Low-Risk Cesarean Delivery in Indiana

Indiana

Nearly one-third of births in the United States were delivered by cesarean (C-section) in 2024. Cesarean delivery is the surgical removal of the baby through an incision in the abdominal wall and uterus. Research indicates that many cesarean births are elective or unnecessary. Variations in practice styles among obstetricians and a lack of a standard process for determining the need for a cesarean delivery contribute to the overuse of this procedure. 

While cesarean deliveries are necessary in some situations, such as slow labor progression, fetal distress or health concerns for the woman, they can cause unnecessary short- and long-term side effects for parents and infants if performed without medical need. C-sections are associated with increased maternal mortality and morbidity compared with vaginal births and are associated with health risks for mother and infant, including:

• Surgical injuries. 
• Uterine lining infections (endometriosis) among women. 
• Postpartum hemorrhage among women. 
• Increased risk of complications in future pregnancies among women.
• Breathing problems among babies.
• Developing allergies or asthma later in life among babies.
• Increased risk of childhood infections.

Surgical procedures are associated with prolonged admissions, making cesarean births more costly than vaginal births. A recent study found that the average spending per C-section among those with employer-sponsored health insurance was $28,988, compared with $15,712 for a vaginal delivery.

The prevalence of low-risk cesarean delivery is higher among:

• Women age 40 and older compared with younger women. The prevalence of low-risk cesarean delivery increases with each increase in age group.
• Black, Asian and Native Hawaiian and Pacific Islander women compared with Hispanic, white and American Indian and Alaska Native women.
• Women with underlying health conditions, such as diabetes, hypertension or obesity. 

After a woman has had a C-section, there is an 86% chance that any subsequent pregnancy will also be delivered by C-section. However, rates of women attempting vaginal birth after a cesarean (VBAC) are increasing nationwide. As of 2024, the annual VBAC rate was 15.5%.

The American College of Obstetricians and Gynecologists recommends that health care providers encourage women without an indication for a C-section to plan on having a vaginal delivery and that providers do not perform elective C-sections before 39 weeks of gestation. Efforts to support vaginal delivery after a cesarean can reduce birth-related morbidity. 

Strategies to reduce C-section rates include:

• Enhanced patient education.
• Supportive care models.
• Policy reforms.
• Interdisciplinary collaborations.
• Monitoring and evaluation.

The Robson 10-group Classification System created by the World Health Organization (WHO) classifies cesarean births across hospitals to improve quality of care. Adopting this system could be beneficial in the United States as it would provide a standard process for determining the need for cesarean deliveries.

Studies show that having the continuous support of a doula throughout pregnancy and labor can reduce the incidence of low-risk C-sections. States can finance and support community-based doula practice through Medicaid policies. Recommendations include providing Medicaid reimbursement for doula services, setting reimbursement rates that adequately cover the costs, and creating fiscal incentives for quality care and performance in maternity care. 

Women can take proactive steps to reduce their risk of a C-section, such as staying physically active and talking with their health care provider about labor and birth preferences.

Healthy People 2030 has an objective to reduce cesarean births among low-risk women with no prior births.

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