Falling C-section rates driven by insurers and patient preference

LOS ANGELES — At hospitals across California, administrators are pushing doctors to perform fewer cesarean deliveries, hiring birth coaches and asking pregnant women to stay in labor longer.

In the era of the Affordable Care Act and its emphasis on low-cost medical care, C-sections — which cost more than vaginal deliveries — have become a sticking point for hospitals and a target for the people paying the bills.

Childbirth is the most common reason for hospitalization in the U.S., said Katy Kozhimannil, a health policy professor at the University of Minnesota, so when insurers and self-insured employers “look at where their costs are going, you start to see cesarean delivery rises to the top.”

In California, maternal care plus a vaginal delivery cost commercial insurers $15,259 on average, while maternal care plus a C-section cost $21,307, according to a report commissioned by the Center for Healthcare Quality and Payment Reform, a nonpartisan research center.