Center for Health Statistics
Texas Health Care Information Collection
Utilization Review: Specific Inpatient Procedures by Texas Hospital Referral Region, 2010
Cesarean section (C-section) is the birth of a baby through a surgical incision, or cut, made in the mother's abdomen and uterus. A primary cesarean delivery means that this is the first time the mother has delivered a baby and this first delivery was performed by cesarean section. The report presents the number of cesarean deliveries per 100 deliveries in women with no history of previous cesarean delivery.
Why is this measure important?
Cesarean section rates vary significantly from region to region and across the United States. There is considerable debate about the high utilization rates for this procedure and the appropriateness of performing this operation on some patients. Good clinical practice aims to minimize the use of C-sections for women who can avoid it. Such an operation entails major abdominal surgery which means that women take much longer to recover from the birth than they would have if they had delivered their baby vaginally. Also, there are greater risks to the mother, such as a higher risk of contracting a hospital-borne infection, if they undergo major surgery. In addition, cesareans are more expensive then vaginal deliveries.
Why might there be variation?
Variations may be a result of regional practice patterns. Other factors, such as patient preference, type of hospital or type of insurance, may also produce variation in the utilization of this procedure. While the appropriateness of Cesarean delivery depends largely on patients' clinical characteristics, studies have shown that individual physician practice patterns account for a significant portion of the variation in Cesarean delivery rates. Non-clinical factors such as patient insurance status and hospital characteristics have also been related to rates. Cesarean delivery is the most common operative procedure performed in the United States and is associated with higher costs than vaginal delivery. Statewide rates decreased from 27.91 in 2001 to 18.92 in 2007, but remain higher than the target of 15 recommended by Healthy People 2010. The overall Cesarean delivery rate cannot determine appropriate use, but the variation in rates across institutions and regions may, if the variations do not reflect variations in patient disease severity and comorbidities.
What does this measure tell us?
The graphs and tables in this section show:
These measures are calculated by comparing the total number of cesarean deliveries with the total number of deliveries. The number of C-sections does not include cases where there was a previous delivery, an abnormal presentation (e.g., the baby was in the breech position), the baby was delivered pre-term, it had died or there was more than one. Cesarean delivery has been identified as an overused procedure. As such, lower rates may represent better quality.