March 24th, 2010
12:46 PM ET

CDC: More C-sections than ever in U.S.

By Elizabeth Landau
CNN.com Health Writer/Producer

Caesarean section births in the United States reached 32 percent in 2007, the highest rate ever reported in the country, according to a new study from the Centers for Disease Control and Prevention.

A third of all births in the United States were done by Caesarean section in 2007, in spite of the health and safety risks for mothers and newborns associated with the procedure, which involves major abdominal surgery. C-sections have been linked to higher rates of surgical complications and rehospitalizations of the mother. There is also a substantial cost involved: hospital charges almost double for a Caesarean delivery compared with a vaginal birth.

Since 1996, the rate of Caesarean sections rose by 53 percent from 1996 to 2007, the study said, with an acceleration from 2000 to 2007. The trend of increased births by Caesarean section was seen in all U.S. states during the 1996 to 2007 time period, and among women in all age groups.

Among the states with the lowest C-section rates were Alaska, Idaho, New Mexico, and Utah, with less than 25 percent. Some of the highest were in Florida, Louisiana, Mississippi, New Jersey, and West Virginia. In Colorado, Connecticut, Florida, Nevada, and Rhode Island, the rate of C-sections increased by more than 70 percent.

The increased rate of multiple births may have something to do with the rise in Caesarean sections, although the  rates for single babies increased much more than for infants in multiple deliveries, the study said.

The study also cited nonmedical factors as potential reasons why there are so many more C-sections in recent years, such as the mother's choice, practice guidelines, and legal pressures - for instance, a study in Illinois found that rising costs of professional liability insurance may have something to do with Caesarean delivery rates.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (122 Responses)

    Epidurals increase the need for Csections because they potentially drop the mother's blood pressure resulting in a decrease of oxygen to the baby and fetal destress. An emergency Csection is the final result.

    March 25, 2010 at 12:06 | Report abuse | Reply
  2. Patricia

    I also forgot to mention the fact that in Germany there is a cap on a lot of healthcare costs, from surgical procedures and medications to the doctors' salaries. Some people say that the system in Germany is horrible compared to the US, but having lived in both countries I can tell you that I would choose to be treated in the German healthcare system over the US any day. The doctors I saw in Germany were in that profession because they had a genuine love for the profession and they cared about their patient's well being. I was never rushed through an exam or needlessly prescribed drugs. They always had me try natural approaches to healing first and only would prescribe meds as a last resort. That is almost unheard of in the US!

    I had less of a wait time to get appointments in Germany and honestly feel the quality of care received was better. When my second child was born naturally, they advised that I stay in the hospital for 5 days although I had the option of signing myself out earlier. In the US, I was made leave the hospital after a c-section before 72 hrs was even up because my insurance would not pay for anything longer....even though I could still hardly walk and couldn't even hold my baby without pain yet! I did suffer from an infection and had a dangerously high fever afterward which required that I go back to my doctor for treatment anyway so I dont really see how the insurance company saved money.

    But that is just what I've experienced so I cannot say that is the same for everyone. I'm just saying that given my experiences, I would choose to go back to Germany for a third child or for any other non-minor treatment. I just don't have the trust in the US healthcare system; it just seems all money driven not matter what the impact to the patient's health.

    March 25, 2010 at 12:12 | Report abuse | Reply
  3. Dave

    To the doctor that posted previously...my experience with OB's has shown that c-sections are partly to do with malpractice, and largely to do with scheduling. Natural labor is unpredictable; my 1st child took 16 hours, and the 2nd took 2 hours. In comparison, c-sections are routine and timely. You can book multiple patients at convenient hours, as not to interfere with your court and tee times.

    OB's have been pushing their patients towards c-sections by scaring them with statistics of possible complications during natural child-birth. What they don't tell you is the number of those "natural births" that were assisted by pitocin or other drugs. They also don't tell you about complications with c-sections such as adhesions, infection, infant pneumonia, etc... Docs like to blame the sharks, but they're just as guilty.

