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Emily MacDonald

The Rise of Cesarean Sections and Maternal Mortality in The United States

Through the data that I accumulate the question I am attempting to answer is: What effect
does the increasing cesarean section rates have on maternal mortality, as well as what is causing
cesarean section rates to rise so much in the United States? The reason I find this to be an
important question is that expecting parents are almost never fully aware of what to expect
during the process of childbirth. Unless you are a medical professional, it is likely that you have
not been taught what determines if the mother and/or the baby is really in danger during birth.
Therefore, in these situations the parents will most likely take the word of the doctors without
much question. I believe that pregnant women may not be fully aware of why doctors decide to
perform a cesarean section, and I fear that this allows doctors to decide that a mother will have a
cesarean section even if it is not completely necessary.

If cesarean section rates are high in the United States, then I hypothesize that this is
causing an increase in maternal mortality rates in the United States as well. It is widely known
that although cesarean sections are now a normal procedure, they do have more risks to them
than vaginal deliveries do. According to Mayo Clinic, some of the risks of this abdominal
surgery include infection, blood clots, postpartum hemorrhage, increased risks in future
pregnancies, and more. Cesarean sections are, however, necessary if the mother or baby is at risk
of being harmed during a vaginal delivery. If the rate of cesarean sections are continuing to
increase, then there are higher chances that these risks will be encountered, resulting in an
increase in maternal mortality.

Additionally, if the increase in cesarean sections does correlate with the higher maternal
mortality rates, then I hypothesize that this says there is at least one incentive for doctors to
decide that patients should have a cesarean section as opposed to a vaginal delivery. I believe
that the patients’ lack of medical knowledge would allow doctors to convince the mothers that a
cesarean section is necessary even if it is avoidable.
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In order to prove my hypotheses to be either true or false, I will collect data that shows
the maternal mortality rates and cesarean rates in the United States and compare it to other
countries. If the rates for the United States are significantly higher, then this shows there is
something that the United States is doing wrong. I will also compare different states within the
United States to further be able to tell if there is a correlation between cesarean rates and
maternal mortality. Finally, I will compare the costs of both cesarean deliveries and vaginal
deliveries to infer if this is a potential reason that the United States would have higher rates of
cesarean sections and maternal mortality than other countries.

The figure above shows information from the CIA World Factbook, and it displays the
maternal mortality rates per 100,000 births in 2015 of eight different countries. As you can see
the United States has the highest rate out of these countries with 14 deaths per 100,000 births,
and the United Kingdom is the second highest with 9 deaths per 100,000 births (cia.gov). Out of
these eight countries, the country with the lowest maternal mortality rate was Sweden with only
4 deaths per 100,000 births (cia.gov). According to ProPublica, “the U.S. has the highest
maternal mortality in the industrialized world”. Furthermore, severe complications following
childbirth are also more common in the United States (ProPublica.org).
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This second figure shows information collected from Forbes, and displays the cesarean
delivery rates in 2013 for seven countries including the United States. As shown, the United
States still leads with a rate of 32.5 cesarean deliveries per 100 births, however, Australia is not
too far behind with 32.2 cesarean deliveries per 100 births (forbes.com). Sweden has the lowest
rate, with 16.4 cesarean deliveries per 100 births (forbes.com). Looking at both of the graphs
above, it is interesting to see that the country with the highest maternal mortality rate also has the
highest cesarean delivery rate, and that the country with the lowest maternal mortality rate also
has the lowest rate of cesarean deliveries. I was also surprised to find that the United States
seems to have a significant lead in maternal mortality rates amongst the countries shown, but as
far as cesarean delivery rates, the United States leads but not by a very large amount compared to
the other countries, especially Australia and Germany. I would interpret this to mean that
cesarean delivery rates do play a role in maternal mortality rates, but other factors also play a
role. For example, this could mean that the United States has the highest rate of unnecessary
cesarean deliveries.

I also decided to focus on the maternal mortality rates in each state in the United States.
From the data I acquired from America’s Health Rankings by the United Health Foundation, I
could see that there are significant differences in maternal mortality rates in each state. The state
with the highest maternal mortality rate in 2016 was Georgia with 46.2 deaths per 100,000 births,
and the state with the lowest maternal mortality rate in 2016 was California with 4.5 deaths per
100,000 births (americanshealthrankings.org). Immediately when I see this I ask myself why
there is such a wide range of deaths in each state. Other states with high maternal mortality
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include Louisiana, Indiana, New Jersey, Arkansas, and Texas (americashealthrankings.org).

