For-Profit Hospitals More Likely to Perform Cesareans

Cesarean sections are on the rise throughout the country, but the exact reason for this trend isn't clear. However, a recent report by the investigative team at California Watch indicates that money may be a motivating factor.

The analysis found that after controlling for other factors, women in California were at least 17 percent more likely to have a C-section at a for-profit hospital than at a non-profit hospital. According to report, a surgical birth can bring in twice the revenue of a vaginal delivery.

California Watch looked at those births not likely to require a C-section -- moms without a previous C-section, a single fetus, head positioned down and at full-term. After adjusting for the women's age, they found that at non-profits the surgical rate was 16 percent, while for-profits it was 19 percent.

The strikingly different rates between hospital throughout California indicates having a C-section has more to do with what hospital a woman chooses than her medical condition. For instance, women with low-risk pregnancies had a 9 percent chance of having a C-section at the nonprofit Kaiser Permanente Redwood City, but a 47 percent chance of having surgery at the for-profit Los Angeles Community Hospital.

Although C-sections can save a baby or mother in distress, they are a variety of reason why they are now performed. This includes an increase in obesity, older mothers, increases in induction and litigation fears. The report also found that some hospitals perform C-sections because of impatient doctors and scheduling conflicts. Now it seems that profit may be another reason.

Nationally, the cesarean section rate has steadily risen from 1996 to 2007, reaching 32 percent in 2007, the highest rate in U.S. history, according to the National Center for Disease Statistics. It is the most common surgical procedure performed in the United States.

Generally considered very safe, C-sections can result in surgical complications like infections and maternal injuries. Many hospitals will not perform vaginal deliveries after a woman has had a C-section, though regulations are changing.

The California Watch report provides evidence to those who have long proposed that the rise in C-sections has nothing to do with medical necessity and has lots to do with profit. According to the report, a 2007 analysis by the Pacific Business Group on Health found that hospitals can increase their revenue by 82 percents by performing a C-section instead of a vaginal birth.

One way to circumvent the question of profit -- for the doctor or hospital -- is to get rid of any financial incentives and payment structures that favor unnecessary surgical intervention.  C-sections can help some women and their babies -- but not when they are abused for profit.

Photo credit: bluekdesign