- [Voiceover] C-sections are the most common major surgery

performed on human beings.

Over basically one generation of moms,

the C-section rate has gone up by 500%.

The problem is that your number one risk for

having a C-section might be which hospital you go to.

That's what wakes me up in the morning.

(mysterious music)

I'm Neel Shah, an obstetrician over at

Beth Israel Deaconess Medical Center.

I'm an assistant professor at Harvard Medical School,

and I'm part of the core faculty here at Ariadne Labs.

A lot of people don't realize the full magnitude

of the problem with C-sections.

Basically, in the late 1960s, early 1970s,

C-section rates were about five percent.

Then all of a sudden, the C-section rate

starts to skyrocket.

Not just increase, but skyrocket.

So, before the end of the century,

the C-section rate goes up to one in three.

And we don't really have a great idea why this is happening.

As a surgeon myself, it's hard to believe

that one in three human beings needs

major surgery to be born.

But that's sort of where we are right now.

And the consequences are significant.

So, things like severe infection, hemorrhage,

organ injury, in addition to five billion dollars of spending annually,

we're talking something like 20,000 major,

avoidable surgical complications that we're seeing

from C-sections we didn't need to do in the first place.

I was really puzzled when I first started this job,

thinking like, what can we possibly do about this.

Epidemiologists, economists, policy makers,

lots of people have been thinking about this

for a long time.

The clue for me was the fact that across country,

C-section rates vary from seven percent to 70% by hospital.

If hospital performance is so uneven,

and it's not explained by patient risk or patient preference,

that means the hospital itself could be a risk factor.

All of our projects right now are actually trying to

figure out what makes hospital A different from hospital B.

(electronic music)

What we've seen is that often times the

labor floor is in kind of like an

almost forgotten about corner and

it just doesn't get a lot of investment

or attention from the hospital.

When we visit a bunch of different hospitals,

we realized that they're laid out very differently,

and that might matter.

For example, there are no rules for how many

labor floor rooms you should have

based on the amount of patients that you see.

The place that does twice as many deliveries

also does way more C-sections.

The only way that's possible is if they're

moving people through much faster.

Almost all labor floors seem really

tight on resources, so the idea is when you have

a huge surgeon patient volume, how do you

flexibly recruit more rooms?

How do you bring in more staff?

You report C-section rates back to your doctors.

Like, I have no idea what my C-section rate is

until somebody tells me.

Now we're testing this hypothesis that management matters

in childbirth just the way it matters

in every other industry.

We're starting to parse differences among C-sections.

So, rather than looking at all C-sections all together,

we're trying to just take the lowest risk women

and focus on their C-section rate.

As soon as you start to do that, two things happen:

Insurance companies start to pay attention,

and then, just women start to pay attention.

And I actually think this is an area where

women's views on this are probably

going to be the driving force behind the change.

There's really no other moment in people's life

where they're so discerning

as when they become pregnant.