There is wide variation in the rate of cesarean sections performed at different hospitals across the U.S. and one explanation has been that hospitals with higher c-section rates serve greater numbers of women at high risk for the procedure. Now, a new study by researchers from Harvard School of Public Health (HSPH) and the Massachusetts Department of Public Health provides the strongest evidence to date that it’s not just medical need that determines who has c-sections, but also something at the hospital level—in other words, the same woman would have a different chance of undergoing a c-section based on the hospital she chooses.

The findings suggest that certain hospitals’ high rates of cesarean births have more to do with characteristics of the hospitals themselves than with characteristics of their patients.

“Even after taking into account factors that put women at risk of having a c-section, such as age,  and pre-existing health conditions, some hospitals still have higher rates of c-section delivery than others,” said senior author S V Subramanian, professor of population health and geography at HSPH. Put simply, for two women with a similar observed risk profile, one might have a c-section delivery and one might not, depending on which hospital they go to, he said.

The study appears in the March 18, 2013 online issue of the journal PLOS ONE. The article is available at this link: http://dx.plos.org/10.1371/journal.pone.0057817.

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