Health Care Usage Patterns Explain 29% of Variation in C-section Rates

We’ve all seen the reports exposing the high rates of cesarean sections in the United States: about one-third of infants in the US are born by cesarean delivery. We’ve also seen that the rate of c-sections in hospitals varies widely and that where a woman delivers may be the biggest factor in whether or not she receives a cesarean section. A new study in the June 2016 Gray Journal exposes yet another set of factors that influence the likelihood of receiving a c-section: regional health care utilization.

Dr. Little and her colleagues at Brigham and Women’s Hospital in Boston, Massachusetts, mined an extraordinary amount of data to uncover these new links. They collected information from 2010 birth certificates and Medicare claims. They wanted to know if there was a correlation between health care usage and cesarean section rate for US communities. For instance, perhaps communities that spend more on healthcare are also more likely to perform more c-sections.

The authors found that the cesarean delivery rate varied across communities from 4% to 65%. They also found that communities that spent more Medicare dollars had higher c-section rates. On the other hand, communities with the lowest Medicare spending had the lowest cesarean rates. The top spenders had a cesarean section rate of 36%, while the lowest spenders had a rate of 29%. Communities in which citizens spent more of their last six months of life in the hospital also had higher c-section rates.

When considering cesarean section rates, researchers will often restrict their analysis to only women who are at low risk of needing one: first-time moms with a term pregnancy and the baby in the head-down position. The authors of this study re-analyzed all their data using just these women and got the same results. Communities that had higher healthcare utilization also had higher cesarean section rates.

Differences in communities’ health care usage patterns explained 29% of the variation in c-section rates. 17% of the variation was explained by differences in obstetric procedures, 8% by hospital structure, and 2% by the medico-legal/ malpractice environment. Only 44% of the variation in cesarean section rates was due to patient differences and demographics.

What can you do about these surprising new findings? You can learn what your hospital’s cesarean rate is before you go into labor. New data sources like and The LeapFrog Group provide c-section rates for thousands of hospitals. And, the best advice is always to talk to your doctor or midwife about your concerns and learn about her philosophy on preventing unnecessary c-sections.