mothers' first births of full-term, head-first singletons) increased from 26.3% in 2022 to 26.6% in 2023, the highest rate since 2013, per the CDC
Yes, but: An increase in C-sections doesn't necessarily mean the rate of unnecessary procedures has risen — there are other factors at play.
Patients are sicker overall.
- With conditions like gestational diabetes and hypertensive disorders in pregnancy on the rise, there could be a greater need for C-sections, says Jane van Dis, OB-GYN and assistant professor at the University of Rochester.
- Van Dis says it's her hypothesis that the rise in those conditions is due to "environmental exposure," and she cites the increasing use of plastics.
Repeat C-sections account for many procedures, even though the old "too posh to push" idea is not widely held.
- "If you have already had a C-section, you will almost always be offered — and indeed the default is likely to be — a second," says Emily Oster, economist and author of "The Unexpected," her book about navigating pregnancy complications, due out April 30.
Between the lines: Hospital politics might also come into play.
- For example, there are cases when doctors are more inclined to perform C-sections because that option would less likely lead to a medical malpractice lawsuit, Van Dis says.
- And health care system reimbursements for C-sections are generally higher than for vaginal births. "Financial incentives almost always play some role," Oster says.
What they're saying: The "biggest consideration" with having a C-section is "future fertility," because of an increased risk of complications in later pregnancies, Oster tells Axios.
- Compared to a vaginal delivery, a C-section doesn't lead to a statistically different outcome for the baby, but it's a major abdominal surgery that tends to require a longer short-term recovery for the mother.
- Overall, a C-section "is an absolutely safe method of childbirth that should be available, and it should not be the first choice," Oster says.
Vaginal deliveries also come with their own risks.
- And there are many situations — like in cases of breech birth, the presence of certain placenta problems, and severe preeclampsia — where a C-section should be performed, Van Dis says.
What we're watching: Expanding access to doula care — as new legislation in New York does — could lower the rates of C-sections.
- A number of studies already suggest that the presence of doulas lowers the use of C-sections, Oster says.
- Doulas are there for psychological support during the often-overwhelming labor process, and to help with birth positions that could avoid the need for a C-section, Van Dis says.
- "Doulas should be in every hospital … paid for," she adds.