- Puerto Rico's C-section rate has skyrocketed to more than 50% of all deliveries, compared to more than 32% in the continental United States, according to a federal report.
- Cesarean section rates on the island increased in each age group under 40 from 2018 to 2022, after being stable for nearly a decade.
- The reasons behind the surge are varied, including the struggles of the island's health care system with limited hospital staff and resources.
The U.S. territory of Puerto Rico has seen a sharp increase in C-sections, with the highest C-section rate in the world, with more than 50% of babies now delivered surgically, according to a federal report released Wednesday. In the continental United States, it is only 32%.
After remaining flat for nearly a decade, C-section rates on the island increased for each age group under 40 from 2018 to 2022, according to the U.S. Centers for Disease Control and Prevention.
Although the report did not provide an explanation, Puerto Rico medical experts say there are a variety of reasons behind the surge, including the island's crumbling health system.
Caesarean section birth rate soars to over 20% worldwide
“Hospitals generally have limited personnel and few economic resources,” said Dr. Carlos Díaz Vélez, president of the Puerto Rican Association of Surgeons.
Doctors and nurses work in the neonatal intensive care unit at a medical center in San Juan, Puerto Rico, on May 11, 2010. Cesarean sections are rapidly increasing in Puerto Rico, a U.S. territory that has one of the highest rates of caesarean sections in the world. New federal report released on January 10, 2024. (AP Photo/Ricardo Arduengo, File)
As a result, she said, obstetricians and gynecologists prefer to schedule C-sections to ensure they have all the medical personnel needed for the birth.
“They prefer to create things organically rather than improvise,” Diaz says. “It guarantees safety.”
Over the past decade, more than a dozen delivery rooms have closed across Puerto Rico, with just 17,772 births reported last year, as doctors relocated to the U.S. mainland and a record low number of births. This is the lowest since record-keeping began in the late 1880s.
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Díaz said a spate of lawsuits he described as “frivolous” against Puerto Rican obstetricians and gynecologists over the past decade also prompted doctors to schedule C-sections to reduce risk.
Additionally, in Puerto Rico, epidurals are often not covered by insurance companies, so women may prefer a C-section for aesthetic reasons or to avoid pain, said a specialist in maternal-fetal medicine who specializes in high-risk pregnancies. said Dr. Annette Perez Delboy, who previously worked at a medical facility at home. new york.
“In Puerto Rico, women are afraid of giving birth vaginally,” she says.
Pérezdelvoy agreed with Díaz that a shortage of medical workers is also contributing to the increase in C-sections. In addition, IVF is on the rise, more twins are becoming pregnant, and caesarean sections are on the rise to avoid risky births, she noted.
Perezdelvoy also said that up-and-coming doctors are not accustomed to using forceps or vacuum cleaners, and as a result are opting for C-sections to avoid legal action.
“Doctors in Puerto Rico are better off doing C-sections because they get paid more, deliver babies on time, have less risk of litigation, and mothers go home happier,” she said. Doctors and patients added: I realize that vaginal birth is better. “Everyone knows that, everyone understands that, but you have to put yourself in the shoes of the doctors.”
In recent years, Cesarean births in Puerto Rico have increased by more than 10% in three of the six municipalities that reported at least 1,000 births, according to a CDC report.
According to the report, the biggest increase was among mothers under 20, who jumped from 37% to more than 42%.
Puerto Rico's health department said more than half of C-sections performed on the island were not medically justified and nearly 80% of women who underwent the procedure had no risk factors.
Heidi Ann Vera, a 47-year-old mother of two, is one of the few women to have a C-section for medical reasons.
“It was an emergency,” she said. “That wasn't planned.”
She was working with a doula to prepare for a home birth, but her son wasn't in the right position and his blood pressure started to spike.
“That's when we decided to go to the doctor,” she said.
The World Health Organization recommends a caesarean section rate of 10% to 15%, noting that the average caesarean section rate in the Americas is nearly 40%. The agency said there is no evidence that mortality rates improve once the mortality rate exceeds 10%.
Brazilian women reportedly spend thousands of dollars on C-section parties
“The sustained and unprecedented rise in C-section rates is a serious public health concern,” the group said in a 2018 report.
Although caesarean section is considered a safe surgery, the World Health Organization (WHO) says that all surgeries carry risks and that if a caesarean section is performed in an area with limited resources, it may affect future pregnancies or He pointed out that it could put someone's life at risk.
The organization said the factors contributing to the increase in C-sections are complex, with the most common reasons being fear of pain, the convenience of scheduling births, and the fact that C-sections are traumatic for babies. He added that there is a perception that there are few.
In the United States as a whole, C-section rates are much lower but on the rise. Although it generally decreased from 2009 to 2019, it has gradually increased for three consecutive years, accounting for 32.2% of births in 2022, a slight increase from 32.1% the previous year.
Data for 2023 has not yet been released.
