2008 Cesarean Statistics in PA: Primary Cesarean Rates (4 of 4)
In all the flurry about VBAC access and VBAC bans, sometimes the “primary” cesarean rate can get lost in the shuffle. I think the primary cesarean rate is the most misunderstood of all the cesarean statistics. I see the media mis-define it over and over, and even occassionally I see medical professionals misdefine it.
And yet, because a primary cesarean, is, by definition, the first cesarean a woman has, it may be, perhaps, her most important. Because it is the one that forever labels her as high risk in future pregnancies. As Joy Szabo and many women like her have found, having a vaginal birth after the cesarean, even having multiple vaginal births in ones history, does not erase the scarlet letter that a woman “earns” when she has that primary cesarean.
So before going any further, I want to clearly define what the “primary cesarean rate” is. A “primary cesarean” is the first cesarean a woman ever has. Where the misdefinition often comes in is saying that the primary cesarean rate applies to the cesarean rate in first time moms. But this is not the case. One woman I know had a planned cesarean for her first birth, while another had 3 vaginal births, followed by an emergency cesarean for her 4th child. By definition, both of these cesareans are “primary” cesareans.
But since a woman who has already had a vaginal birth is much less likely to have a cesarean birth for her subsequent births, most primary cesareans do occur in the first pregnancy (case in point, with the pair above, the first mother was automatically scheduled for a cesarean for her second birth, even though the first cesarean was for breech that did not recurr in the second pregnancy. When she desired a VBAC for her 3rd birth, she needed to drive nearly an hour to her prenatal visits, and 2 hours to the hospital where she had her birth. The second woman was just assumed to be able to birth vaginally for all of her births following her first, and was suprised to need a cesarean for her 4th).
I have long contended that the risk a first time mother has of birthing via cesarean lies somewhere around 1.5 times the primary cesarean rate, but I did not have any hard data to back it up, just my “logical suspicions,” and data from the Listening to Mothers I Survey. Correspondingly, in 2005 the primary cesarean rate in PA was 21.9%, while the data that is now available through the CDC Wonder Database shows the cesarean rate for first time mothers in PA in that year was 29.9% –this is 1.37 times the primary cesarean rate.*
Given this, the choice of which hospital to birth in** has significant impact on a first time mother’s odds of having a cesarean. While the cesarean rates of hospitals with LDRs in PA ranged from 23.2 to 53.6%, the expected cesarean rate for first time mothers ranges from about 16% to 61% — or even higher. So watching the “primary” cesarean rate, not just the total cesarean rate, of a hospital, is of vital importance to the first time mother who hopes to avoid unnecessary surgery.
The following table presents all of the cesarean rates for the 113 hospitals with LDR’s in PA.
County of Delivery |
Hospital of Delivery |
Total Births |
Cesarean Rate |
Primary Cesarean Rate |
VBAC rate |
ICAN VBAC Ban Report |
|
State Total |
|
148,464 |
30.9% |
22.8% |
13.3% |
|
|
Adams |
Gettysburg Hsp |
558 |
25.8% |
17.6% |
1.8% |
D |
|
Allegheny |
Allegheny General Hsp |
1,316 |
48.5% |
39.0% |
9.5% |
D |
|
Allegheny |
Heritage Valley Sewickley |
888 |
35.8% |
30.9% |
11.8% |
A |
|
Allegheny |
Magee Womens Hsp Of UPMC Health Sys |
9,818 |
