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For-profit hospitals across the state of California are performing Cesarean sections at higher rates than nonprofit hospitals, a California Watch analysis has found.
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.
Across the state, more women are having C-sections for a variety of reasons: a rise in obesity and the number of older mothers, fear of lawsuits among doctors and hospitals, and a growing cultural acceptance of the procedure. Rather than examine these well-known trends, California Watch looked at why individual hospitals are performing Cesarean sections at higher rates than others.
The statewide database revealed significant differences among 253 hospitals in California. Women, whose pregnancies were deemed to be low-risk, had a nine percent chance of giving birth by C-section at the nonprofit Kaiser Permanente Redwood City Medical Center, for example, while at the for-profit Los Angeles Community Hospital, women had a 47 percent chance of undergoing a surgical birth. When you factor in moms who needed to have C-sections for medical reasons, the Los Angeles hospital’s rate jumps to 59 percent. In Riverside County, hospitals just miles apart had dramatically different rates, even though they serve essentially the same population.
Some critics say the numbers provide ammunition to those who have long suspected that unnecessary C-sections are performed to help pad the bottom line.
“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.
To doctors and other health professionals, the results of the analysis were troubling.
“We take this extremely seriously. The wide variation in C-section rates really is a cause for concern,” said Dr. Jeanne Conry, California district chairwoman of the American Congress of Obstetricians and Gynecologists.
This was the first independent analysis of C-section rates at the 253 hospitals reporting birth statistics to state health authorities from 2005 through 2007 and the first showing for-profit hospitals with higher rates than nonprofit ones. Studies in other countries have shown the same relationship between for-profit health care institutions and C-sections.
The notion that hospitals could be pushing C-sections for money is “a wrong premise,” according to Tenet Healthcare representative Rick Black, who said the decision to perform the surgery is made by the doctor and patient, while the hospital exerts no direct influence.
“You don’t just come into a hospital and they say, ‘We want to give you a C-section so we can drive up profits.’ ”
In 2008, more than 180,000 C-sections were performed in California. It’s unclear what percentage of these procedures led to adverse outcomes because some injuries are the result of underlying conditions.
By comparing hospitals with similar demographics, the California Watch analysis revealed that rising C-section rates cannot be completely attributed to changes in patient health and preference.
“If you look at this variation among hospitals, it’s clear we can’t just blame women,” said Debra Bingham, president-elect of Lamaze International, a group that promotes natural birth.
Pressure for a C-Section
Even at nonprofit hospitals, some women say they felt pressured to have a C-section.
Rebecca Zavala, 29, a teacher and make-up 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
