A colleague from Evansville, Ind., recently looked at cesarean section rates for Indiana hospitals and sent a spreadsheet file out to those of us who wanted to see it.

Of course I wanted to see it.

The data she gathered from the Indiana Department of Health is public, though you have to ask for it then extract it from databases and dig through it to compare numbers and prepare reports yourself. Did you catch that? Ask, extract, dig through, compare and prepare? That’s a lot of work, something I — and, apparently, the IDH — don’t have time to do.

You can check out the report, compiled carefully by doula and childbirth educator Andie Gunter, here: http://www.andiethedoula.com/apps/blog/show/10724520-indiana-hospital-cesarean-rates-2010. Thanks, Andie, for taking the time and making the effort.

Because there are so many questions to ask and answer, if I had any say-so — and a whole bunch of money — I’d hire a professional statistician to micro-analyze the numbers.

Like … How many cesareans started with inductions? Included augmented labor? Included epidural anesthesia before surgery was in the picture? What’s the surgery rate for planned out-of-hospital births? What about the rates for vaginal births after cesarean (VBAC)? I’d be interested in specific provider cesarean rates, which — I found once when I asked a defensive Elkhart obstetrical practice — are hard to come by.

I’ve been told my use of statistics sometimes is a little soft — I’m definitely no mathematician, and I, like most everyone, take a little license to support an assertion. But even if Andie’s numbers are off by a percentage point here and there, we can still draw some solid conclusions to consider.

Let’s look.



ACCORDING TO ANDIE’S calculations, which she garnered from hospital discharge data, there were 81,380 hospital births in Indiana in 2010. Some 31.4 percent of those hospital births were by cesarean section, she figured.

Quick note: There likely were more Indiana births overall, as some 1 percent to 2 percent of women — me one of them — birth outside the hospital, meaning hospital discharge data would not include some births. Obviously, however, all cesarean sections themselves are done in the hospital, so the cesarean section number of hospital births should be about accurate.

Does everyone know what cesarean section is? It’s extracting a baby from its mother via major abdominal surgery. Personally, I refuse to call it “giving birth” and insist on often using its factually accurate terms — ie, “major abdominal surgery,” like I just did — just to keep it real.

Though it is an oft-performed surgery and thus likely has become safer to undergo than in years past, in medical terms, it’s still serious business. It is not, I repeat NOT, a simple “alternative” to having a baby the nature-intended way.

For a decent overview of cesareans, check out the International Cesarean Awareness Network at www.ican-online.org for solid information about the procedure.

That percentage for Indiana — 31.4 percent — is slightly lower than the national average for 2010, which the National Center for Health Statistics logged at 32.8 percent.

By the way, that 2010 national number — 32.8 percent — was down one-tenth of one percent from the all-time high cesarean rate of 32.9 percent in 2009. The rate rose every year for 13 years from 20 percent in 1996 to 32.9 percent in 2009.

All that just so you know: There’s been a gross rise in the number of major abdominal surgeries performed as a form of childbirth in our country. Where it was one in five in 1996, it’s one in three now.

One in three. If that does not offend you — it should.

To wit: The World Health Organization says that, for developed nations like ours, a better rate is more like one to two out of ten. One could infer, then, that, perhaps, some half of all our cesarean sections are avoidable if not downright unnecessary.



WHY SO MUCH SURGERY then? Well, that’s one of the $64,000 questions. (The “$64,000 question” is an obscure reference to a 1950s-era game show I’ve actually never watched. Just means it’s the BIG QUESTION.)

The answer is multi-pronged, no doubt, and spans arenas of politics, finances, philosophy and medicine.

For an introduction to the bigger issue of “medicalized birth versus natural birth” — which is a very broad way to begin to look at it all — I recommend starting with the book “Pushed: The Painful Truth about Childbirth and Modern Maternity Care” by Jennifer Block or with the documentary DVD “The Business of Being Born.” You can find both at local libraries for sure along with a slew of related information on the Internet.

So, back to it. In Indiana, we’re doing cesareans on something like 31.4 percent of mothers birthing in the hospital and on some women who plan to birth out of the hospital but end up there with complications. (My very informal guess at those numbers, based on my experience working with out-of-hospital maternity care providers, is that less than 10 percent of planned out-of-hospital birthers end up in the hospital at all, and fewer than that have cesareans.)  

Again — why so many surgeries as birth?

Next week I’ll take a look at what we’re TOLD are the reasons — and what else might be at play. For now, suffice to say if you don’t need a cesarean, take it from me: You don’t want one.



Goshen News columnist Stephanie Price is a wife, mother, teacher, childbirth educator, midwife’s assistant and nursing student living in Union, Mich. Contact her at wholefamily@goshennews.com or 269-641-7249.