Iowa's C-section rates on the rise
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The rate of cesarean births in Iowa has gone up since 2016 to a little over 30%, according to new data from the CDC.
- Nationally, the C-section delivery rate in 2023 came to 32.4%.
Why it matters: That's well above the 10-15% rate that the WHO considers "ideal."
State of play: Repeat C-sections account for many of the procedures nationally, even though most individuals can have a successful vaginal birth after a cesarean section (VBAC).
Yes, but: In Iowa, it's especially difficult to find a provider who will offer that option, says Rachel Bruns, the International Cesarean Awareness Network's local chapter leader.
- Last year, MercyOne ended the only hospital-based midwifery program in Des Moines that offered VBAC.
- That is directly affecting C-section rates, Bruns tells Axios as well as worse patient outcomes, such as placenta accreta, a life-threatening condition.
Between the lines: Health care system reimbursements for C-sections are generally higher than for vaginal births. "Financial incentives almost always play some role," says Emily Oster, economist and author of "The Unexpected,"
- Some Des Moines hospitals outright ban VBAC services, while others have no policies and leave it up to the doctors to decide, Bruns says.
- Doctors may recommend C-sections to avoid increased liability, Bruns says.
What they're saying: The country's higher C-section rate can also be attributed to care that prioritizes practitioners rather than midwives, who can provide more specific attention to patients, Bruns says.
- Iowa's Medicaid rate reimburses certified nurse midwives at only 85% of the rate for physicians, which does not incentivize hospitals to offer midwifery care.
Reality check: 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 or severe preeclampsia — where a C-section should be performed, says Jane van Dis, OB-GYN and assistant professor at the University of Rochester.