Why we need to prioritize lowering C-section rates

Family benefits continue to be an essential part of DE&I strategies. In the midst of the maternal mortality crisis in the U.S., which impacts Black women at three times the rate of white women, it’s important to consider the risks of every part of growing and building a family—especially the procedures during childbirth and postpartum care. One factor that may be contributing to the maternal mortality crisis is the increase in C-sections, especially along racial lines. 

But why is lowering C-section rates important? Although C-sections are critical procedures in certain scenarios, their increased usage suggests deeper problems: that the risk factors necessitating C-sections are rising or that people are receiving potentially unnecessary surgeries. 

Why are C-sections becoming so widespread?

A Cesarean section, or C-section, is the surgical delivery of a baby through incisions in the abdomen and uterus. “We’re always trying to decrease the rate of primary C-sections or first C-sections,” adds Ericka Quezada-York, a midwife and Certified Nurse Midwife (CNM). “It is an option in cases that we truly need it.” The procedure can be lifesaving for birthing people and their babies during complications during pregnancy, but C-sections are also associated with higher risks in future births, health challenges, and a more difficult return to work. By providing comprehensive resources and care, employers can play an important role in supporting their employees in this crucial moment of their family-building journeys. 

How are C-sections contributing to the maternal mortality crisis?

One of the biggest factors for deciding to perform primary C-sections is race—and these decisions have huge ramifications. “Over the past five years, as we’ve talked more about the maternal mortality crisis and obstetric racism, I’m finding people more willing to acknowledge that the high rate of C-sections is part of it,” explains Quezada-York. From 2018 to 2020, C-section rates were highest for Black birthing people (35.8%) and Asian birthing people (32.6%). “The real reason for higher rates of C-sections among marginalized communities is systemic racism. In the Black and Latine communities, there are high rates of gestational diabetes and preeclampsia,” explains doula and nurse Qef Johnson. “But when you look back on that, those factors are largely due to systemic racism, like access to nutritious food, stress from jobs, racism, and life.” 

There are many reasons for racial disparities in care that lead to increased C-section rates among racial lines, including: 

• Providers underestimating and undertreating factors in pregnancy that could later contribute to Cesarean risk
• Patients not feeling heard and being unable to express their needs to their providers. “A lot of the maternal mortality in this area that occurs happens after C-sections, and that goes back to systemic racism as well,” says Johnson.
• Providers not acting on communicated preferences from minority patients 

“People aren’t listening to Black families when they say something is wrong,” says Johnson. “So if a patient is already pressured into a C-section and then maybe afterward they feel extra bleeding or pain, that isn’t taken as seriously because it’s a Black person saying it.”

The risks of C-sections

A C-section may be the right choice for some birthing people and their families, but should come with education, support and open conversations with providers. For many people, C-sections are seen as the ‘safer’ option. While C-sections are the most common obstetric surgery performed today, there are greater risks associated with the procedure. Research shows that C-sections are associated with 2.7 times the risk of negative health outcomes after childbirth compared to vaginal delivery. 

“The biggest risks of C-sections are similar to the risks of any type of surgery, which includes blood loss and the risk of infection,” says Quezada-York. “With a C-section, you typically lose two to three times more blood than with a vaginal birth.” Considering bleeding out after giving birth is one of the leading causes of childbearing-related death, people who have c-sections are twice as likely to experience a severe hemorrhage compared with a vaginal birth. 

Additional risks can include: 

• Longer recovery period
• Higher potential for postpartum depression
• Increased risks for future pregnancy 

How can employers help? 

Employers can play an important role in supporting birthing people through their pregnancy and making sure they have the resources necessary to make the best decisions for themselves and their families. “If someone has had a C-section, they need empathy to get through that experience.” To best support employees, employers can: 

1. Offer virtual preconception care, ensuring everyone has access to care that addresses risks to birthing people and partners before conception, and reducing C-section rates through increased education and risk identification 
2. Provide digital care so people can have unlimited access to providers when they need it and more opportunities to catch any issues early, decreasing rates of C-sections
3. Understand that it may take longer for birthing parents to return to work from a C-section due to the physical toll of the surgery. Recovery for C-sections can take from six to eight weeks and may include longer hospital stays than vaginal birth. “They may need more time, but also maybe emotional support,” says Johnson. "Any extra mental support and community support may be helpful. They might need a little more time and leniency in adjusting during the return to work phase.” 

Maven’s approach to lower C-section rates

Maven is the complete digital family health platform for employers seeking to support their teams as they grow and raise their families. With Maven’s diverse array of specialty providers and a whole-person approach to care, members can navigate the complex digital health system easily. By connecting members to 24/7 virtual support with proactive check-ins and ongoing assessments, Maven has lowered member C-section rates by 20%. To learn how you can support your team through all pathways to parenthood, schedule a call with Maven. 

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