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C-section scrutiny saving Oklahoma money

by The Oklahoman Editorial Board Published: August 9, 2012

Macduff, the Thane of Fife, was from his mother's womb “untimely ripped.”

So wrote Shakespeare in “Macbeth,” a play about an ambitious Scot who'd been told he faced no harm from any man “of woman born.” The bard also wrote about Julius Caesar, another figure from history linked to an unnatural delivery — almost certainly false because his mother didn't die in childbirth. Not until 1500 A.D. did a mother and child survive what we now know as a C-section. Nevertheless Caesar's association with “untimely” births has stuck.

What was once dangerous for the baby and fatal for the mother is now a medical procedure viewed as relatively safe but not always necessary — and possibly a detriment to infants. As reported by The Oklahoman's Jaclyn Cosgrove, this state has the nation's 14th highest cesarean delivery rate. Nationally, as many as 20 percent of C-sections aren't medically justifiable.

The Oklahoma Health Care Authority wants to reduce the number of expensive C-section births. The authority is the state's Medicaid administrator. As such, it's forced to stretch scarce dollars in covering medical services. Doctors accepting Medicaid are being scrutinized. If the rate of C-sections crosses a threshold of 18 percent, the fees paid to physicians and hospitals are reduced. Just the threat of reduced fees has had the effect of lowering C-sections significantly, according to the authority.

Induced births related to convenience rather than necessity are a luxury that Medicaid can't afford. The authority and private insurance carriers have an obligation to scrutinize nonemergency C-section births. There's also the effect on children: Infants who are born this way tend to have higher rates of admission to neonatal intensive care units.

The debate about C-sections isn't much ado about nothing. The procedure is often medically justified. The current scrutiny is aimed at cases where it isn't.

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