Kelsey Birch experienced a painful emergency cesarean after labor failed to progress despite pushing for just over two hours following an epidural. The American College of Obstetricians and Gynecologists recommends up to four hours of pushing for first-time labor with an epidural. The half-hour surgery triggered months of recovery, interfered with breastfeeding, caused severe incision pain and scar-tissue adhesions, and produced intrusive memories. C-sections are now the most common inpatient surgery in the United States, with about one in three births delivered surgically. Hospital delivery data from Florida, Mississippi, and Iowa show sharp C-section rate differences between nearby hospitals for similar low-risk patients. Hospital policies, culture, and financial incentives contribute to higher and variable C-section rates.
Birch, a then 28-year-old emergency dispatcher in Colorado, hadn't gone into labor expecting surgery. She was healthy. Her first pregnancy had been going well, and her full-term baby was positioned face down - an ideal candidate for a vaginal birth. As her contractions grew stronger, a delivery room nurse urged Birch to get an epidural before the hospital anesthesiologist finished his shift. Birch agreed.
The American College of Obstetricians and Gynecologists recommends that a woman with an epidural in first-time labor push for up to four hours. Birch pushed for just over two before a doctor intervened. Her labor had failed to progress, her medical records noted, so, like one in three American women who give birth, Birch underwent a cesarean section.
The half-hour surgery began months of recovery. For weeks, Birch struggled to hold and breastfeed her newborn daughter. Her incision site was searingly painful; first as a fresh wound and again as it healed, scar tissue adhering to skin and muscle. Like many women who undergo a C-section, she learned to cope with intrusive memories of the surgery.
C-sections are now the most common inpatient surgery in America. Business Insider analyzed years of hospital delivery data from Florida, Mississippi, and Iowa and found that C-section rates can differ sharply between hospitals just miles apart - even when caring for similar, low-risk patients. Those gaps, experts say, point to how a hospital's policies, culture, and financial incentives can push surgery rates higher, helping explain why the US consistently performs far more C-sections than global health authorities consider necessary.
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