Is Money Motivating Doctors To Perform C-Sections?

Chances are, when you found out you were pregnant with your first baby, you wanted a vaginal birth — perhaps even an unmedicated physiological birth.

Maybe you planned to have some medicinal pain relief, but your chosen option was a vaginal birth.

According to the Listening to Mothers survey, just 1% of women who have a primary c-section choose to do so without medical necessity, meaning most first time mothers begin pregnancy desiring a vaginal birth.

In spite of this there is a c-section rate of around 30%, double the World Health Organization’s recommendation of just 10-15%. Statistics above this level have not been associated with saving more lives. This means about half of the women having c-sections might be having them without medical necessity.

So why are c-section rates so high? One recent study has found that money could be motivating doctors to perform more c-sections than are medically necessary.

Are Doctors Performing C-Sections For More Money?

Health care economists Erin Johnson and M. Marit Rehavi, who published a paper for the National Bureau of Economic Research, wanted to investigate the reasons for high c-section rates and wondered whether money might be a motivating factor for performing c-sections. They calculated that doctors often receive a few hundred dollars more for attending a c-section birth rather than a vaginal birth, and hospitals receive thousands more.

As well as examining the financial incentives, they also looked at other factors that might influence a provider to perform a c-section. One was patient knowledge; they found that fellow physicians were less likely to have a c-section.

Do Physicians Receive Better Care Than Others?

An NPR story likened c-sections and patient knowledge to car maintenance and knowledge. Have you ever taken your car to the mechanics, and been offered a lot more services than the oil change you brought it in for? If you’re knowledgeable about cars, you can probably assess whether or not your car does in fact need extra services. If you’re not familiar with cars, you might be inclined simply to accept them all.

The published results found something similar with regard to birth and c-sections. The healthcare economists found that physicians were 10% less likely to have a c-section than non-physicians, suggesting that having more knowledge leads to better birth outcomes.

Incentive Isn’t Always Monetary

The study also found that in situations where physicians aren’t paid differently, based on birth outcome, the c-section rate among non-physicians is actually lower than among physicians. This could mean that women who might benefit from a c-section birth aren’t being offered one.

In places where physicians’ pay doesn’t change, based on the type of birth, the incentive might be that a vaginal birth has fewer potential complications, and requires less time actually providing patient care.

Are Doctors Making Decisions Based On Time And Money?

While this study shows a correlation between money or time incentives, and c-section births, Johnson doesn’t believe doctors are fully conscious of the role money might play in their decision-making process. Several studies and analyses find that doctors are influenced in a variety of ways – most of them subtle.

It’s vital to remember that each doctor is a unique individual whose practice is based on his or her own medical and birth philosophies, hospital policies, and other factors. This economic analysis doesn’t mean that doctors will perform c-sections simply to make money, nor that they will refuse a necessary c-section, and choose an easier option. What it does suggest is that there are several factors at play when investigating high c-section rates.

What Does This Mean For Me?

If you are pregnant, and not already a physician, chances are you won’t complete your medical studies before you give birth. Fortunately, when it comes to birth outcomes, there are two big factors you can control: choosing your maternity care provider and educating yourself. It’s not uncommon to choose an OB based on location, convenience of scheduling appointments, or a friend’s recommendation. Neither is it uncommon to spend just a couple of hours on childbirth preparation.

When it comes to choosing a maternity care provider it’s a good idea to be sure their birth philosophy and their statistics reflect the type of maternity care you desire. If your OB or midwife has a high c-section rate, regularly induces at 40 weeks, and encourages medicinal pain relief, but you desire an unmedicated vaginal birth, you’re likely to find your prenatal, labour and birth care frustrating. If your OB or midwife has a c-section rate closer to the WHO recommendation, believes your estimated due date is just an estimate, and believes that birth is a normal physiological process, then your desired unmedicated birth is likely to be better supported.

While a comprehensive childbirth preparation class certainly isn’t medical school, it can definitely help you become more knowledgeable about birth. Knowing the benefits and risks of procedures, and what to expect during a normal physiological birth can help you make informed decisions regarding interventions and c-section birth. Also available are wonderful books, to build your confidence in normal physiological birth, and give you the information you need to make decisions about your care.

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It can be worrying to see analyses suggesting that healthcare providers might not always act solely in your best interest; but remember that this is only one piece of the large healthcare puzzle. Each provider is an individual, and many are acting in your best interest. As a consumer, you can be an active participant in your healthcare, and should discuss all care options presented to you. Most importantly, you can choose a healthcare provider that you trust.