A report released Wednesday found that Long Island has among the state's highest rates of Caesarean sections, which some doctors say is driven by the Island's socioeconomics and fear of lawsuits.
In Nassau, 41.5 percent of women in 2007 had babies by C-section; in Suffolk, 42.7 percent. Statewide, 34.1 percent of women in 2007 had babies by surgery, according to the report by Public Citizen in Washington, D.C. Only Westchester County was higher, with 43.1 percent.
Caesareans are associated with higher rates of surgical complications for the mother, more re-hospitalizations, and complications for the baby requiring admission to neonatal intensive care units, said a report published last month by the U.S. National Center for Health Statistics. Hospital charges for a C-section cost almost twice that of a vaginal delivery, the report said.
Eight states have higher C-section percentages than New York. Nationally, 31.8 percent of women got Caesareans in 2007 - a percentage that has been growing. In 1996, about 20.7 percent of births were C-sections, according to the report.
Experts point to several factors that may contribute to Long Island's high rates, which are typical in higher socioeconomic areas, said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group.
Age is a major factor, said Dr. Gustavo San Roman, an obstetrician-gynecologist at St. Charles Hospital in Port Jefferson. Older women are more likely to undergo a C-section. Nationally the average age of a first-time mother is 25; at St. Charles it is 31, he said.
Inducing labor with drugs, which can be a convenience for both the patient and the doctor, also increases the risk of C-sections, said Dr. Adiel Fleischer, chairman of obstetrics and gynecology at North Shore University Hospital and Long Island Jewish Medical Center. Fleischer said elective inductions are no longer allowed at the two hospitals.
Fear of lawsuits is another factor, Fleischer and San Roman agreed. Long Island's obstetricians pay the highest malpractice premiums in the state, $178,000 a year, according to Ed Amsler, vice president of Medical Liability Mutual Insurance Co., the state's largest malpractice insurer.
Many doctors at smaller community hospitals that don't have the ability to do emergency Caesareans are fearful of letting women who have had a previous C-section try to have a vaginal birth the next time because of the small risk of uterine rupture, Fleischer said.
But Wolfe said these issues do not explain - or excuse - the high percentage of C-sections. Statewide, one-third are unnecessary, he said. "It's the culture of the doctors," he said. "It's the default to do a C-section and that's the wrong default."Midwives are less likely to recommend C-sections, Wolfe said. That is in part a function of having lower risk patients, but also of spending more time educating mothers and staying with them throughout labor, said Christina Kocis, a midwife at Stony Brook Midwifery Practice. "We are not impatient," she said.