2008 Cesarean Statistics in PA: VBAC Rates (2 of 4)
After publishing my initial post about the cesarean stats in PA, focussing on the Lehigh Valley, my goal was to continue on with an analysis of the whole state. Jill at The Unnecessarean “scooped” me slightly by posting the cesarean rate for all hospitals in PA, but I don’t mind. Thank you Jill, for jumping on board! The more voices, the merrier! Well…maybe not “merrier” on this topic…but we definitely need as many voices as possible if we want positive change.
I’m going to present a bit more analysis though still. I hope this is helpful for someone!
As Jill already presented, the cesarean rate in hospitals in PA ranged from 0% to 66%. Obviously, the hospitals at the low end are somewhat “unique” to be acheiving that…and indeed, they are. They all have single digit births, which would indicate that they don’t actually have LDR units, but these are cases where women went there in labor, and were too far along to be transferred to other hospitals. In one case (St Luke’s Miners Memorial Hsp in Skulykill County), the birth was actually a VBAC. The other hospital in the same county, Schulykill Medical Center on Jackson Street, has a 4% VBAC rate, which might lead one to believe the birth at St. Luke’s was a deliberate plan on the part of the mother to avoid a birth facility that was less than “VBAC friendly.”
At the other end of the spectrum, Children’s Hospital of Philadelphia, or “CHOP” boasts a 66% cesarean rate, which shockingly, is actually an improvement over its 2007 cesarean rate of 100%. This was discussed at some length over at The Unnecessarean. CHOP is not a hospital where women really go to labor. The only reason a woman would birth there (rather than at The Hospital of the University of PA which is literally connected to CHOP with a breezeway) would be because the baby is in such poor condition that surgery will be needed or high level NICU care IMMEDIATELY after the birth. These women often have planned cesareans so that they can be assured of having all the necessary medical staff in place when the birth occurs.
Eliminating those “outlyers,” there appear to be 113 hospitals in PA that have LDR’s. 15 of those have cesarean rates that are below 25%, and of those, 9 have VBAC rates higher than the state average.
County of Delivery |
Hospital of Delivery |
Total Births |
Cesarean Rate |
Primary Cesarean Rate |
VBAC rate |
|
State Total |
|
148,464 |
30.9% |
22.8% |
13.3% |
|
Chester |
Jennersville Regional Hsp |
373 |
21.2% |
11.9% |
24.1% |
|
Washington |
Washington Hsp |
1,096 |
22.0% |
15.6% |
17.3% |
|
Somerset |
Somerset Hsp |
389 |
22.1% |
18.1% |
16.7% |
|
Crawford |
Titusville Area Hsp |
233 |
22.3% |
12.6% |
22.9% |
|
Indiana |
Indiana Regional Medical Center |
639 |
22.7% |
13.7% |
10.5% |
|
Franklin |
Waynesboro Hsp |
497 |
22.7% |
15.8% |
18.9% |
|
Westmoreland |
Excela Health Westmoreland Reg Hsp |
1,590 |
22.9% |
15.9% |
14.9% |
|
Clearfield |
Clearfield Hsp |
231 |
22.9% |
13.7% |
3.8% |
|
Philadelphia |
Northeastern Hsp |
1,820 |
23.1% |
13.7% |
6.9% |
|
Cumberland |
Holy Spirit Hsp |
1,164 |
23.2% |
16.0% |
24.8% |
|
Potter |
Charles Cole Memorial Hsp |
254 |
23.2% |
11.9% |
5.7% |
|
Philadelphia |
Chestnut Hill Hsp |
804 |
23.5% |
19.4% |
31.3% |
|
York |
Memorial Hsp York |
791 |
24.7% |
16.2% |
6.9% |
|
Bradford |
Robert Packer Hsp |
747 |
24.9% |
20.6% |
17.3% |
On the opposite end of the spectrum, 10 hospitals have cesarean rates 40% or higher, and all of them have VBAC rates in the single digits. A staggering 35 hospitals have cesarean rates at or above 35%, and only 9 of them have VBAC rates over 10%.
