October 2016

New Health of America Report Links C-Section Rates to Where Members Live

The rates of babies delivered by cesarean section (C-section) varies widely by geographic location, indicating that where a mother lives has a significant impact on how she will give birth, according to the newest Health of America Report by the Blue Cross and Blue Shield Association (BCBSA). The study, Cesarean Birth Trends: Where You Live Significantly Impacts How You Give Birth, represents a comprehensive analysis of medical claims from 3 million commercially insured Blue Cross and Blue Shield members across the U.S.

Results of the study show that in a five-year span from 2010 to 2015, certain parts of the country – primarily the West South Central divisions of the U.S. – had the highest C-section rate of 39.4 percent, while the lowest rate of 29.3 percent was found in the Mountain division. In fact, the rate of C-section deliveries was more than twice as high in some parts of the country than in others, after adjusting for factors such as age, breech birth and multiple births.

The study looked at markets that had at least 5,000 births from 2010 to 2015. Among markets served by Blue Cross and Blue Shield of Texas, those making the list of markets with high C-section rates include most major markets in Texas, including Houston, Dallas-Sherman-Denison, San Antonio, and Midland-Odessa. The south Texas market that includes McAllen, Edinburg, Mission, Brownsville and Harlingen had the third highest rate of C-section use across the nation, only trailing behind Miami, Florida and Jackson, Mississippi.

While the reasons for the variations were not included in the study, the report indicated that factors such as local and regional practice patterns and malpractice laws may play a role.

The data also pointed to a consistent decline in the national rate of C-section births, reversing a 20-year trend of increasing rates. Given the increased medical complications and extended recovery time association with C-sections, this reversal is promising. The report does not examine the cause or factors that affect the rate decrease. It notes that general awareness by women and the medical community as well as trends toward healthy living could be contributing to the decline.

Besides the higher likelihood of complications for mothers and babies, C-section deliveries that are not medically necessary add cost to the health care system. For commercially-insured BCBS members the average cost difference between cesarean and vaginal deliveries, adjusted for risk, currently exceeds $4,000 -- $17,482 for C-section compared to $13,32 for natural birth.

For more information, see the full report.