Hospitals drive Swiss cantonal differences in C-section rates

Hospitals and their medical practices have a stronger influence on Switzerland’s caesarean section rates than the canton where a woman lives, according to a study reported by SRF.

About one in three children in Switzerland is born by caesarean section, but rates vary sharply by region. The rate is around 40 per cent in the canton of Zug and just under 25 per cent in the canton of Jura.

The Swiss Health Observatory, known as Obsan, analysed births between 2015 and 2023 to investigate the regional differences. Study project leader Florence Stempfel said factors such as the mother’s age or multiple births could explain only part of the variation.

“The hospital providing the treatment and its medical practice culture have a major influence on the likelihood of a caesarean section,” Stempfel said. Once the hospital was included in the analysis, the influence of a woman’s canton of residence almost entirely disappeared.

The study’s authors could not conclusively explain why some hospitals have higher caesarean rates than others. Anne Steiner, head of the maternity unit at Aarau Cantonal Hospital and a representative of the Swiss Midwives Association, said the finding did not surprise her.

In the long term, it is generally healthier not to have had a caesarean section, Steiner said, because it avoids certain risks. However, vaginal births can also cause problems, while a caesarean section carries the risks of major abdominal surgery.

More than 90 per cent of women simply want to give birth with as few interventions as possible, according to Steiner. Yet almost 35 per cent of them end up having a caesarean section, which can be disappointing because it was not their primary wish.

She said this suggests that the decision is often influenced by standard practices at individual hospitals. A caesarean section is justified when there are medical reasons or when a woman explicitly requests one, Steiner said.

Steiner also criticised the different levels of reimbursement for vaginal births and caesarean sections. Vaginal births require midwives and doctors from several professions to be available around the clock, even though they may ultimately need to do very little. Despite this effort, she said, hospitals receive significantly less money than they do for a caesarean section.