By DANI BRADLEY MS, MPH
The United States is the only developed nation in the world with a steadily increasing maternal mortality rate — and C-sections are to blame. Nearly 32% of babies are born via C-section in the United States, a rate of double or almost triple what the World Health Organization recommends. While C-sections are an incredibly important life-saving intervention when vaginal delivery is too dangerous, they are not devoid of risks for mom or for baby. Hospitals and doctors alike are aware, as it’s been widely reported that unnecessary C-sections are dangerous — and hospitals and doctors agree that the number one way to reduce this risk is to choose a delivery hospital with low a C-section rate. However, information on hospitals’ C-section rates is incredibly hard to find, which leaves women in the dark as they try to make this important choice.
In an effort to help women make informed decisions about where to deliver their babies, we set out to collect a comprehensive, nationwide database of hospitals’ C-section rates. Knowing that the federal government mandates surveillance and reporting of vital statistics through the National Vital Statistics System, we contacted all 50 states’ (+Washington D.C.) Departments of Public Health (DPH) asking for access to de-identified birth data from all of their hospitals. What we learned might not surprise you — the lack of transparency in the United States healthcare system extends to quality information, and specifically C-section data.
After contacting 51 DPHs, 44 departments provided some level of birth data upon request — but the majority of those shared C-section rates for their state’s counties or districts, which doesn’t help when a patient needs hospital-specific data in order to select where she’ll deliver. Some states, such as Alabama, California, Massachusetts, Pennsylvania, Vermont, and West Virginia, have very transparent data-sharing practices, posting the vital data on their websites for the public to access and use. Other states, such as Wisconsin, Missouri, and Nebraska, put obstacles to accessing their data in place, including charging fees, requiring a signed data use agreement, and sometimes demanding institutional review board exemption. Still, six states — Illinois, Kentucky, Georgia, Wyoming, and Connecticut — outright refused to share their data, citing verbiage in their state’s statutes as the rationale.
While it’s clearly difficult for patients to access these quality data on their own, thankfully there are organizations working to address the issue of unnecessary C-sections head-on. On the West Coast, the California Health Care Foundation developed a comprehensive initiative to reduce unnecessary C-sections, and on the East Coast, Ariadne Labs, a research group out of Harvard Medical School, has an entire department devoted to “Addressing the world’s most common and consequential surgical error: the decision to perform a C-section.” While these programs are making great strides, the U.S. could be doing a lot more to give the patient a voice and promote informed healthcare decision-making.
For organizations who want improve health outcomes, reduce healthcare spending, or enhance patients’ interactions with the healthcare system, allowing access to a comprehensive, accurate dataset of hospital C-section rates should be a top priority. The publication of C-section data at the hospital level would allow women to make informed decisions about their healthcare, mitigate unnecessary adverse outcomes, and reduce healthcare spending. Public data might also help influence change among healthcare providers and hospitals. Healthcare advocates, payers, patients, researchers, and the public alike need to band together to change this opacity. Mothers’ lives depend on it.