D.C. is seeing more babies delivered by C-section

By the numbers: In D.C., the 2023 C-section rate was 34.1% according to preliminary Centers for Disease Control data.

• In Maryland, it was 35%, and 32.3% in Virginia.

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

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

• With conditions like gestational diabetes and hypertensive disorders in pregnancy on the rise, there could be a greater need for C-sections, says Jane van Dis, OB-GYN and assistant professor at the University of Rochester.
• Van Dis says it's her hypothesis that the rise in those conditions is due to "environmental exposure," and she cites the 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.

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, 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.