Impacts of the Rising Cesarean Rate and Evidence-Based Strategies for Intervention

The escalating C-section rates have paralleled rises in maternal and perinatal morbidity and cost billions in additional health care spending annually. These recent and sharp trends reflect a larger problem with the way birth is managed and suggest a larger cultural shift in obstetric care. Despite increased attention and research on the impacts of the rising rate of C-sections, the public health field offers little practical guidance on how to effectively reverse this trend.

This session aims to: (1) identify the health and economic impacts of the increased incidence of cesareans, (2) examine current evidence-based practices and policies that effectively reduced cesarean rates (3) consider missed opportunities for intervention.

Based on a review of the evidence, five critical places for intervention emerge: 1. Develop clearer and more standardized guidelines for obstetrical interventions. 2. Restrict the use of elective inductions. 3. Level payment structures that reimburse for costs of labor. 4. Combat incentives that encourage providers to perform cesarean sections. 5. Make cesarean birth more mother-baby friendly and family centered.

This section will dissect three existing programs and policies that incorporate one or more of the above objectives in an effort to reduce the rate of primary C-sections or mitigate the health consequences associated with the procedure. Second, this discussion focuses on potential barriers to the implementation and examines strategies to overcome these obstacles. Finally, this session identifies missing places for intervention.