Insurance Companies Urge Doctors & Hospitals to Ease Up on C-Sections


Major insurance companies, including Aetna and Cigna, are asking obstetricians and hospitals to ease up the number of c-sections.

Research shows that c-sections–which now account for one-in-three births in the US–can lead to increased complications as well as costs. Recent studies have showed increased risk for early (>39 weeks), elective inductions and c-sections.

“We’ve known the risks of these procedures for a long time, yet the rates continue to rise,” Maureen Corry,  executive director at Childbirth Connection, a New York-based advocacy group focused on maternity care,  told, “The payors are finally saying, ‘Enough is enough. This is crazy.'”

Though life-saving under specific circumstances, many experts consider the US c-section rate of 33.5%, too high. The World Health Organization has suggested that the c-section rate be no higher than 15% in the industrialized world. Once c-sections eclipse this rate, one can argue that the risks of the surgery start to outweigh the benefits.

C-sections run approximately twice what a vaginal birth costs. Aetna and Cigna will offer incentives for hospitals to reduce c-section rates: Aetna will adjust costs for cesareans;  Cigna is considering this and bonuses for hospitals that bring their rates down. Insurance companies are working with advocacy organizations to figure out how to bring the c-section rate down. In 2009 United Health Group Inc,, the biggest U.S. health insurer, gave $60,000 towards a symposium on maternity care run by Childbirth Connection.

Here’s a good quote from Business Week about the incentives for doctors to perform surgery:

“Insurers are trying to shift what Main* calls the ‘perverse incentives’ that push doctors to speed up deliveries. C- sections not only pay more; along with inductions they also allow doctors to cluster births and schedule other visits around them, he said. And they assure a physician will be on hand for a delivery — and get the insurance payment — when a baby arrives. Wary of litigation, many hospitals also refuse to do vaginal births if a mom has had a prior C-section, even when natural delivery is a viable option, Main said.”

(*Elliott Main is the chairman of obstetrics and gynecology at California Pacific Medical Center in San Francisco.)

It will be interesting to see how rates of c-sections (and complications) change once these incentives are in place.


Ceridwen Morris (CCE) is a childbirth educator and co-author of the pregnancy and birth guide, From The Hips. Follow her pregnancy and birth blogging on Facebook.



photo credit: Michael E Clarke/Flickr

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