Caesarean Sections at an All-Time High

Here is a great example of what is wrong with American health care:

The Caesarean section rate in the United States reached 32 percent in 2007, the country’s highest rate ever, health officials are reporting.

This is simply crazy. A c-section is major surgery, and unless there is a crisis, turning the natural process of birth into a surgical invasion is bad for both mothers and babies. Every serious analyst thinks the rate should be no higher than 15%, and some think it should be under 10%. It keeps going up because all the incentives in American medicine are aligned toward doing more: the doctors and hospitals make more money the more procedures they do, patients like to feel cared for, and the costs are hidden.

Consider that within the US the rate varies wildly, from 38% in New Jersey to 22% in Utah and Alaska. (I suppose Mormon mothers are more inclined to patiently endure their God-given lot in life, and in Alaska they are all tough from hunting moose.) Higher rates do not lead to better outcomes.

A big part of the problem is the reluctance of many doctors and hospitals to allow a woman who has had one c-section to give birth vaginally, VBAC as it is called. This is also nutty; yes, such women have elevated risks, but c-sections are still worse for most of them.

This is one of those problems that makes me want to be the Tsar.