27.2% |
23.1% |
25.9% |
A |
|
Allegheny |
Ohio Valley General Hsp |
308 |
37.0% |
29.5% |
0.0% |
D |
|
Allegheny |
St Clair Memorial Hsp |
1,170 |
37.7% |
31.0% |
5.6% |
A |
|
Allegheny |
UPMC Mercy |
1,390 |
32.9% |
26.1% |
11.8% |
A |
|
Allegheny |
Western PA Hsp Forbes Regional Campus |
944 |
30.3% |
24.7% |
11.9% |
A |
|
Allegheny |
Western Pennsylvania Hsp |
2,684 |
31.3% |
21.5% |
15.7% |
A |
|
Armstrong |
Armstrong County Memorial Hsp |
691 |
37.9% |
27.3% |
8.0% |
|
|
Beaver |
Heritage Valley Beaver |
1,097 |
28.6% |
23.9% |
16.1% |
A |
|
Bedford |
UPMC Bedford |
290 |
35.9% |
28.3% |
15.4% |
A |
|
Berks |
Reading Hsp & Medical Center |
3,629 |
27.6% |
17.9% |
18.7% |
A |
|
Berks |
St Joseph Medical Center Reading |
795 |
25.2% |
15.7% |
14.0% |
D |
|
Blair |
Altoona Regional Health System |
1,211 |
27.6% |
19.6% |
13.2% |
|
|
Blair |
Nason Hsp |
546 |
29.7% |
20.3% |
9.6% |
A |
|
Bradford |
Memorial Hsp Inc Towanda |
193 |
31.6% |
24.1% |
0.0% |
D |
|
Bradford |
Robert Packer Hsp |
747 |
24.9% |
20.6% |
17.3% |
A |
|
Bucks |
Doylestown Hsp |
1,327 |
41.0% |
29.7% |
1.4% |
A |
|
Bucks |
Grand View Hsp |
1,459 |
34.9% |
28.1% |
1.4% |
D |
|
Bucks |
Lower Bucks Hsp |
1,137 |
41.8% |
29.8% |
3.9% |
D |
|
Bucks |
St Mary Medical Center |
1,775 |
35.8% |
27.0% |
3.6% |
A |
|
Butler |
Butler Memorial Hsp |
763 |
27.8% |
25.7% |
14.8% |
|
|
Cambria |
Conemaugh Valley Memorial Hsp |
1,332 |
27.4% |
17.6% |
16.7% |
A |
|
Carbon |
Gnaden Huetten Memorial Hsp |
456 |
28.9% |
17.8% |
8.7% |
|
|
Centre |
Mount Nittany Medical Center |
1,268 |
26.5% |
19.3% |
5.0% |
A |
|
Chester |
Brandywine Hsp |
239 |
33.9% |
30.1% |
0.0% |
|
|
Chester |
Chester County Hsp |
2,550 |
28.8% |
20.1% |
13.9% |
A |
|
Chester |
Jennersville Regional Hsp |
373 |
21.2% |
11.9% |
24.1% |
A |
|
Chester |
Main Line Hsp Paoli |
2,232 |
38.5% |
29.8% |
5.6% |
A |
|
Chester |
Phoenixville Hsp Company LLC |
1,020 |
28.5% |
21.5% |
22.7% |
A |
|
Clarion |
Clarion Hsp |
375 |
53.6% |
40.8% |
0.0% |
D |
|
Clearfield |
Clearfield Hsp |
231 |
22.9% |
13.7% |
3.8% |
D |
|
Clearfield |
Dubois Regional Medical Center |
1,026 |
35.9% |
29.3% |
7.5% |
A |
|
Clinton |
Lock Haven Hsp |
188 |
26.6% |
22.5% |
0.0% |
A |
|
Columbia |
Berwick Hsp Center |
126 |
41.3% |
31.8% |
5.3% |
|
|
Columbia |
Bloomsburg Hsp |
303 |
35.0% |
26.7% |
12.2% |
D |
|
Crawford |
Meadville Medical Center |
559 |
31.3% |
24.2% |
1.9% |
A |
|
Crawford |
Titusville Area Hsp |
233 |
22.3% |
12.6% |
22.9% |
A |
|
Cumberland |
Carlisle Regional Medical Center |
395 |
33.7% |
27.2% |
5.3% |
B |
|
Cumberland |
Holy Spirit Hsp |
1,164 |
23.2% |
16.0% |
24.8% |
A |
|
Dauphin |
Milton S Hershey Medical Center |
1,709 |
37.4% |
28.2% |
11.1% |
A |
|
Dauphin |
Pinnacle Health Hospitals |
4,344 |
30.0% |
22.5% |
3.4% |
A |
|
Delaware |
Crozer Chester Medical Center |
2,053 |
34.3% |
23.3% |
9.2% |
|
|
Delaware |
Delaware County Memorial Hsp |
1,729 |
27.5% |
19.7% |
21.1% |
A |
|
Delaware |
Riddle Memorial Hsp |
905 |
32.8% |
20.2% |
8.2% |
A |
|
Elk |
Elk Regional Health Center |
197 |
39.6% |
28.3% |
0.0% |
|
|
Erie |
Hamot Medical Center |
1,014 |
37.6% |
23.5% |
4.5% |
A |
|
Erie |
Millcreek Community Hsp |
218 |
29.8% |
21.9% |
11.5% |
A |
|
Erie |
Saint Vincent Health Center |
2,389 |
37.6% |
27.6% |
11.6% |
A |
|
Fayette |
Uniontown Hsp |
959 |
31.6% |
21.7% |
8.8% |
A |
|
Franklin |
Chambersburg Hsp |
1,496 |
25.1% |
16.2% |
13.7% |
A |
|
Franklin |
Waynesboro Hsp |
497 |
22.7% |
15.8% |
18.9% |
A |
|
Huntingdon |
JC Blair Memorial Hsp |
372 |
27.7% |
19.8% |
25.9% |
A |
|
Indiana |
Indiana Regional Medical Center |
639 |
22.7% |
