One of the hottest topics this season seems to be the climbing rate of cesarean section births in the United States. Maybe it's the thought of springtime, and happy, hopping bunnies procreating like, well, bunnies; Whatever the reason, articles discussing the rapid rise of C-section births are everywhere it seems. And while the procedures are increasing all over the country, there are some areas that are experiencing a sharper rise. So, why are C-section rates higher in coastal states, like Florida? Well, research shows that geography can play a larger role in the delivery process than you might initially think.
According to the Centers for Disease Control and Prevention, the current rates for C-sections in the United States are almost one-third of all births, 32.2 percent to be exact. And while that rate is higher than the World Health Organization would like — experts are aiming for around 10 percent max — the fact is that C-section rates are even higher in certain parts of the country. Florida, for example, totals in at 42.8 percent, and Wisconsin is the lowest, with 20.8 percent.
Consumer healthcare company Amino, which matches patients with doctors for free using a handy app, explained these findings in a post back in November 2015 using an interesting algorithm to understand an individual's own chances of having a C-section birth, depending on a wide array of factors.
Explaining why some states have higher rates of C-section births, Amino's Kate Lewis wrote:
There are many reasons why states might have drastically different C-section rates. A woman’s ethnicity, race, culture, and socioeconomic status all might affect her chance of having a C-section. There are also staff practices at hospitals that can affect childbirth outcomes. For example, one recent study shows that 24-hour on-call obstetricians and availability of midwifery care may lead to a lower rate of C-sections.
The other four states with the highest rates of C-section procedures after Florida are New Jersey with 42.3 percent, Connecticut with 42.1 percent, Kentucky with 41 percent, and Maryland with 40.9 percent of births being C-section. On the other side of things, Utah (28.1 percent), South Dakota and Minnesota (29.6 percent each), and Hawaii (30 percent) all had the lowest rates after Wisconsin.
However, geographical indications aren't the only reasons that some states had higher C-section rates. The design of the birthing center, hospital staff preparedness, and socioeconomic factors all play a role as well.
MASS Design Group performed its own study to fully understand the relationship between hospital design and the care mothers receive, including the numbers of C-section births. Recognizing that geography plays a part in the outcome, the study noted that "the hospital itself is a risk factor for delivery by C-section." The group explained,
Through prior work at Ariadne Labs, aimed at understanding the impact of management on care processes in childbirth, we had developed the “PressureTank Model” to explain the how the environment a clinician is working in may influence the decision to perform a cesarean delivery. In the Pressure Tank Model, limited resources, high workload, or limited motivation and accountability increase the pressure on clinicians to accelerate patient flow, which may lead to cesarean deliveries in clinically marginal cases. ...
Capacity design elements theoretically impact the availability of space to perform the core functions of the facility. To better compare capacity across facilities, we calculated the metrics as ratios relative to the annual delivery volume or the number of labor and delivery rooms. We found that many childbirth facilities are challenged by limited physical space to house labor and delivery patients relative to the number of patients who deliver at the facility each year. The degree of this challenge differs by facility based on factors such as funding, whether the facility or unit is located in an intentionally built or retrofitted space, and how their delivery volume has changed since their most recent construction.
In short? The types of facilities available in regions with high numbers of C-sections could be at play, depending on their size, delivery room availability, or their expectations and resources.
Along with geography and hospital design, socioeconomic factors also play a significant role in whether or not a woman has a C-section. Women who can afford private insurance with the assistance of midwives and 24-hour obstetrician coverage are less likely to have a C-section, a study published by The American College of Obstetricians and Gynecologists showed. While Florida is one of the states with the highest uninsured rates, this information makes sense. It's also worth noting that the only state with a higher C-section rate to also have a high poverty level is Kentucky.
Obviously, many women have crucial health risks that lead to their C-sections, and those should be handled seriously at all times. For now, knowing the reasons behind some of the numbers as they stand could help lower the rate of unnecessary procedures — so long as society is ready to tackle the issues head on.