C-section rates: Consider this when deciding where to have your baby

Hope Ricciotti, MD

Editor in Chief, Harvard Women's Health Watch

For many years, there has been criticism that the rates of cesarean births are too high because higher rates have not resulted in improvements in maternal or child health.

Many expectant moms feel strongly about having a natural vaginal birth, and want to do all they can to avoid a cesarean section. But for some, a C-section may seem like a good option for a range of reasons. And for others, a cesarean may be essential to protect the health — or life — of mom and baby.

In parts of the world where C-sections are not readily available, complications of vaginal birth often lead to serious consequences, including loss of life for mother and baby. In contrast, quick access to cesareans has its own problems. Over all, cesarean delivery is a very safe procedure. But it carries higher risks than vaginal delivery, including a three-fold higher rate of infection, hemorrhage, and organ damage. It also has a longer recovery period.

So how many cesareans we’re doing is a number worth paying attention to.

Finding the optimal C-section rate

As it turns out, there is a sweet spot — a certain “rate” of cesareans needed to prevent the terrible suffering and aftermath that can occur when a baby can’t move though the birth canal, or when there’s an emergency requiring immediate delivery.

Recently, a study from researchers at Harvard Medical School and the Stanford University School of Medicine found that the ideal rate of childbirth by C-section appears to be about 19% of all births. This number is higher than previous guidelines have recommended, but lower than the rate in most US hospitals — which can be as high as 70%.

How did the researchers come to this number? They looked at C-section rates from 194 countries and compared them to maternal and infant mortality rates. Their analysis suggests that babies and mothers don’t fare better when cesarean rates are above 19%. Cesarean rates below 19% were associated with more birth-related complications and poorer outcomes.

This research also suggests that some of the reasons commonly cited for high C-section rates — moms who are older or obese, or who’ve had multiple previous births, along with doctors’ fear of being sued — may be only a small part of the bigger picture. In particular, these examples don’t account for why some doctors and hospitals simply do more (or fewer) C-sections than others do.

Dr. Neel Shah is one of the co-authors of the study and an obstetrician in my department at Harvard-affiliated Beth Israel Deaconess Medical Center. Dr. Shah has uncovered some previously unrecognized factors that help explain the variation in C-section rates. For example, his research suggests that time pressures in some hospitals may lead to more C-sections, since in comparison, vaginal birth can take a great deal of time and staff resources. Providing the clinical team with access to better data and technology can help them make better decisions based on patient volume, staffing, and the overall resources needed to support safe care.

What this means for expectant parents

If you are a healthy woman and have a low-risk pregnancy, the hospital you plan to use may determine the likelihood you’ll have a C-section more than any other factor. So find out the C-section rate at the hospital where you plan to deliver your baby. Talk to your doctor about this as well. If you are early in your pregnancy, you might opt to choose your doctor based on where he or she practices.

Finally, it’s important to remember that there are times when a C-section is the only safe way to deliver a baby. When that happens, a woman may feel a sense of loss for the birth experience she had hoped to have. But doing your homework about quality of care can help assure you that your method of delivery was determined for the right reasons.


Related Information: Harvard Women’s Health Watch


  1. monica wood

    Hi all…
    This is am indeed a very interesting article!

    Every one has different opinions about child birth. I can say that birth is a beautiful experience. One should go for natural birth and let the nature do its work until there is a complication .

    Vaginal Birth vs. C-Section: Pros & Cons
    by Cari Nierenberg, Live Science Contributor | March 20, 2015 08:50pm ET



    delivery, vaginal, c-section, cesarean
    Pin It Expectant parents should talk to their healthcare professional about a birthing plan that takes all risks and benefits into account.

    Babies can enter this world in one of two ways: Pregnant women can have either a vaginal birth or a surgical delivery by Caesarean section, but the ultimate goal is to safely give birth to a healthy baby.

    In some cases, C-sections are planned because of medical reasons that make a vaginal birth risky. A woman may know in advance that she will need a C-section and schedule it because she is expecting twins or other multiples, or because the mother may have a medical condition, such as diabetes etc.

    When first measured in 1965, the national U.S. cesarean birth rate was 4.5%.1 Since then, large groups of healthy, low-risk American women who have received care that supported their bodies’ innate capacity for giving birth have achieved 4% to 6% cesarean birth rates and good overall birth outcomes.2,3,4 However, the national cesarean rate has increased seven-fold.

    It peaked in 2009 at 32.9% and had dropped slightly, to 32.2%, in 2014.5 So, about one mother in three now gives birth by cesarean section the nations most common operating room procedure.
    In my view one should go for natural birth because it has less pain and is naural.
    Thanks in advance :00

  2. cookiesfromhome

    Increase in c-section rate is a big issue now because in some cases it is quite difficult for middle class family to pay high amount in c-section case.So, only solution to this problem is take full care of yourself and your baby during pregnancy. If you are healthier then these are low chances that you will have c-section.

  3. Anna

    Maybe looking indiscriminately at data is not the best way to determine the ideal c-section rate. Maybe we should look at was is possible, instead at the mediocre general practice.

    19% is still unnecessarily high. The Austrian Professor Alfred Rockenschaub was responsible for the deliveries of over 30.000 babies in Vienna up until the mid 80s with c-sections not exceeding 2 % by providing excellent midwife care (European standard). The midwives took full charge of the births. The outcomes were generally better (!) than in the surrounding hospitals, where the rates of c-sections were around 15-20 %. Breech and twin births were no problem, as the midwives were excellently trained to handle all variations of the normal birth process. One other major aspect for their success was their high standard of ante- and post-natal care (healthy happy moms equal healthy happy births and baybs more often than not).

    Ina May Gaskin also delivers breech births and twins naturally and her mortality rate is way below national average, while her c-section rate is nill. She also takes excellent care of the mothers. They are not a number, nuisance, or cost centre, but a person.

    While the article makes some good points, it is still tamely mainstream. If you want to have a higher than 1:1 or 1:2 chance for natural delivery you will have to get down to business and do some serious research on the net. Get rid of the myths and fears fed to us all by the media. Ask questions. Make demands, You got a voice – make yourself heard. The birth is about you and the baby. Don’t just say yes to everything. Remember in health care, it is mostly about cost, regulations and law-suits, not about what is best for the patient. Don’t put your ob/gyn on a pedestal, who is … just a person who whatever (s) he may promise, (s)he can’t guarantee anything. Nobody can. Life is full of risks, but birth is relatively safe, if handled by true experts. Rely on your own strength and trust in your ability to to give birth. It worked for me twice. Good Luck!

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