13.7% |
10.5% |
A |
|
Jefferson |
Punxsutawney Area Hsp |
135 |
33.3% |
22.4% |
0.0% |
A |
|
Lackawanna |
Moses Taylor Hsp |
2,805 |
33.3% |
25.2% |
11.2% |
A |
|
Lancaster |
Ephrata Community Hsp |
843 |
27.8% |
20.8% |
35.3% |
A |
|
Lancaster |
Heart Of Lancaster Reg Medical Center |
244 |
36.5% |
30.3% |
4.3% |
B |
|
Lancaster |
Lancaster General Hsp |
5,077 |
30.6% |
20.6% |
11.1% |
A |
|
Lawrence |
Ellwood City Hsp |
285 |
40.0% |
28.9% |
2.2% |
D |
|
Lawrence |
Jameson Memorial Hsp |
432 |
25.7% |
17.3% |
10.0% |
A |
|
Lebanon |
Good Samaritan Hsp |
999 |
29.3% |
20.2% |
13.8% |
A |
|
Lehigh |
Lehigh Valley Hsp |
3,865 |
26.4% |
18.9% |
23.6% |
A |
|
Lehigh |
Sacred Heart Hsp |
291 |
30.6% |
19.4% |
6.8% |
A |
|
Lehigh |
St Luke’s Hsp Allentown |
1,417 |
35.0% |
25.3% |
10.7% |
|
|
Luzerne |
Geisinger Wyoming Valley |
1,116 |
42.2% |
30.3% |
4.9% |
D |
|
Luzerne |
Hazleton General Hsp |
614 |
35.2% |
24.5% |
3.3% |
B |
|
Luzerne |
Nesbitt Memorial Hsp |
1,408 |
41.5% |
33.1% |
8.4% |
|
|
Lycoming |
Williamsport Hsp & Medical Center |
1,168 |
31.9% |
23.8% |
13.8% |
A |
|
McKean |
Bradford Regional Medical Center |
305 |
45.6% |
33.3% |
0.0% |
|
|
Mercer |
Grove City Medical Center |
257 |
33.5% |
25.2% |
6.5% |
A |
|
Mercer |
Sharon Regional Health System |
390 |
27.7% |
18.6% |
13.5% |
A |
|
Mercer |
Shenango Valley Medical Center |
660 |
27.9% |
21.8% |
11.7% |
|
|
Mifflin |
Lewistown Hsp |
560 |
30.0% |
19.1% |
15.1% |
|
|
Monroe |
Pocono Medical Center |
773 |
25.5% |
18.9% |
17.5% |
A |
|
Montgomery |
Abington Memorial Hsp |
5,143 |
34.6% |
25.0% |
11.0% |
A |
|
Montgomery |
Central Montgomery Medical Center |
349 |
29.5% |
22.2% |
2.9% |
|
|
Montgomery |
Holy Redeemer Hsp & Medical Center |
2,842 |
35.5% |
25.6% |
7.2% |
D |
|
Montgomery |
Main Line Hsp Bryn Mawr |
1,921 |
34.0% |
26.5% |
7.4% |
A |
|
Montgomery |
Main Line Hsp Lankenau |
2,220 |
41.8% |
31.8% |
5.4% |
A |
|
Montgomery |
Mercy Suburban Hsp Norristown |
640 |
35.9% |
27.0% |
2.5% |
A |
|
Montgomery |
Montgomery Hsp |
693 |
38.2% |
27.0% |
9.0% |
A |
|
Montgomery |
Pottstown Memorial Medical Center |
761 |
31.4% |
23.5% |
13.5% |
A |
|
Montour |
Geisinger Medical Center |
1,677 |
37.4% |
28.6% |
8.1% |
A |
|
Northamptom |
St Luke’s Hsp Bethlehem |
2,788 |
35.9% |
27.1% |
13.1% |
A |
|
Northampton |
Easton Hsp |
636 |
35.5% |
28.1% |
5.6% |
D |
|
Philadelphia |
Albert Einstein Medical Center |
2,810 |
28.4% |
22.0% |
26.2% |
A |
|
Philadelphia |
Chestnut Hill Hsp |
804 |
23.5% |
19.4% |
31.3% |
|
|
Philadelphia |
Hahnemann University Hsp |
1,936 |
27.8% |
25.4% |
27.8% |
A |
|
Philadelphia |
Hsp Of The University Of PA |
4,326 |
28.0% |
20.7% |
25.5% |
A |
|
Philadelphia |
Northeastern Hsp |
1,820 |
23.1% |
13.7% |
6.9% |
A |
|
Philadelphia |
PA Hsp Of The Univer Of PA Health Sys |
4,986 |
37.4% |
28.3% |
12.9% |
A |
|
Philadelphia |
Temple University Hsp |
2,493 |
30.5% |
26.0% |
21.1% |
A |
|
Philadelphia |
Thomas Jefferson University Hsp |
2,123 |
30.6% |
22.8% |
18.7% |
A |
|
Potter |
Charles Cole Memorial Hsp |
254 |
23.2% |
11.9% |
5.7% |
A |
|
Schuylkill |
Schuylkill Medical Ctr-S Jackson St |
1,178 |
31.2% |
21.8% |
4.0% |
A |
|
Somerset |
Somerset Hsp |
389 |
22.1% |
18.1% |
16.7% |
A |
|
Somerset |
Windber Hsp |
312 |
32.7% |
22.8% |
6.8% |
A |
|
Susquehanna |
Barnes-Kasson County Hsp |
58 |
29.3% |
25.5% |
0.0% |
D |
|
Tioga |
Soldiers & Sailors Memorial Hsp |
298 |
31.2% |
22.6% |
0.0% |
B |
|
Union |
Evangelical Community Hsp |
1,056 |
37.2% |
26.6% |
10.2% |
A |
|
Venango |
UPMC Northwest Seneca |
500 |
27.8% |
20.0% |
13.6% |
A |
|
Warren |
Warren General Hsp |
374 |
