This data, incomplete as it is, comes at a time when the national C-section rates are dropping after more than a decade of increases. The Centers for Disease Control and Prevention reports that the low-risk cesarean delivery rates peaked at 28.1% in 2009. The rate decreased from 2009 through 2013, reaching 26.9%. "Declines were widespread during this time. Low-risk cesarean delivery rates were down for more than one-half of states."
Hospitals are dealing with a lot of demands, right now, including meeting health information technology standards, ICD-10 implementation, Medicare performance measures, and other patient safety initiatives. And on top of the hospital ranking efforts of Leapfrog, Consumer reports, and U.S. News & World Report, hospitals now have to cope with the sometimes snarky rankings from patients/consumers on Yelp and Facebook.
C-section Reporting Guidelines Issued
Leapfrog set its target rate at 23.9%, not a huge difference from the actual national rate. Still, that the rates vary so much suggests that there's a problem.
For example, a pregnant woman in Colorado has a 22% chance of getting a C-section; in Florida, the rate is 33%. With no Medicare stick out there, we'll have to count on hospitals and the doctors who work in them—or increasingly for them—to assess and address their rates, and by doing so, improve outcomes.
Last year, the American College of Obstetrics and Gynecology offered some help by issuing new guidelines that call on doctors to allow women to spend more time in labor before considering a C-section.
"Although cesarean birth can be life-saving for the baby and/or the mother, the rapid increase in cesarean birth rates raises significant concern that cesarean delivery is overused without clear evidence of improved maternal or newborn outcomes," the ACOG statement read.
A recent review published in the British Medical Journal offered another reason to avoid the operation if possible—higher rates of asthma, diabetes, and obesity in those delivered via C-section.
The hundreds of hospitals that didn't report their rates to the Leapfrog Group should be aware that they may not be able to keep them private for long. Consumer Reports notes that fewer than half the states currently collect C-section numbers. With the push for transparency in health quality and health pricing, that number is likely to grow.
Tinker Ready is a contributing writer at HealthLeaders Media.