Cesarean delivery rates ranged from as low as 7% to as high as 70% at U.S. hospitals, a nationwide study showed.

The magnitude of the variation was more than could be accounted for by case mix, suggesting a possible quality-of-care problem, Katy Backes Kozhimannil, PhD, of the University of Minnesota School of Public Health in Minneapolis, and colleagues reported.

Even among lower-risk pregnancies, ‘in which more limited variation might be expected,’ hospital cesarean rates varied 15-fold, from 2% to 37%.

‘Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many U.S. hospitals,’ they wrote in the March issue of Health Affairs. ‘Because Medicaid pays for nearly half of U.S. births, government efforts to decrease variation are warranted.’

C-section is the most common procedure done in the operating room, and boosted the cost of delivery to an average of almost $13,000 compared with $9,000 for vaginal births in 2010, based on a prior study of private health insurance payments.

Both overuse and underuse of cesarean delivery may be clinically harmful as well, with higher risk of infection, injury, and need for emergency hysterectomy for the mother and greater risk of asphyxia, respiratory distress, and other pulmonary disorders […]