One way or another, most pregnant women usually have an idea of how they'd ideally like their delivery to go, and often, those ideas include some kind of opinion about having a C-section. Although surgical deliveries are at times totally unavoidable (and literally life-saving), many women worry they aren't "natural," or as good as vaginal births, and, of course, there are concerns about C-section recovery or complications. C-section rates in the United States are also higher than recommended, and that's left some women wondering if doctors might be more inclined to do them because they're more profitable. It's true that doctors do make more money from performing C-sections, but a breakdown of C-section costs shows that the difference isn't likely enough to have an influence.
According to CNBC, a 2016 study by Castlight Health found that, on average, the cost of a routine vaginal delivery in the United States is about $8,775, compared to about $11,525 for a C-section. It makes sense, of course, that C-sections would be more expensive than routine vaginal deliveries: as Coney Island Hospital Chair of Obstetrics and Gynecology Dr. Toni Stern explained to Parents, "a C-section is a major operation that involves anesthesia, longer hospital stays, and higher instances of morbidity and mortality." But Castlight's figures found that the cost of both procedures can actually vary significantly from city to city — and in Los Angeles, the most expensive city to have a C-section, prices ran as high as $42,530.
A similar study published in 2014 by researchers at the University of California San Francisco found that some California medical centers actually charge eight to 11 times more than others for deliveries, with the highest price for a C-section being a whopping $70,908, according to Kaiser Health News. That sounds alarming (and it is), but before you assume your OB-GYN's C-section recommendation was profit-inspired, it's important to note that these figures are hospital charges, and are separate from physicians' fees. As lead researcher Dr. Renee Y. Hsia explained to Kaiser Health News:
Health care pricing is kind of like the Wild West. There is no real system of health care pricing. The ‘system’ is that hospitals are allowed to charge whatever they want and whatever they feel they merit.
Furthermore, according to Hsia, childbirth isn't the only medical procedure in which huge cost variation is seen among hospitals: in a separate study published in 2012, Hsia found that in California, some hospitals charged as little as $1,500 for a routine appendectomy, while others charged as much as $182,955.
So how might that variation affect your doctor? It's hard to say, but according to NPR, it probably doesn't. In a 2013 paper published by the National Bureau of Economic Research, health care economists Erin Johnson and M. Marit Rehavi found that doctors might make a few hundred dollars more for a C-section compared to a vaginal delivery, and were less likely to recommend C-sections if they were being paid a flat rate for deliveries. But they noted that it's unlikely that the doctors are consciously influenced by that difference, and that, in the flat rate model, it was possible that women who actually needed C-sections weren't always getting them. What's more though is that, like the variation in cost, it actually seems that the likelihood of having a C-section primarily comes down to the hospital, not necessarily the doctor.
According to Consumer Reports, the biggest factor affecting how likely a women is to have a C-section is actually what hospital she delivers in — and 60 percent of hospitals in the United States have C-section rates higher than what's recommended for low-risk births. That's problematic, and certainly suggests that hospital choice is something that parents-to-be will want to be aware of and research ahead of their deliveries. But according to Harvard Magazine, from the doctor's position, it's likely that concerns about risk is what's actually motivating the increased number of C-sections more than anything else.
As Massachusetts General Hospital high-risk obstetrician Dr. Jeffrey Ecker explained to Harvard Magazine in 2012, risk perception and tolerance help determine professional standards of care in medicine, and unless a C-section has been planned in advance for a specific reason, the decision is usually a judgement call made by the doctor during delivery. That ultimately means that C-sections can occur unnecessarily depending on how safe the procedure appears to be versus the risks involved in not doing it. As Harvard Magazine noted,
[If] the obstetrician sees C-sections as generally safe, and if the outcome he or she wants to avoid is dire, even devastating—such as a baby’s becoming stuck and deprived of oxygen, which could lead to cerebral palsy—why wait to find out what will happen, however unlikely that outcome may be?
Of course, it's impossible to say exactly what motivates doctors to make different decisions when it comes to deliveries, and there may be factors coming into play that aren't always in patients' best interest. But given that the number one goal of a delivery for both parents and the doctor is to have a healthy baby, the reality is that most parents just have to trust that their doctor is making the right call.