Meanwhile Massachusetts, Nevada, Colorado, Hawaii, and West Virginia are amongst the states
with the lowest maternal mortality rates (americashealthrankings.org).

The figure below shows the cesarean delivery rates in 2016 by states, with information
obtained from the Centers for Disease Control and Prevention National Center for Health
Statistics. As shown, the state with the highest rate of cesarean deliveries is Mississippi with 38.2
percent of all live births being cesarean sections, followed by Louisiana, Florida, New Jersey,
and Connecticut (cdc.gov). According to the Centers for Disease Control and Prevention
National Center for Health, the state with the lowest rate of cesarean deliveries is Utah with 22.3
percent of all live births being cesarean sections, followed by Alaska, Idaho, New Mexico, and
Hawaii.

Comparing this information on state cesarean delivery rates with state maternal mortality
rates, it is interesting to see that there isn’t a completely direct correlation between the rates of
each. For example, California has the lowest mortality rate but also has about an average amount
of cesarean deliveries compared to other the other states. However, there generally does seem to
be a trend that states with higher cesarean delivery rates typically also have higher maternal
mortality rates. States such as New Jersey, Minnesota, and Louisiana are examples of states that
fall almost exactly in the same ranking for both rates. I believe it is accurate to state that the trend
does exist, there are just some states that are exceptions.
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Observing this data leads to asking the second part of my question: Why is there such a
large rate of cesarean deliveries and maternal mortality rates in the United States, and certain
specific states? One way to attempt to answer this is by looking at the costs of both vaginal and
cesarean deliveries. From data collected from Castlight Health, I could compare the differences
in costs of both types of deliveries in different cities. For example, according Castlight Health, a
cesarean delivery in Sacramento, CA would on average cost $27,067 while a vaginal delivery
would on average cost $15,420. A similar trend can be seen in each of the other cities listed; on
average it is much more costly to have a cesarean delivery than a vaginal delivery.

The initial question that I asked was: What effect does the increasing cesarean section
rates have on maternal mortality, as well as what is causing cesarean section rates to rise so much
in the United States? I hypothesized that if cesarean section rates are increasing in the United
States, then this is causing an increase in maternal mortality rates in the United States as well. I
believe that the data shows that the rise of cesarean deliveries do play a role in higher maternal
mortality rates. The United States has by far the highest maternal mortality rate out of the
countries observed, and has the highest rate of cesarean sections. Looking at each state
individually, states with higher cesarean rates generally also have higher maternal mortality
rates. Additionally, I hypothesized that if the increase in cesarean sections does correlate with the
higher maternal mortality rates, then this says there is at least one incentive for doctors to decide
that patients should have a cesarean section as opposed to a vaginal delivery. I observed the costs
of both types of delivery within various cities in the United States and found that cesarean
deliveries are much more costly. I believe this means that doctors have a financial incentive to
persuade mothers to have a cesarean section even if it is not completely necessary. Women most
likely aren’t able to tell for themselves if they really need a cesarean or not, so they don’t want to
question a doctor if they say to deliver through a cesarean. I think the question that this brings up
is: What can be done to lower the amount of cesarean deliveries?
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Works Cited

Central Intelligence Agency, Central Intelligence Agency, www.cia.gov/library/publications/the-world-

factbook/fields/2223.html.

Ellison, Katherine, and Nina Martin. “Severe Complications for Women During Childbirth Are
Skyrocketing - and Could Often Be Prevented.” ProPublica, ProPublica,
www.propublica.org/article/severe-complications-for-women-during-childbirth-are-
skyrocketing-and-could-often-be-prevented.

Magill, Shannon. “New Study Shows Huge Cost Differences for Having a Baby, Often in the Same
City.” Castlight Health, 30 June 2016, www.castlighthealth.com/press-releases/new-study-
shows-huge-cost-differences-for-having-a-baby-often-in-the-same-city/.

Mayo Clinic Staff. “C-Section.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9
June 2018, www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655.

McCarthy, Niall. “Which Countries Have The Highest Caesarean Section Rates? [Infographic].” Forbes,
Forbes Magazine, 12 Jan. 2016, www.forbes.com/sites/niallmccarthy/2016/01/12/which-
countries-have-the-highest-caesarean-section-rates-infographic/.

“National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease
Control and Prevention, 1 Feb. 2018,
www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm.

United Health Foundation. "Explore Maternal Mortality in the United States | 2018 Health of Women
and Children Report." America's Health Rankings,
www.americashealthrankings.org/explore/health-of-women-and-
children/measure/maternal_mortality/state/ALL.