25.9% |
15.1% |
4.0% |
D |
|
Washington |
Washington Hsp |
1,096 |
22.0% |
15.6% |
17.3% |
A |
|
Wayne |
Wayne Memorial Hsp |
346 |
25.7% |
16.0% |
10.9% |
A |
|
Westmoreland |
Excela Health Latrobe Hsp |
256 |
28.5% |
21.9% |
4.3% |
|
|
Westmoreland |
Excela Health Westmoreland Reg Hsp |
1,590 |
22.9% |
15.9% |
14.9% |
A |
|
Westmoreland |
Mercy Jeannette Hsp |
113 |
34.5% |
29.5% |
0.0% |
D |
|
Wyoming |
Tyler Memorial Hsp |
209 |
36.4% |
25.8% |
3.2% |
D |
|
York |
Hanover Hsp |
634 |
26.2% |
18.1% |
4.5% |
B |
|
York |
Memorial Hsp York |
791 |
24.7% |
16.2% |
6.9% |
D |
|
York |
York Hsp |
3,065 |
33.6% |
24.6% |
12.9% |
A |
*The CDC Wonder data set starts tracking birth method–vaginal vs. cesarean–in 1999. In 1999 through 2002, the cesarean rate for first time moms was over 1.5 times the primary rate, trending slightly downward from 1.52 in 1999 to 1.5 in 2002. Then it abruptly dropped to 1.33 in 2003, then rose 0.02 each year. If that trend continued, the cesarean rate for first time mothers in 2008 was about 1.41 times the primary cesarean rate. To calculate the range of cesarean rates first time mothers could expect, I calculated the primary rate times 1.37–the ratio from 2005, the last year that I am able to calculate it–for the low value, and times 1.5 for the high value. Due to variability between hospitals, there is always the possibility that either of these values could be higher or lower.
**While hospial choice is important due to the environment that is present in any given hospital, women should remember that the cesarean statistics do not tell the whole story. They should be sure to ask questions about how likely they are to get the type of care that they want in the hospital. They also should be aware that even a hospital with a low cesarean rate may have a care provider with a very high cesarean rate, and visa versa, so they should ask specific questions of their care provider about cesarean rate and practice style. I wrote more about choosing a care provider at this post: Finding the Right Maternity Care Provider.
Tags: cesarean, chose care provider, ICAN, VBAC/Cesarean
Kinda scary that my hospital on there gets an A for VBACs. Our VBAC rate is horrid. Very rarely do any physicians offer it, much less support it when the woman presents in labor.
Oops! Went to your other post - an “A” for VBAC simply means it’s allowed. ::snort:: Doesn’t mean hospitals offer or support VBACs though. Case in point: my hospital does well over 3000 births/year. Our VBAC rate is a paltry <4%. I would venture to guess that the actual VBAC rate is even lower. Our monthly stats show that we have about 1-2 VBACs per month. Out of 300+ births per month. That’s way less then 4%.
Woo hoo! I got comments from “At Your Cervix.” I’m so honored! Did you happen to look at my “resources” page? You are listed there!
So…of course I’m making a stab at guessing what hospital you work at now.
If I guessed right, the raw data reports 15 VBACs in 2008, and 438 previous cesareans. The “VBAC rate” is calculated based not on the total number of births in a hospital, but based on the total number of previous cesareans. So if a hospital wanted to have a really good VBAC rate, they could just refuse to do any elective repeat cesareans–tell women they have to attempt VBAC, or take their business to another hospital.
Ironically, a Clarion Hospital (53% cesarean, 0% VBAC, “defacto” VBAC ban) spokesperson is quoted as saying they don’t “force” women with previous cesareans to have a trial of labor. Hmmm…guess that statement was before they started forcing women to have a repeat cesarean.