1 in 3 Arkansas births are by C-section

The rate of cesarean births in Arkansas is higher than the national average, new data show.

By the numbers: Arkansas' rate for C-sections in 2023 was nearly 34% but has declined since 2018, according to provisional CDC data.

Why it matters: The World Health Organization considers 10-15% "ideal."

Zoom out: The national C-section delivery rate increased in 2023 to 32.4%, from 32.1% in 2022.

• That's the highest rate since 2013 and the fourth annual increase after the rate generally declined from 2009 to 2019, the CDC says.

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

Patients are sicker overall.

• With conditions like gestational diabetes and hypertensive disorders in pregnancy on the rise, the need for C-sections could be greater, says Dr. Jane van Dis, OB-GYN and assistant professor at the University of Rochester.
• Van Dis says she believes the rise in those conditions is due to "environmental exposure" and cites increasing use of plastics.

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.

Vaginal deliveries also come with their own risks.

• And there are many situations — like in cases of breech birth, certain placenta problems or 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 lower 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 avert the need for a C-section, van Dis says.
• "Doulas should be in every hospital … paid for," she adds.