Forum Session

Caesar's Ghost: The Effect of the Rising Rate of C-Sections on Health Care Costs and Quality
March 30, 2012


Jessamy Taylor, MPP & Michele J. Orza, ScD


Delivering babies is big business in the United States, with childbirth-related hospital costs totaling $27.6 billion in 2009--7.6 percent of all inpatient hospital costs. The rate of delivery by cesarean section (c-section) has risen steadily over the past 15 years, and now roughly one-third of all births are by c-section. This increase is of concern because, while all deliveries have risks, c-sections are associated with substantially greater risks to the mother and baby. And c-sections are more costly: in 2009, the average cost for an uncomplicated vaginal delivery was $2,962 but an uncomplicated c-section was $5,351.  Medicaid pays for a large proportion of all maternal childbirth-related hospital stays, and in 2009 paid for 42 percent of all c-sections at a total cost of $3.1 billion.

A number of factors have been suggested to explain the high rate of c-sections: maternal choice, physician practice patterns, liability concerns, convenience, guidelines that have discouraged vaginal birth after a previous birth by c-section, and payment incentives.  Although debate continues about the optimal rate of c-sections, and rates vary widely across the states, there is agreement that on average the rate is too high. Healthy People 2020 goals include a 10 percent reduction in c-section rates. Efforts involving numerous private and public partners are under way nationally, in states, and in communities to achieve these reductions in rates.

This Forum session explored the rising rate of c-sections: its drivers and consequences and public- and private-sector initiatives to achieve a more optimal rate.


Related Materials

See also a previous Forum session, "Mission Possible? Saving on Health Care Costs by Reducing Unnecessary Services" (December 2, 2011).

For more on maternity care, see:

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