Every year, more mothers in California deliver their babies by Caesarean section.
Thirty-three percent of births in California were performed by C-section in 2008, compared with 22 percent 10 years earlier. The upward trend is happening with mothers across the demographic spectrum, regardless of race, age or weight.
The numbers come from a report released this week by the California Maternal Quality Care Collaborative, a Palo Alto-based group of government agencies, hospitals and physicians' associations from across the state.
Sometimes C-sections are medically necessary, as in breech births where the baby is oriented feet-down, the report said.
When they're not strictly necessary, surgical births raise "considerable" financial costs and risks of health complications for the mother, such as bleeding and infection, the report's authors wrote. They estimated the price of a C-section to be about 70 percent higher than for a vaginal birth.
Other oversight groups have weighed in on the Caesarean boom, which is happening nationwide. The Joint Commission, the national nonprofit that accredits hospitals, wrote in its standards: "There are no data that higher rates improve any outcomes, yet the C-section rates continue to rise."
The World Health Organization formerly pegged the ideal C-section rate at 10 to 15 percent of births, but last year erased that recommendation, saying simply that women should have the procedure if they need it.
In California, rates of birth done by C-section vary widely from hospital to hospital. The CMQCC report found they ranged from 18 percent to over 50 percent at locations across the state. The Sacramento region came out below the state average, with around 28 percent of births done surgically.
The most likely reason for the variation, the report said, is differences in hospital policies and attitudes among doctors and nurses in the childbirth unit.
Changes in recent years have often made C-section the "path of least resistance" for mothers and doctors, the authors wrote. For example, physicians have grown more worried about being sued for malpractice, they said.
To ensure that C-sections are done only when necessary, the authors suggested that health care groups develop new measures of quality against which hospitals can check themselves.
They said the industry should rethink payment systems that give doctors and hospitals substantially more money for performing C-sections.