Erica Hensley
Though they can be life-saving, growing research suggests that cesarian sections, or C-sections, are vastly overused in the United States, especially among first-time moms who are low-risk. At best, this can strip autonomy from new parents. At worst, it can cause irreversible infertility and complications that can result in death.
C-sections are major abdominal surgeries with immediate and long-term risks, including infection, hemorrhage and future placenta problems. The more of these surgeries a woman has, the riskier they become due to repeated irritation of scar tissue. C-sections are also correlated with increased maternal mortality — an important consideration in Mississippi, which has one of the highest maternal mortality rates in the U.S.
The problem isn’t unique to Mississippi — but it is worse in Mississippi. Across the country, C-sections have been on the rise for decades. The rise in the surgery coincides with the introduction and widespread use of electronic fetal monitoring, which experts say points to providers’ increasing reliance on technology, and an aversion to what used to be considered normal risk in birth — without improved outcomes.
In Mississippi — where 39% of births result in C-sections and 32% among low-risk women — the problem becomes more complicated, with poverty, provider shortages and lack of access to health care playing significant parts, as well as a history of racial bias baked into the obstetrics system.
Markedia Perryman, 31, is still dealing with complications from a C-section four years ago — which resulted in an infection, an emergency transfer to another hospital and a month-long stay there after delivery. She wasn’t able to breastfeed or bond with her daughter in those first few weeks.
“When I got home, me being away from my daughter for so long, when I tried to hold her … she wouldn’t do nothing but cry. She didn’t know me because she wasn’t around me, that hurt me a lot,” she said.
Nearly half — 46.7% — of birthing folks at low risk for a C-section received one anyway at her hospital, in the rural Mississippi Delta, between 2014 and 2022 — the highest in the state across the decade.
To date, this is the first known reporting on low-risk C-sections at hospitals in Mississippi — one of the most dangerous places to give birth in the U.S. The C-sections investigated here are those that occur in first-time moms who are at least 37 weeks pregnant and delivering a single baby in the head-down position. These cesareans, referred to in the medical world as NTSV — which stands for nulliparous, term, singleton, vertex — are described by the Centers for Medicare and Medicaid Services and other federal agencies as “low-risk cesareans.”
Despite national pressure to reduce these types of C-sections, Mississippi’s rate has stayed high across the last decade — peaking at 32.5% in 2018, according to data obtained from the Mississippi State Health Department. While the state’s overall prevalence of these surgeries is high, it’s the extreme variation across otherwise similar hospitals that shows the layers of a complex problem, experts say.
“C-section rates vary so widely at the hospital level, such that a person’s biggest risk factor for getting a C-section isn’t her personal preferences or [medical] needs,” said Dr. Neel Shah, an OB-GYN and chief medical officer at Maven Clinic, a virtual clinic for women focused on reducing barriers to maternal health care, whose medical research has focused on preventing unnecessary C-sections. “It’s which door she walks through.”
Read our two-part series — the problem and the solutions — in collaboration with Mississippi Today here.