County of Delivery |
Hospital of Delivery |
Total Births |
Cesarean Rate |
Primary Cesarean Rate |
VBAC rate |
|
State Total |
|
148,464 |
30.9% |
22.8% |
13.3% |
|
Clarion |
Clarion Hsp |
375 |
53.6% |
40.8% |
0.0% |
|
Allegheny |
Allegheny General Hsp |
1,316 |
48.5% |
39.0% |
9.5% |
|
McKean |
Bradford Regional Medical Center |
305 |
45.6% |
33.3% |
0.0% |
|
Luzerne |
Geisinger Wyoming Valley |
1,116 |
42.2% |
30.3% |
4.9% |
|
Bucks |
Lower Bucks Hsp |
1,137 |
41.8% |
29.8% |
3.9% |
|
Montgomery |
Main Line Hsp Lankenau |
2,220 |
41.8% |
31.8% |
5.4% |
|
Luzerne |
Nesbitt Memorial Hsp |
1,408 |
41.5% |
33.1% |
8.4% |
|
Columbia |
Berwick Hsp Center |
126 |
41.3% |
31.8% |
5.3% |
|
Bucks |
Doylestown Hsp |
1,327 |
41.0% |
29.7% |
1.4% |
|
Lawrence |
Ellwood City Hsp |
285 |
40.0% |
28.9% |
2.2% |
Cross checking with the ICAN data base on VBAC bans, 5 of these “Top 10″ hospitals ban VBAC with “De Facto” bans, 3 are not listed, and 2–Doylestown and Lankenau–report that they allow VBAC.
The 1.4% VBAC rate a Doylestown Hospital where VBAC is “allowed” highlights something that is well known in the doula/childbirth educator community. Just because a hospital “allows” VBAC does not mean that it is likely to happen. Of the more than 65 hospitals that reported allowing VBAC, the VBAC rate ranges from 35.3% down to 0%, and 26 of them have VBAC rates that are 10% or lower.
Next in this series: VBAC bans
Tags: cesarean, ICAN, VBAC/Cesarean
In your first table, with the lower c/s rates - I can tell you that quite a few of those hospitals do not do “high risk” pregnancies/births. They are transferred out to the tertiary care facilities (like where I work). Thus, those that mainly do low risk births are going to have better (lower) c/s rates. (Also, we get high risk transfers from several of those hospitals listed in that first table.)
You mentioned about some hospitals having a higher level of higher risk clients…and that certainly is true. That is why I give CHOP a “bye” on their extremely high cesarean rate.
But the PA Cost Containment Council has found that the percentage of high risk clients does NOT correlate well to cesarean rate. In fact, I’d be willing to guess that the hospital with the highest cesarean rate in the state (other than CHOP), Clarion Hospital, is one of those hospitals transferring out their high risk clients! Just based on the volume of births, I’d guess that 3 other hospitals in the “top 10″ list transfer out high-risk clients.
Oddly enough, Lankenau is one of the best places in the Philly area to have a VBAC…. with the right doctor. Dr Bailey is one doctor in the area who will give women a fair shot a VBAC and does not appear to do the bait and switch by encouraging a repeat c-section at the last minute. Unfortunately there was a multimillion dollar lawsuit at Lankenau in 2001 because parents of a baby born with cerebral palsy sued saying they should have had a c-section. Lawsuits like that are especially unfortunate since it makes the doctors scared and there is no evidence that our rising cesarean rate has had any effect on rates of cerebral palsy.
Regarding high risk hospitals having higher cesarean rates than hospitals doing mainly low risk birth, I looked at the stats on NJ hospitals and the range of c-section rates was similar when hospitals were grouped by Level I, II or III NICU (i.e. some level III NICU hospitals had low c-section rates while some had high. The same trends were seen in hospitals with Level I and Level II NICU hospitals) http://www.icanofnj.com/csectionratebynicu.htm