A new report from the Arkansas Center for Health Improvement shows that mothers who live in certain parts of Arkansas are much more likely to give birth through a cesarean section, as revealed by analysis of birth records and insurance claims.
A C-section is used to deliver a baby through surgical incisions made through the abdomen and uterus. Though necessary in certain circumstances, in most pregnancies, particularly in the case of first-time mothers, a vaginal delivery is safer, with a lower risk of complications such as infection, blood loss, blood clots and injury to organs. As such, Healthy People 2030, a federal initiative that identifies public health priorities, has set a national target of reducing the national C-section rate among first-time mothers to 23.6%
ACHI found that, between 2019 and 2021, the statewide C-section rate among all mothers, including those with a previous C-section, was 33.5%, which is slightly higher than the national average of 32.1%. County rates, however, varied significantly from 26.2% at the lowest in Johnson County up to 45.6% in both Dallas and Desha counties.
ACHI also examined C-section rates among first-birth mothers, which were defined in this report as women giving birth for the first time with full-term pregnancies and singletons – i.e. not twins or multiples – in a head-down position. For these mothers, the statewide C-section rate from 2019-2021 was a significantly lower 27.6%, though county rates varied even more drastically from 15.2% in Woodruff County to 45.3% in Desha County. The national C-section rate for first-time mothers in 2021 was 26.3%.
“The wide variation in C-section rates by county of residence shows that where you live has a lot to do with your likelihood of delivering by C-section,” said ACHI President and CEO Dr. Joe Thompson. “These variations are likely associated with both disparate health risks among the mothers and the journey they experience through their pregnancy. Health care providers, stakeholders and policymakers should explore the reasons behind these differences and work to ensure that mothers only receive this procedure when it is necessary, wherever they live.”
The study also revealed a number of other trends: C-section rates for first-birth deliveries statewide were much higher for Black and American Indian or Alaskan Native mothers, 32.5% and 36.6% respectively, than for white mothers at 26.7%. C-section rates for first-birth deliveries also increase dramatically with age, ranging from 18.5% for mothers 20 or younger up to 54.5% for mothers 40 or older. C-sections are also associated with a greater risk of asthma and allergies in children, additional C-sections for future pregnancies, uterine rupture and placenta issues.
ACHI noted that Arkansas women of birthing age, i.e. 18-44, have high rates of diabetes, hypertension and obesity, which could be a factor in C-section rates. It also noted several actions taken by other states to reduce C-section rates. Texas, for example, adopted “hard-stop” policies for labor and delivery services not medically indicated, as well as nonpayment for early elective deliveries prior to 39 weeks, including C-sections. These policies reduced the rates of such deliveries by 10-14%.
New Jersey began a statewide patient safety initiative led by a state hospital association and adopted best practices including provider education, protocols, standardized plans, checklists and screenings, resulting in a 14% reduction in C-section rates between 2016 and 2021. Oklahoma, much like Texas, initiated a program to reduce elective C-sections without medical indication through provider education and reimbursement reform, which brought both reduced C-section rates and cost savings.
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