PROVIDENCE, R.I. (WPRI) — When Nora Crowley’s doctor told her she’d need to have a C-section, she burst into tears.
“I’ve been working through the feeling that my body couldn’t do what it was supposed to do,” Crowley said. “That’s been a hard part of the recovery.”
In addition to the psychological distress of the unexpected abdominal surgery, Crowley said the physical recovery was excruciating. There were nights she considered going to the emergency room for the pain.
“It didn’t seem like that was a normal reaction,” she said.
Crowley is far from alone. In 2022, data collected by the Rhode Island Department of Health showed a third of babies were delivered via cesarean, and it’s a number that’s been climbing locally and nationally.
Now, health leaders are looking to decrease the number, particularly C-sections among those who are considered “low-risk,” defined as first-time moms with a full-term baby that’s head down.
Last year, Rhode Island’s low-risk C-section rate was 30.2%, which is higher than the region and the national average, according to the Health Department.
“Those are high numbers,” said Dr. Neel Shah, an OBGYN and chief medical officer of Maven Clinic, a New York-based digital health company that serves as a virtual clinic for women’s and family health issues.
Shah, a Brown and Harvard graduate who’s spent much of his career studying C-section data, said it shows there’s no population benefit to a C-section rate over 19%.
“The difference between 20 and 30 percent really, really matters,” Shah said. “Across the country that is potentially hundreds of thousands of people that are getting surgery that don’t need it.”
“I would go as far as to say the decision to do a C-section is the largest and most consequential surgical error in the world based on how often we get it wrong,” he added.
Elizabeth Rochin with the National Perinatal Information Center is working with local institutions to get the low-risk C-section rate down to 23.6% by the year 2030.
“There are absolutely reasons why we need to do [C-sections], why a mom’s health or baby’s health could be in jeopardy and in that case it’s important to do so,” she said. “But [then] there are low-risk women.”
Research has shown C-sections can increase a mother’s risk of infection, hemorrhaging or death. It also reveals that, when a woman has one C-section, she’s more likely to get another, which further drives up the overall rate.
“A first-time C-section is a pretty straight forward surgery but the second or third or fourth time even they can get pretty complicated,” Shah said, noting that obstetric surgeons are among the only ones who repeatedly cut on the same scar. “There is real morbidity and real harm to doing too many C-sections.”
WATCH: Extended interview with Dr. Neel Shah (Story continues below.)
In 1970, the C-section rate in the United States was roughly 5%, according to the National Institutes of Health.
Shah said the way women give birth has changed from generation to the generation. He also said the rise in C-section rates can’t be precisely attributed to moms being older or more obese, the increased use of in vitro fertilization, or even higher reimbursement rates incentivizing surgery.
Instead, he said it comes down to the environment laboring mothers are put in: something akin to an ICU where they’re surrounded by surgeons who are trained to perform surgeries. He also said understaffed labor and delivery floors could be a factor.
When asked if providers might decide to do a C-section sooner to open a labor and delivery room more quickly, Shah said, “100% yes.”
“In fact, that’s probably the biggest explanation for the variation in C-section rates by hospital and the changes over time,” he said, adding fewer than 1% of expecting mothers elect to have a C-section. “The hard thing is to persist. The easy thing is to go to the operating room, and we actually have data that shows the busier a labor floor is, the more likely it is for a C-section to happen.”
The Health Department provided 12 News with a breakdown of low-risk cesareans by birthing center last year. The data revealed that Landmark Medical Center in Woonsocket had the highest rate at 35.4%, followed by Women and Infants (30.3%), South County Hospital (30.1%), Kent County Memorial Hospital (29.2%) and Newport Hospital (26.3%).
Joseph Wendelken, a spokesperson for the Health Department, said a myriad of factors contribute to the varied hospitals’ rates, including the fact that some hospitals care for more high-risk patients. The numbers could also include elective C-sections among low-risk women, he said.
“The Noreen Stonor Drexel Birthing Center at Newport Hospital is fortunate to have a premier tertiary maternity hospital in the state to take care of our patients who need a higher level of care. As a result, we tend to have a higher rate of low-risk vaginal deliveries (and lower rate of C-sections),” said Dr. Emily Blosser, an OBGYN with Newport Women’s Health. “We owe much of this to the excellent collaborative care that other centers in the state provide.”
“While we have made great progress, we are not done,” Dr. Kevin Charpentier, chief medical officer for South County Health told 12 News in a statement. “We have been extremely successful, reducing the C-section rate by 6% from 2022 to 2023. This is in contrast to the Rhode Island, national, and international trends, which continue to display a rise in C-sections. This has largely been accomplished through a patient-focused approach, educating patients on the safest method for each patient and their baby to deliver based on their individual medical history and needs.”
Charpentier said they’ve set a goal to get their C-section rate below 24% by 2024.
12 News first reached out to Care New England — which owns Women and Infants Hospital — seeking an interview in mid-September, but no one was made available. On Tuesday, a spokesperson also said she could not provide a comment for this report. Women and Infants conducted the vast majority of low-risk C-sections in Rhode Island last year.
A spokesperson for Landmark Medical Center did not return a request for comment by the time of publication.
Shah and Rochin offered solutions like the increased use of midwives and doulas, investing more in maternal healthcare and empowering mothers throughout the process.
Crowley remains focused on her baby’s health as she continues her physical and mental recovery, but worries that other moms who undergo the surgery might not have access to the same resources she has.
“When doctors are recommending that C-section be the path forward, recognizing it’s not routine for the patients. It might be an easy hour for the doctor but it’s not at all for the parent in front of them,” she said. “If we’re not making sure people are getting access to that kind of support, I think having those numbers go higher is a scary prospect.”
In addition to the rise in C-sections, the United States is also dealing with rise in maternal morbidity. In 2021, the Centers for Disease Control and Prevention reported that the number of women who died during or shortly after pregnancy hit its highest rate since 1965. It’s an issue that disproportionately affects women of color, according to the data, and is a greater problem in the United States than any other high-income country.