    March 25, 2010 at 13:15 | Report abuse | Reply
  4. Love

    C-sections are not bad when needed, and unplanned and emergency ones help save lives.

    however, it's when they really are not medically neccesary that bothers people. A doctor can lie and off you go for major sugery...when really you COULD have done something your body was designed for and recovered in less time. First off, there are very few reasons Pitocin should be used...instead it's used ALL the time. This makes labor (contractions) more painful and intense than normal labor. This can stress mother and baby out...C section. Or they then get an epidural and labor slows down and now-a-days they have time limits on labor (god forbid they let you labor the way YOUR body wants to labor...even if it takes 30 hours) so then they bring you in for a c-section becuase youre not "progressing."

    I'm lucky to have an ob that actually encourages VBAC and is onboard for whatever labor plans the mother has (ie she supported my decision NOT to have a C-section just because my 1st was taking a while to come. The baby kept slipping back up. I had her after 24 hours of labor and she was healthy and fine...and i had a fairly easy recovery compared to what i was expecting. Many doctors would have done a C section.)

    March 25, 2010 at 13:31 | Report abuse | Reply
  5. PiercedPsycho

    I had my daughter vaginally with an epidural, and I wonder how it would have been different if they had not given me Pitocin. My OB\GYN was well aware that I intended on a vaginal birth with an epidural, because while I know my body is built to give birth, that doesn't mean I should have to deliver my daughter AND fight through the pain.

    March 25, 2010 at 13:59 | Report abuse | Reply
  6. OB Doc

    How many of you who are decrying the use of epidurals and pitocin and insinuating that there are few indications for either, and that women are pushed into accepting them and C-sections, actually went to medical or nursing school? Are you basing your presumptions on a review of the medical literature, or on a docudrama by Rikki Lake? Because there's a difference.

    Epidurals may increase the length of the the second stage of labor (the pushing stage)–known fact. They DO NOT increase C-section rates (see Cochrane Database). Pitocin may be used to induce labor or to augment labor safely, and there are situations, too numerous to detail here, that literally require its use. Newsflash: not all inductions are ELECTIVE. Mom may have severe preeclampsia, there may be low amniotic fluid, or a million other reasons why induction is indicated apart from convenience. Also, please don't discount the fact that although those interested in natural childbirth seem to frequent these forums more often than their counterparts, I get at least one REQUEST for induction per day. I try to tell all my patients early on that induction should be reserved for medical indications, but once they hit 37 weeks, some women don't want to hear it. I have had women leave for another practice b/c I wouldn't induce them before 39 weeks (my absolute earliest cutoff without an amnio documenting that the fetal lungs are mature). You really have no idea how many things may go into this increase in C-section rate.

    In addition, if a woman requests a C-section, and wants no more than 2 children, I will do it for her. Why? Because a) if I don't and something happens to her baby, I will get sued and b) I happen to think it's a very safe way to deliver a baby. Most horror stories you hear are from women who had a section after hours of labor, not from women with planned sections. If a woman is well informed of all possible outcomes for both modes of delivery, I believe it is her choice. Just as it is unconscionable to force a C-section on someone who doesn't want it, it is paternalistic to force a vaginal delivery on someone who doesn't want it. Caveat: as above, planned maximum of 2-3 kids if planning a primary elective C-section.

    March 25, 2010 at 22:29 | Report abuse | Reply
  7. Renard

    Epidurals do not increase the risk of C-sections. Sorry, JEANNEBOO you are mistaken. They do increase the rate of 'instrumented' delivery (forceps, manual assist, vacuum, etc), but do not have any affect on maternal or neonatal outcomes. In fact, due to less IV medications to control mom's pain babies tend to have higher APGAR scores. Yes, I am an anesthesiologist.

    March 26, 2010 at 05:04 | Report abuse | Reply
  8. jules

    to heather, i am happy for your son's safe and happy delivery. NOT all of us can have that. if my body could have delivered my transverse "feet first" baby i would have done it.

    March 27, 2010 at 16:42 | Report abuse | Reply
  9. Jen

    I was going to have a vaginal, but my son's head was turned sideways! The OB tried to turn him, tried having me push, to no avail, and the last time she tried to turn his head his heart rate stayed low (cord was around his neck). So, immediate C-section.

