If you’re pregnant or planning to become pregnant, whom you choose as your maternity provider is a big deal. Your physician and hospital should ideally be trustworthy, up front about procedures, and in your insurance network. If your pregnancy is an uncomplicated one, you will probably also want to consider the doc’s cesarean section rate for similar pregnancies.
That’s because more C-sections are performed nationwide than are necessary, and rates have been rising. To put a number on that rise, the national C-section rate was 22 percent in 1990 and jumped to 32.7 percent just 20 years later in 2010. More recent data suggests nationwide cesarean section rates have been leveling off in the past few years, but averages are still much higher than decades past. Currently, only one state in the country performs cesareans at a rate below the 1990 average.
Certainly, some women need the procedure, which can save the lives of both mother and baby if there are problems. C-sections are common for mothers of multiples, older women, and high-risk mothers, all of whom are good candidates for the procedure. Still, far more women are receiving cesarean sections than fit into these groups, and there are downsides to the procedure.
For a healthy woman with a healthy pregnancy, an unnecessary C-section can result in unwanted complications, longer recovery times, and much higher hospital bills. So even if everything goes smoothly with your C-section, you’ll probably end up paying more: Natural births cost about $30,000 on average nationwide, while cesarean deliveries cost about $50,000.
There are a number of reasons these rates might be rising. Some research suggests doctors might be ordering C-sections for financial incentives. Since it is a surgery, the hospital can charge you more for that procedure than it does for a vaginal birth, and the doctor is paid more as well.
This notion was shrugged off until a 2013 study showed that doctors are almost 10 percent less likely to have unplanned cesareans themselves than non-physicians. The research, done by the (non-government) National Bureau of Economics Research, also showed physicians have better health outcomes during childbirth, and concluded that financial incentives do play a role, though possibly an unintentional one, in the ordering of an unplanned C-section.
Rates of C-sections vary widely, and can even be vastly different between hospitals within the same city and state, but there are also national trends. In fact, the state that performs the most cesarean births does so at a rate twice as high as the state that performs the least.
The Ten States with the Most Cesareans
1. Louisiana 39.7 percent
2. New Jersey 38.4 percent
3. Florida 37.8 percent
4. Mississippi 37.0 percent
5. West Virginia 36.0 percent
6. Kentucky 35.4 percent
7. Alabama 35.3 percent
8. Connecticut 35.1 percent
9. Texas 35.1 percent
10. South Carolina 35.0 percent
These 10 states also happen to be the only states with cesarean rates at 35 percent or higher, and are all located in the southern and eastern parts of the United States. There are higher rates of obesity and diabetes in the south, both of which tend to make for complicated pregnancies, but there are no studies that have linked the two directly. The rates are based on Centers for Disease Control and Prevention (CDC) statistics for the year 2010, the most recent year complete statistics are available.
The Ten States with the Fewest Cesareans
1. Alaska 21.5 percent
2. New Mexico 22.8 percent
3. Utah 23.1 percent
4. Idaho 24.8 percent
5. Colorado 25.9 percent
6. Wisconsin 26.0 percent
7. South Dakota 26.6 percent
8. Arizona 27.0 percent
9. Minnesota 27.1 percent
10. Hawaii 27.2 percent
These 10 states with the lowest C-section rates are mostly western and midwestern states with sparse populations. These states are also among the fittest in the nation, which could translate into healthier mothers needing fewer cesareans. You may notice that Minnesota and Hawaii have similar rates. Vermont, North Dakota and Wyoming were all within one percentage point of Hawaii’s rate, so rank among the states with the lowest rates as well.
Finding a Quality Provider
If you’re newly pregnant or planning to be, you can potentially save yourself a lot of money and possible problems down the road by doing a little homework before choosing an obstetrician and hospital for maternity care. Always select a doctor and hospital in your insurance network, and call the office to ask what their C-section rates are.
You may also want to know how the doctor manages emergencies and, if you turn out to have a high-risk pregnancy, what the plan would be. Lastly, check into whether the hospital your doc has privileges at offers a comprehensive maternity package for uncomplicated pregnancies. This can save you money by offering a base price for the total delivery, instead of charging for each specific service.
Lacie Glover writes for NerdWallet Health, a website that empowers consumers to find high quality, affordable health care and insurance.