Apr 29, 2024 - Health

1 in 3 births: C-section rate increases, again

Share of babies delivered by cesarean section, 2023
Data: CDC; Map: Axios Visuals

The rate of cesarean births in the U.S. has gone up, again.

Why it matters: About one in three births in the U.S. are C-sections, according to new data, well above the 10-15% rate that the WHO considers "ideal."

By the numbers: The national C-section delivery rate increased in 2023 to 32.4%, up from 32.1% in 2022, according to provisional CDC numbers.

  • That's the highest rate since 2013, and the fourth annual increase after the rate generally declined 2009 - 2019, the CDC says.
  • The rate of low-risk cesarean deliveries (mothers' first births of full-term, head-first singletons) increased from 26.3% in 2022 to 26.6% in 2023, the highest rate since 2013, per the CDC

Yes, but: An increase in C-sections doesn't necessarily mean the rate of unnecessary procedures has risen — there are other factors at play.

Patients are sicker overall.

Repeat C-sections account for many procedures, even though the old "too posh to push" idea is not widely held.

  • "If you have already had a C-section, you will almost always be offered — and indeed the default is likely to be — a second," says Emily Oster, economist and author of "The Unexpected," her book about navigating pregnancy complications, due out April 30.

Between the lines: Hospital politics might also come into play.

  • For example, there are cases when doctors are more inclined to perform C-sections because that option would less likely lead to a medical malpractice lawsuit, Van Dis says.
  • And health care system reimbursements for C-sections are generally higher than for vaginal births. "Financial incentives almost always play some role," Oster says.

What they're saying: The "biggest consideration" with having a C-section is "future fertility," because of an increased risk of complications in later pregnancies, Oster tells Axios.

  • Compared to a vaginal delivery, a C-section doesn't lead to a statistically different outcome for the baby, but it's a major abdominal surgery that tends to require a longer short-term recovery for the mother.
  • Overall, a C-section "is an absolutely safe method of childbirth that should be available, and it should not be the first choice," Oster says.

Vaginal deliveries also come with their own risks.

  • And there are many situations — like in cases of breech birth, the presence of certain placenta problems, and severe preeclampsia — where a C-section should be performed, Van Dis says.

What we're watching: Expanding access to doula care — as new legislation in New York does — could lower the rates of C-sections.

  • A number of studies already suggest that the presence of doulas lowers the use of C-sections, Oster says.
  • Doulas are there for psychological support during the often-overwhelming labor process, and to help with birth positions that could avoid the need for a C-section, Van Dis says.
  • "Doulas should be in every hospital … paid for," she adds.
Go deeper