Rates of cesarean delivery vary almost tenfold across hospitals, from 7.1% to 69.9%, according to a study.
Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 to 36.5%, reported researchers with the University of Minnesota, who studied 2009 data from 593 hospitals nationwide.
Katy B. Kozhimannil, PhD, assistant professor at the University of Minnesota School of Public Health, said in a news release that factors such as hospital size, geographic location and teaching status did not explain the variation.
“Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many U.S. hospitals,” the researchers wrote in the March issue of Health Affairs. “Because Medicaid pays for nearly half of U.S. births, government efforts to decrease variation are warranted.”
The researchers highlight several promising directions for reducing variations. One recommendation centers on better coordination of maternity care. For example, women with healthy pregnancies may benefit from care provided by midwives, support from trained doulas and access to care in licensed birth centers, according to the news release.
Collecting and measuring more data and tying Medicaid payments to quality improvement also could reduce the variation in cesarean delivery rates, the authors wrote, as could making information about cesarean rates and maternity care more readily available to pregnant women who have the time, motivation and interest to research their options.
The study is available via subscription or purchase at http://content.healthaffairs.org/content/32/3/527.abstract.