    However, the OB even apologized afterward, and was as disappointed as I was to not have a vaginal birth. I was just glad to have a healthy baby boy. So, not all OBs are pushing C-sections- mine tried everything she could to avoid it, until my son started getting into trouble.

    March 27, 2010 at 20:26 | Report abuse | Reply
  10. Erica

    Unfortunately for some people, like myself and my sister in law, we had to have emergency c sections due to preeclampsia/eclampsia......something we NEVER expected or knew about. THAT would be a great study....to find out why the body does this and to find a cure. "They" say there is no way to prevent it..."they" need to be proven wrong.

    March 28, 2010 at 19:58 | Report abuse | Reply
  11. Tony

    Doctor's like C-sections because their malpractice insurance tells them they are less likely to get sued.

    March 29, 2010 at 14:45 | Report abuse | Reply
  12. Kris

    My parents have 11 grandchildren all born by c-sections. Each one of us moms were over 35 at delivery. I believe the older a women gets it becomes harder to deliver naturally. My sisters and I all entered the hospital planning on having vaginal deliveries. C-sections were performed on each of us after many, many hours of labor and different treatments to assist in labor. After the extended labor for our first deliveries the babies became distressed and needed to be born emergently. I am grateful for the c-sections that birthed my 3 children and each of my 8 nieces and nephews. I also think better monitoring of babies condition during labor diagnoses problems with baby and adds up to more c-sections.

    March 29, 2010 at 15:22 | Report abuse | Reply
  13. Lori

    Of my grandparents 7 grandchildren born between 1955 and 1972, none of us were C-sections. Of their 10 great-grandchildren born between 1977 and 2007 there were 7 C-sections and only 3 natural births. Granted some of them were needed because of fetal distress, but somehow I doubt that every operation was necessary.

    March 29, 2010 at 18:14 | Report abuse | Reply
  14. Nancy


    The chances that your child would have actually been too big for your body to have (fetal macrosomia) are very slim. This is a pretty invalid fear. There are women who safely deliver babies weighing over 10 lbs. My very petite mother in law was one of them. I am 5'3" and weigh 125 normally. I have naturally and vaginally had one 7lbs 5 oz baby and one 8 lbs 2 oz baby. Also, ultrasound estimates of the baby's weight can be as much as a pound off.

    As for your second post on fetal and maternal health, the United States currently has the WORST fetal and maternal death rates of ALL industrialized countries.
    Fetal: http://www.wsws.org/articles/2008/oct2008/mort-o18.shtml
    Read the maternal one. It actually CONDEMNS the US for how high our rates our. One of the reasons, the many surgeries. You can't tell me that 1/3 of all women are unable to deliver their babies vaginally.

    Medicine has it's place. I just graduated Bio/Pre-med with Honors and top of my class and I'm having to decide what to do about grad school because I am disillusioned with traditional medicine due to issues like these. Birth has become too medical and it does nothing but disrupt a woman's natural instincts and progressions. Without interference, I was in active labor and pushing with my FIRST child for a total of 4 hours (that's with getting stalled at 9cm for an hour). Had I accepted intervening measures, or not relaxed and let my body work, then it would not have progressed so rapidly. I've seen it time and time again. Granted, I gave birth in a hospital with a midwife both times so I guess I walk the middle line. I actually had a doctor tell me I couldn't have the birth I wanted even though my first was natural with no complications, because of hospital LAWYERS.

    March 30, 2010 at 11:49 | Report abuse | Reply
  15. Jessica

    I just delivered my first daughter via c-section about 2 yrs ago, and i was planning for a natural birth but she was not head down pretty late in the game, and my doctor didn't want to take that risk of me going into labor with her in that position. At first I was upset, but it was a nice experience. I would say it should be avoided if necessary, because it is MAJOR surgery and there are MANY complications that could occur from it. The doctors dont stress that enough to people, prob becuase of the larger payouts they get from performing c-sections.. But it isn't "natural" and should be avoided if necessary.

    March 31, 2010 at 10:19 | Report abuse | Reply
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