Too Many C-Sections

There are a lot of places in the health care system where we can save money, but C-sections are a real potential. Although there are many situations where a Cesarean is indicated for the safety of the mother or baby, there is a pretty big gray zone of situations where C-sections are performed but perhaps unnecessarily. I've even encountered an extreme where the mother simply didn't want to labor, and wanted to go straight to C-section. I think if we tumble down the slippery slope of offering C-sections simply to avoid the normal process of labor and delivery, we will run into a lot of problems. C-sections are, in words from Macbeth, a child "from his mother's womb / Untimely ripped." The process of labor is important both for mother and child. The recovery is much easier. The amount of anesthetic required is much lower. The risks are fewer. And though we balk at thinking of costs in the U.S., the cost difference is significant. A C-section buys a patient more days in the hospital; it makes future pregnancies more likely to go to C-section; it involves operating room time; and it uses up a lot of resources which are ultimately finite. It's so easy to forget that a Cesarean is an actual surgery. We should only invoke it when necessary. Unfortunately, the financial incentives are against it; surgeons, anesthesiologists, and even the hospital makes more money from a C-section than a regular delivery. So it can be so easy for a clinician to offer it when the patient is in that gray zone. To fix this, we need culture, policies, and education around decreasing unnecessary C-sections.