Cesareans 17% more likely at for-profit hospitals

California Watch, a nonpartisan investigative reporting initiative, has released a study showing that for-profit hospitals in California are performing cesareans at higher rates than non-profits, even in low-risk pregnancies.

A database  compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery.

In addition, some hospitals appear to be performing more C-sections for non-medical reasons – including an individual doctor’s level of patience and the staffing schedules in maternity wards, according to interviews with health professionals…

…California Watch examined the births least likely to require C-sections, those in which mothers without prior C-sections carry a single fetus – positioned head down – at full term, and found that, after adjusting for the age of the mothers, the average weighted C-section rate for nonprofit hospitals was 16 percent, while for-profit hospitals had a rate of 19 percent.

That may seem like a small percentage gap to the casual observer, but medical experts consider it a significant difference. It means women are 17 percent more likely to have a C-section if they give birth at a for-profit hospital. (When calculated without weighting averages by number of patients, the difference is slightly larger.)

This analysis provides evidence of what many have long suspected – that profit drives cesarean rates. As ICAN President Desiree Andrews comments:

“This data is compelling and strongly suggests, as many childbirth advocates currently suspect, that there may be a provable connection between profit and the cesarean rate,” said Desirre Andrews, president of the International Cesarean Awareness Network, a nonprofit group that would like to see C-sections only in cases of medical need.

Eugene Declerq weighs in on the study, noting that while profit motives may not be explicit, other factors such as efficiency can result in the same effect:

Gene Declercq, professor of community health sciences at the Boston University School of Public Health, agrees that hospitals would not explicitly push C-sections for profit. But subtle incentives to increase efficiency could have the same effect.

“There are factors that are attractive to hospitals in terms of training and staff and facilities,” he said. “It’s a lot easier if you can do all your births between seven and 10 in the morning and know exactly how many operating rooms and beds you need.” Vaginal births are unpredictable, creating inefficiencies that can hurt the bottom line.

Two ICAN mamas are also quoted in the report, citing their own experiences at California hospitals.

Even at nonprofit hospitals, some women say they felt pressured to have a C-section.

Rebecca Zavala, 29, a teacher and makeup artist in Ventura, was one.

Zavala consented to have her delivery induced a week early because the baby’s head seemed large and because the doctor was about to leave for vacation.

Zavala went to the nonprofit Santa Monica-UCLA Medical Center, where nurses gave her drugs to dilate her cervix and start the contractions. After four hours, in which labor progressed slowly, Zavala’s doctor broke her water and turned up the drug, stimulating contractions.

“It felt like there was this monster on top of me all of a sudden,” Zavala said. “It was terrifying. I was totally unprepared for anything like that.”

Shortly thereafter, her doctor informed Zavala that her baby was showing signs of distress and recommended a C-section. Zavala agreed. Nurses congratulated Zavala on being an accommodating patient.

But Zavala said she felt manipulated. Her doctor hadn’t told her that induction increased the likelihood that she’d have a C-section, and that C-sections came with health risks, she said. Now that she is pregnant again, she has learned that most hospitals are unlikely to allow a woman with a prior C-section to give birth naturally.

“She told me nothing,” Zavala said of her doctor, noting that the doctor left for her vacation shortly after the delivery.

And…

For some, a C-section can have devastating consequences.

After Heather Kirwan had been in labor for a few hours her doctor at Rancho Springs Medical Center in Murrieta urged her to have a C-section, warning that the baby was too big for her birth canal. She reluctantly agreed to the procedure, but now questions that decision.

“She ended up being a 5-pound, 12-ounce baby,” said Kirwan, 26, a manager for The Home Depot who lives in Murrieta. “So that was obviously a lie.”

A year and a half later, Kirwan was pregnant again, but the doctors found that the embryo was developing outside the uterus. Before her C-section, Kirwan said no one had warned her that C-sections increase the risk of this life-threatening condition, called ectopic pregnancy. And if it were listed in her lengthy consent form at the time of her first delivery, Kirwan said, no one bothered to point it out.

The doctors removed the embryo, along with one of Kirwan’s ovaries and fallopian tubes. She has been unable to conceive since.

“I’ve been trying for years and years, and I still can’t get pregnant. It’s very heartbreaking,” Kirwan said. “I just want people to know the risks.”