That and they make significantly more money.
Always, always, follow the money!
No, they don't pay us that much more. The hospitals charge a significant surcharge for C-sections, but the doctor gets no increase at all from most insurance plans. The figure a delivery is a delivery. The following article sheds light on the REAL reason.......
Primary elective C-section up 20% from 1999 to 2001; VBAC rate at 12.7%: overall C-section rate is at a record 26.1%
OB/GYN News, Sept 1, 2003 by Gwendolyn Hall
The rate of primary elective cesarean sections is on the rise.
Among women with no prior history of cesarean section, the rate rose almost 20% between 1999 and 2001, from 1.56% to 1.87%. Primary elective or "patient choice" C-sections now comprise 22% of primary preplanned cesarean deliveries, according to a report issued by HealthGrades, a health care quality company.
Overall C-section rates continue to rise, up 7% since 2001, with the national rate at a record 26.1%, the Centers for Disease Control and Prevention reported in preliminary data for 2002. Meanwhile, the vaginal birth after cesarean section (VBAC) rate continues to drop sharply, down 29% from 16.4% in 2001 to 12.7% in 2002 (Natl. Vital Stat. Rep. 51[11]:1-20, 2003).
The national C-section rate of 26.1% in 2002 is an "all-time record, and part of that is patient-choice cesarean," Dr. Bruce L. Flamm, area research chairman and a practicing ob.gyn, at the Kaiser Permanente Medical Center in Riverside, Calif., said in an interview.
The HealthGrades study defined primary patient-choice cesarean sections as first-time C-sections in women who have not labored, have no prior history of C-section, and have no medical indications for C-section. The study, which included 1,920 hospitals in 18 states, found that the rate of primary patient-choice cesareans in 2001 was 1.87% among women with no prior history of C-section. This extrapolates to about 62,970 women nationwide.
In evaluating the appropriateness of primary, preplanned C-sections in various hospitals, the investigators tried to determine how many patients who underwent a C-section actually had a medical indication for the procedure. "No one has really been tracking that particular patient subgroup," said Dr. Samantha Collier, vice president of medical affairs at HealthGrades, Denver.
Although the study did not address why the rate of primary elective C-sections is increasing, Dr. Collier noted that two factors may play a role: the perceived long-term consequences of vaginal delivery and the perception that the risks of C-section and vaginal delivery are equal.
The patients who are choosing to have cesarean deliveries are likely to be first-time mothers. "They're older, more affluent, more educated, [and] more empowered, so we're just seeing trends that also reflect certain patient characteristics," she said.
Among physicians, not all believe that the risks of C-section and vaginal delivery are comparable.
Of those who do, some hold "an ethical, professional belief that women should have the right to decide what's best for them.... If you think the risks are equal, then you see greater benefit to the patient to be able to choose. If you think the risks are truly different--that C-section still carries more--then C-section is really not a viable option," she said.
Dr. Flamm said that he has "mixed feelings" about primary elective C-sections. "I have concerns that there is no free lunch," he said. If a woman has a patient-choice C-section this year, she may come back in 2 or 3 years pregnant again, and then she's a pregnant patient with a scarred uterus, which carries some risks of its own."
The decision then has to be made whether she should attempt VBAC or have another cesarean. "Both of those options have higher risk than in a woman without a scarred uterus," he said.
VBAC carries the risk of uterine rupture, and a second cesarean carries the risks of placenta previa, placenta previa accreta, and often the complicating factors of scar tissue and adhesions.
"Statistics prove that the majority of babies born in this country are not [from] planned pregnancies." So even if a woman believes she will have just the one cesarean section, "things in life don't always work out that way," Dr. Flamm said.
Patient-choice C-section "may be a reasonable choice for some patients," but women also can have misconceptions about the procedure, Dr. Flamm said. Some feel that a C-section "is not really an operation."
In addition, many journal articles published in the past few years have reported perineal trauma and damage to the pelvic floor with vaginal birth, and some of those have filtered into the lay press. "Some of these things are based on very little data, yet the perception is out there that having a baby tears you to shreds," he said.
As for the current difficulties with VBAC, "there is no question that it is very difficult for some physicians and hospitals to comply with [American College of Obstetricians and Gynecologists] guidelines on VBAC," Dr. Flamm said. But if they can't, they still have several options. The first is not to do VBAC. The second is to transfer the patient to a facility that can perform the procedure according to ACOG guidelines.
There is a third option available to communities where it's not possible to have staff standing by around the clock ready to perform emergency cesareans. Staff in these locations could agree beforehand to stay at the hospital when a VBAC patient comes in.
Such a situation may occur a few nights a month, as opposed to every night, "not an untenable compromise," Dr. Flamm said.
[GRAPHIC OMITTED]
The HealthGrades report is available online at www.healthgrades.com.
COPYRIGHT 2003 International Medical News Group
COPYRIGHT 2003 Gale Group
What might be a contributing factor is that C-sections can be scheduled or at least involve no waiting, and are therefore more convenient in some instances for the doctor. But without the risk of lawsuits for NOT performing a C-section, this wouldn't be an issue, since there are increased risks with surgical patients that would outweigh the convenience factor. In a sane world, a doctor would be INCREASING his malpractice risks by proceding with a surgical procedure.
No, the fundamental calculus is this: If the doc performs a C-section then he "did all he could", whereas if he doesn't, and there is a bad outcome, then he is toast in court thanks to Edwards, et al saying that it was the failure to perform a C-section that caused Johnny not to get into Harvard, or whatever...
Provide real tort reform, and C-section rates will drop significantly.