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2008 PA Cesarean Statistics are Now Available! (1 of 4)

In an early Christmas present, the PA Department of Health has released birth data for 2008, including cesarean statistics by hospital.

The cesarean rate in PA in 2008 rose just under 3% over 2007, going from 30.05% to 30.86%.  Most likely this will still keep us under the national average…but just barely.  The VBAC rate dropped from 13.8% to 13.3%.  

Looking more local to the Lehigh Valley, some of the results are very sobering.  Overall, the combined data for the 5 hospitals in the Lehigh Valley with maternity units saw their cesarean rate rise by over 5% from 29.9% to 31.5%.  The VBAC rate in the Lehigh Valley dropped by a staggering 14% over 2007, going from 19% to 16.3%.  While this a better VBAC rate than the rest of the state, if the trend continues we can expect to have a VBAC rate lower than the state rate by the end of 2010. 

I will discuss more details about each hospital in alphabetical order.

Easton Hospital  In a year when births were down in the state, this hospital saw their volume of births rise by about 23% to 636 births.  However, with this rise came some other troubling changes to their statistics.  Their overall cesarean rate rose from 28.5% to 35.5%, giving it the second highest cesarean rate in the area.  In the past 10 years, this hospital has had the highest or second highest cesarean rate in the valley 7 times.

A particularly troubling part of the rise in the cesarean rate at Easton Hospital is that the percentage of the cesareans that were repeat cesarean dropped, meaning that the increased volume of cesareans came through a shocking rise in the “primary” cesarean rate from 22%* to 28%.  The “primary” cesarean rate is a measure of how many cesareans are the first cesarean for the mother–but the mother may not necessarily be a first time mother.  For example, I know several women who had “primary” cesareans in their 3rd pregnancy.  Since first time moms are, however, more likely to have primary cesareans than multiparous women, a first time mom can estimate that her odds of having a cesarean in a particular hospital are somewhere between the hospital’s reported primary cesarean rate, and 1.5 times that rate.  This means that first time mothers who birthed at Easton Hospital likely had somewhere between a 28-42% cesarean rate.  Which, considering that Easton Hospital boasts the lowest VBAC rate in the valley at 5.6%, is not good news for their chances of future vaginal births if they continue to utilize that hospital.  

Lehigh Valley Health Network  Lehigh Valley Health Network at Cedar Crest saw their number of births rise for the 4th year in a row.  This hospital handles the most births in the valley, accounting for 43% of the births, and surpassing its nearest competition, St. Luke’s Bethlehem, by over 1000 births.  Despite having an increase in the number of cesareans performed, the rise in total volume of births resulted in a net effect of a slight decrease in the cesarean rate over 2007, dropping to 26.4% from 26.8%. 

In addition to the rise in the number of cesareans performed, there was also a rise in the number of VBAC’s achieved, however this rise in number still saw a 10% drop in the VBAC percentage from 26.1% to 23.6%.  This data actually leaves me scratching my head in confusion, as Dr. Hutchinson, the head of OB at Lehigh Valley Health Network, had issued a statement earlier this year where he cited a VBAC rate for 2008 of 15.5%.  The difference between the 23.6% VBAC rate and 15.5% VBAC rate is 41 births. 

Many people will point out that The Midwives and Associates were actively attending births at this hospital in 2008, including a significant number of VBACs.  The loss of this option in 2009 may result in a significant drop in the VBAC rate in 2009; however, due to the low overall birth volume performed by The Midwives and Associates, we should not expect to see a significant effect on the overall cesarean rate.

Lehigh Valley Health Network is the only hospital in the Lehigh Valley that has seen a drop in their cesarean rate in the past few years.  In fact, for 2007 and 2008 this hosptal has had the lowest cesarean rate of any local hospitals, representing a stark turn around.  Up until 2004 this hospital consistently had the highest cesarean rate in the area.  I believe it would be worth while for other local hospitals to talk to the administrators at Lehigh Valley to find out what they are doing to bring their cesarean rates down.  I have to admit to finding this data puzzling, as my clients who have birthed at Lehigh Valley Health Network have a significantly higher cesarean rate than those who birth at other local hospitals.

Sacred Heart  This hospital has suffered a severe blow in volume of births by loosing The Midwives and Associates in 2006/2007.  At its high point in 2005, this inner city Allentown hospital saw 542 annual births.  However, by 2008 that number had dropped to 291.  Sacred Heart saw a decline in their cesarean rate from 35.2% to 30.6%, however, this may not be a “real” decline, as the cesarean data for 2007 seems to be a spike in a steadily rising curve that began rising in 2000.  In order, the cesarean rates from 2004 onward were:  21.6%, 23.4%, 22.6%, 35.2%, 30.6%.  The ”30.6%” figure, when displayed on a graph, seems to fit well on a “best fit line” showing a rising trend. 

Coupled with the trend of a rising cesarean rate, there was a decline in their VBAC rate from 8.2% to 6.8%.  In addition to the loss of The Midwives and Associates attending VBACs, this decline may also represent a transfer of VBAC cases to larger hospitals that are better equipped to handle complicated births, however the data available does not allow us to draw that conclusion definitely.

St. Luke’s Allentown  For the 3rd straight year this hospital saw a decline in the number of births, after steadily rising numbers since the mid 90’s.  This decline was probably due in a very large part to the situation that existed for several years where post-partum rooms were often shared, and there was a shared shower room.  With the recent remodeling and expansion of the post-partum unit, rooms are now private again, and include private showers as well.

St. Luke’s Allentown saw a 5% rise in their cesarean rate over 2007, bringing it to an even 35% from 33.2%.  This puts it squarely in the middle of the 5 area hospitals in cesarean rate, and at the bottm for the 3 higher volume hospitals.  This is a sad change, as in the last 10 years this hospital has had the lowest (once) and second lowest cesarean rate in the Lehigh Valley 7 years.

This hospital also saw an 18% decline in VBAC rate, from 13.1% to 10.7%.  This may be largely attributed to the move of The Midwives and Associates from attending births in this hospital and Sacred Heart, to exclusively attending births at Lehigh Valley Health Network.

St. Luke’s Bethlehem  This hospital serves 31% of mothers giving birth in the Lehigh Valley, holding the position of the 2nd largest birth facility in the area.  Over the past 7 years this hospital has seen its volume fluctuate between 2730 and 2950.  In 2008, 2788 babies were born here.

This year saw a 13.6% jump in cesarean rate from a rate of 31.6% in 2007 to 35.9% in 2008, earning this hospital the dubious distinction of having the highest cesarean rate in the area, a title that it has held for 3 of the past 4 years.  In the past 10 years it has held the 3rd place spot 6 times.

In 2008 St. Luke’s Bethlehem did have the second highest VBAC rate at 13.1% (10 percentage points lower than Lehigh Valley Health Network), however this represents a staggering 30% drop from the 18.7% VBAC rate in 2007.  If the VBAC rate continues declining at this pace, women can expect the 2010 VBAC rate at this hospital to be well into the single digits.

*Easton Hospital’s previous 3 year average primary cesarean rate was 24%, 2007 had an abnormally low primary cesarean rate

Tags: cesarean, Easton Hospital, hospital birth, Lehigh Valley Health Network, Lehigh Valley Hospital, Sacred Heart Hospital, St. Luke's Hospital, VBAC/Cesarean