Connecticut taking steps to reduce its high C-section rates as doctors worry it’s being overused

CT Insider – Tuesday, June 3, 2025
By Cris Villalonga-Vivoni

About one in three babies nationwide are delivered through a cesarean procedure, or C-section, and the rates are continuously rising. C-sections can be lifesaving procedures, however, experts worry that the rapid rate increase over the years shows that the surgery is being overused.

Connecticut has had historically high rates of births via C-section that have steadily increased, too. Now, local providers are taking it into their own hands through education initiatives and continuous labor support.

“C-section is a necessary procedure sometimes. It is life-saving for mothers, and it’s life-saving for babies. What we’re trying to avoid is unnecessary C-sections,” said Dr. Elizabeth Deckers, director of maternal quality and safety program for Hartford HealthCare. “That’s the distinction that we make between a medically needed C-section versus one that perhaps if you had given things a little bit more time, you might have had a successful vaginal delivery.”

The nationwide rate of C-sections rose from 20.7% in 1996 to 32.9% to 2009, prompting some of the first alarm bells for providers. According to the Centers for Disease Control, the rate declined slightly in 2019 but increased again the following year, continuing to fluctuate. It is currently hovering around 32.3%.

In Connecticut, approximately 35% of all live births are through a C-section as of 2023, historically hovering above the national average, according to the nonprofit March of Dimes.

Experts across the world have been theorizing what drives the rapid rise in C-sections, considering international research has shown no clear maternal health benefit. When compared to vaginal delivery, C-sections are associated with a high risk of complications and an increased risk of death. It could also lead to future fertility problems in subsequent pregnancies.

There are times when a C-section is the necessary intervention needed for a successful birth, such as when the labor fails to progress or if there are concerns for the baby’s health, Deckers said.

Yet the rapid increase could indicate variations in labor care standards, more complicated pregnancies, and higher rates of first-time C-sections.

“We’ll never have a C-section rate of zero. That would be unsafe for mothers and babies,” Deckers said. “Nationally, the goal is to have the C-section, 23.6% and so that’s a goal that we’re all working towards.”

Although higher than the national average, Connecticut’s rate has been relatively consistent for years, said Dr. Manisha Juthani, state Department of Public Health commissioner. Yet, that doesn’t mean there isn’t room for improvement.

Reducing the number of unnecessary C-sections is often part of the broader conversation on maternal health and mortality, said Juthani. Connecticut legislators and organizations have been working over the years to collect data, make recommendations and pass laws to reduce maternal health disparities. Some of the efforts have included expanding doula support, blueprints for maternal health equity plans and a mortality review committee to look at all pregnancy-associated deaths.

Standardizing guidelines for evidence-based practices in labor management has also helped reduce maternal health issues. At Hartford HealthCare, for example, staff follow resources and best practices published by California’s Maternal Quality Care Collaborative and “made some great strides” in reducing the number of unnecessary C-sections, said Jen Moller, a registered nurse and a perinatal patient safety program manager at Hartford HealthCare.

Moller said there’s also a lot of hands-on work by physicians and nurses to lower the risk of C-sections when possible. The staff also meets regularly to discuss best practices and strategies. One idea, for example, is to create a “labor walk” around Hartford Hospital’s campus so that if a mother experiences long labor, she has an area to walk freely but remains close to medical staff.

“Vaginal birth that really is the best thing for mom, because if you have a C-section, that really sets you up for some very serious complications moving forward for your subsequent pregnancies,” she said. “That’s one of the main reasons why we’re working so hard on this, and we’ve seen those complications rising and becoming more and more prevalent.”

Another way to decrease the overall C-section rate is to prevent the surgery in low-risk, first time moms by offering more comprehensive support and education during the labor process, Deckers said. This could be done in a few ways, but Hartford HealthCare is looking to doulas to provide the support.

Doulas are state-certified non-medical professionals who can support individuals throughout their pregnancy, birth, and early parenting. Deckers said there’s evidence showing that continuous support from a doula can help reduce C-section rates, decrease preterm birth, and improve breastfeeding rates.

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