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America’s High C-Section Rate Not Based on Lawsuit Fear

With policymakers and tort reform advocates recently making a big push for the American Health Care Act (AHCA), patient and elder rights advocates have come out in full force to discredit many of the non-truths being touted as facts to promote tort reform. Last month, Sabrina Safrin, an attorney and Professor of Law at Rutgers University, published an enlightening article entitled ‘The C-Section Epidemic: What’s Tort Reform Got to Do with It?‘ Ms. Safrin’s report investigated the exceedingly high rate of C-Sections in this country and compared the rate in states with medical malpractice caps vs. those without. Her research led her to conclude that there is no reduction in C-Sections in states that have imposed a cap. Based of the most recently available CDC data on births, Ms. Safrin and her team concluded that there is actually a 1% higher rate of C-Sections in states with a malpractice cap.  The author also suggested several strategies that could assist in bringing down the number of C-Sections, something the American Congress of Obstetricians and Gynecologists (ACOG) has theorized will be directly reduced by enacting tort reform.

Caesarean Section: Facts & Figures
A C-Section is currently the most common procedure in hospital operating rooms across the country. According to the CDC, 1 in 3 babies is delivered by C-Section, a more than 50% increase from just 20 years ago. Such a large jump would lead one to assume that it has been discovered that C-Sections lead to better outcomes for neonatal health. Not so. In fact, data shows that hospitals with higher C-Section rates show no decrease in neonatal death rates, higher APGAR scores (a measure of baby’s health at birth), or reduction in time spent in a NICU. In fact, babies delivered via elective C-Section spend more time in the NICU, typically for respiratory issues due to early delivery. A C-Section also mandates a longer hospital stay for both the mother and baby, as well as a longer recovery, which all lead to higher hospital bills. Ms. Safrin notes that a C-Section costs 33-50% more than a vaginal delivery and that privately insured women are 33% more likely than an uninsured woman to deliver via C-Section, while those on Medicaid are 17% more likely to have one. Also worth noting is that half of all deliveries in this country are paid for by Medicaid.

The study author also stated that were C-Sections to be reduced from 33% of all births to the maximum recommended by the World Health Organization (15%), there would be an annual savings to Medicaid of $870 million on just the delivery alone, with an extra $2 billion a year saved by Medicaid on neonatal healthcare resulting from the method of delivery. Private insurers would be looking at a savings of $4 billion a year on neonatal care.

All of these facts can only lead to one conclusion: reducing C-Sections is not about tort reform, it’s about insurance and payment reform and arming expectant mothers with the necessary information to make personal decisions.

Author’s Suggestions for Reducing C-Section Rates
Sabrina Safrin gives 4 recommendations for helping reduce the rate of C-Sections in this country. First, she addressed the fact that OBs are paid more for the operation than for a vaginal birth, despite the fact that vaginal births take significantly longer. She acknowledges that if half of all deliveries are paid by Medicaid, one would automatically assume that Medicaid would be harder hit by paying physicians more for a vaginal birth. Safrin reminds readers that by paying OBs more for vaginal deliveries, Medicaid would also be spending less for the hospital visit (vaginal deliveries require less recuperation time in the hospital), for anesthesia and operating room charges, and potentially less for neonatal healthcare immediately following the delivery.

Ms. Safrin also advocates for pay-for-performance programs that would incentivize hospitals and physicians to reduce C-Section rates. With the passage and implementation of the Affordable Care Act, pay-for-performance programs have become more popular as a means to help curtail some of the expenses surrounding healthcare and insurance. Why not extend this to hospitals and physicians in the form of bonuses and other forms of recognition?

Another suggestion for reducing C-Section rates is curtailing the ability of malpractice insurers to explicitly or covertly refuse to cover vaginal births after Caesarean Section (VBAC) or vaginal delivery of more than one baby at a time. While many malpractice insurers do not include specific wording of such a rule in their policies, fmany patients and physicians have noted that they have heard their insurer would not cover a VBAC or an attempted vaginal delivery for twins. Ms. Safrin questions why business is involved in healthcare decisions, especially given that Consumer Reports revealed in 2016 that after an evaluation of 1200 hospitals, almost half of all C-Sections could have been avoided.  The author believes that C-Sections have become a defense, allowing a physician to say that by performing a C-Section, they did everything they could to prevent injury or harm to the mother or infant.

Finally, Ms. Safrin calls for publicly available C-Section rates for hospitals and individual physicians. Currently only Massachusetts and New York are the only two states who have legally required such information to be made public. While hospitals self-report data to other safety and research groups, those groups do not disclose the data to the public. Instead, the information is used for the group to render a score or an endorsement of the hospital. The author further suggests that the Centers for Medicare and Medicaid Services include C-Section rates as part of their quality assessment of hospitals.

In conclusion, while there are certainly situations in which a C-Section is appropriate, the fact is that they are performed more often than necessary. The blame has always been that physicians feel forced to perform C-Sections to avoid lawsuits, but there seems to be more at play than lawsuit fear. Factors such as less compensation for physician time, potential for not receiving payment for a VBAC or vaginal delivery of multiples, and plain old habit seem to be driving the record high number of C-Sections in this country. If the ACOG is even calling for a reduction, it’s time to stop pointing fingers in the wrong direction and start changing the system.

Birth Injury Attorneys
If you have been injured by medical professionals making a mistake while performing a c-section (including not performing the procedure in a timely manner), you need to speak with an experienced birth injury attorney. The attorneys at Levin & Perconti have worked on hundreds of cases like this. For example, we achieved a $4.5 million settlement for a child who suffered cerebral palsy when a physician failed to perform a timely c-section after fetal distress was detected. Call us at 312-332-2872 or 877-374-1417 or complete our online personal injury case form and someone will get back to you promptly for a free consultation.