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C-sections leap to 1 in 3 births in Bay State, to outstrip US

Email|Print| Text size + By Stephen Smith
Globe Staff / February 14, 2008

One-third of Massachusetts infants, the highest proportion ever, were delivered by caesarean section in 2006, according to a state report released yesterday.

The report charts a dramatic rise in surgical deliveries in the past decade. In 1997, barely 20 percent of Bay State babies were born via C-section, placing the state slightly below the national average. By 2006, the Massachusetts rate had eclipsed the national figure.

The state's secretary of health and human services, Dr. JudyAnn Bigby, said yesterday that she was sufficiently alarmed by the findings that she is establishing a panel to investigate the steep increase. That panel, Bigby said, could potentially set standards for delivery methods in obstetrical units.

"It's important for us to step back and say, 'Why is this happening, and is it in the best interest of the public?' " said Bigby, whose research before entering state government had focused on women's health issues at Brigham and Women's Hospital. "This is not a minor surgical procedure; it's a big deal. We need to understand why this trend continues."

But there's far from universal agreement among maternal health specialists that C-sections are riskier than vaginal deliveries.

A panel of specialists convened by the National Institutes of Health concluded in 2006 that while vaginal delivery may be safer in some ways (with a lower risk of infection), C-sections are safer in other ways (with a lower risk of incontinence later in life). Ultimately, the commission decided it could not find enough evidence to routinely recommend for or against C-sections.

Eugene Declercq, a Boston University School of Public Health researcher who has studied delivery trends extensively, said he finds the rise in C-sections worrisome.

"Caesareans are an absolutely appropriate approach to deal with a whole array of risk factors," he said. "But obviously a third of births are not high-risk births."

Bigby and other specialists attributed the increase in C-sections to a constellation of factors, many reflecting broader trends in healthcare.

For one, women are giving birth later in life, when complications are more common and when C-sections may thus be viewed as medically necessary. Increasing obesity rates are another potential cause, with obese mothers more prone to difficulties during pregnancy and delivery.

Obstetricians, Declercq said, sometimes grow weary of waiting for women to complete a lengthy labor. "You're waiting around forever," he said. "The patience has been lost, and at that point it becomes much easier to say, 'Let's do a caesarean.' "

Obstetricians' fears of lawsuits may also fuel some of the increase.

"There's no doubt about the medical-legal burden; the litigious nature of society has an impact on this," said Dr. Fred Frigoletto, chief of obstetrics at Massachusetts General Hospital. "Very few obstetricians have been litigated because they did a C-section. But they're always litigated because they didn't do one."

Frigoletto said it is important for medical and financial reasons to monitor caesarean delivery rates and to explore the underlying reasons for changes in the use of the procedure.

C-sections are the most common form of surgery in the nation, he said, and cost more than vaginal deliveries.

Some of the increase in recent years, Frigoletto said, may be attributable to a change in medical orthodoxy about handling a woman's pregnancies after she has had a C-section.

It once was popular to deliver subsequent babies by vaginal birth, but by the late 1990s the practice began to fall out of favor because of potential risks.

The findings about C-section rates were part of a larger annual report on births in Massachusetts. That study also found that racial gaps in infant mortality rates persist in the state, with African-American babies more than 2 1/2 times more likely to die before their first birthday than white infants.

Black babies are almost twice as likely as Hispanic newborns to die before the age of 1.

"We continue to face an unacceptable gap for African-Americans compared with white infants," said Dr. Lauren Smith, medical director of the state Department of Public Health.

The report also found that gestational diabetes among expectant mothers rose from 2000 to 2006, with nearly 4 percent of women developing the condition during their pregnancies.

Asian women were the most likely to be diagnosed with gestational diabetes.

Stephen Smith can be reached at stsmith@globe.com.

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