C-section rate varies in state

Health center’s analysis finds disparity across counties

Births by Cesarean section are far more common in some parts of Arkansas than others, an analysis released Thursday by the Arkansas Center for Health Improvement found.

From 2019 through 2021, the percentage of deliveries performed via C-section ranged from 45.6% in Dallas and Desha counties to 26.2% in Johnson County, according to the analysis by the center of birth records and insurance claims.

Statewide, the percentage deliveries by C-section was 33.5%, slightly above the national rate in 2021 of 32.1%, the center said.

The center also analyzed low-risk births by mothers giving birth for the first time. Low risk was defined as a woman pregnant with a single child — not twins or other multiples — giving birth after at least 37 weeks of pregnancy, with the baby in the head-down position.

It found the C-section rate for such births statewide was 27.6%, slightly above the national rate of 26.3%.

Within Arkansas, the rate ranged from 15.2% in Woodruff County to 45.3% in Desha County.

Healthy People 2030, a federal initiative that identifies public health priorities, set a national target of reducing the national C-section rate for low-risk, first time births to 23.6%, the center said in a news release.

Dr. Joe Thompson, the center’s president and CEO, said multiple factors account for the variation in C-section rates within Arkansas.

Some of the difference could be explained by a “mother’s desire or physicians’ practices,” he said.

“We need to look at these things to know when to use C-sections when appropriate but then when to reserve them and not use them for elective opportunities that place either the mom or the baby at increased risk,” he said.

A C-section delivery can be medically necessary, but for most pregnancies a vaginal delivery is safer, with a lower risk of complications such as infection, blood loss, blood clots and injury to organs, the center said in its release.

“We definitely have an access problem for people in the rural areas and even in

other parts of the state where the C-section rates are high,” Thompson said.

After Desha County, the counties with the highest C-section rates for low-risk, first-birth deliveries were Ashley, Chicot, Drew and Stone, with rates of 42.5%, 41.2%, 37.6% and 35.7%, respectively.

The five counties with the lowest rates were Woodruff, 15.2%; Searcy, 17.1%; Johnson, 17.8%; Marion, 18.4% and Boone, 18.7%.

Statewide, the C-section rate for low risk, first-birth deliveries was 32.5% for Black mothers, 36.6% for American Indian or Alaskan Native mothers and 26.7% for white mothers.

“Health care providers, stakeholders and policymakers should explore the reasons behind these differences and work to ensure that mothers only receive this procedure when it is necessary, wherever they live,” Thompson said.

In many births, especially first births, the health of the mother may play a role in determining if a C-section is necessary, Thompson said.

“This is a challenge that contributes overall to the maternal mortality rate,” Thompson said.

“Obviously we’ve got wide variations across the state. Many of those could be due to maternal risk. We know that high blood pressure, Type 2 diabetes and obesity can lead to maternal challenges that could result in a C-section.”

According to the U.S. Centers for Disease Control and Prevention, Arkansas’ maternal mortality rate, 43.5 deaths per 100,000 births, in 20182021 was the highest among states for which a rate could be reliably calculated.

Sarita Hendrix, a practicing doula who co-founded the Ujima Maternity Network, which works to increase the number of Black midwives, doulas and lactation consultants in Arkansas, attributed high rates of C-sections in some areas to lack of education among patients about their options.

“If a doctor tells a patient that her baby is gigantic and won’t fit through her pelvis, of course she’s going to elect to have a C-section, because she’s scared. If women are not well versed on what their options are, of course they’ll elect to have a C-section,” she said.

Hendrix said many C-sections are a result of inducing labor, which she said can lead to many complications for both the mother and the baby because “the body is being forced to do something it’s not naturally ready to do.”

A lack of health care providers in some areas could also contribute to higher C-section rates, she said.

“Many Black and Native women are in rural areas, and if they are in an area where there is maybe one or two obstetricians, [a C-section] is what’s going to happen,” she said.