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Monday
Dec212009

Pennsylvania Department of Health Releases 2008 Hospital Cesarean Rates

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The Pennsylvania Department of Health released its 2008 Birth and Death Statistics. Of the 148,464 total live births in Pennsylvania in 2008, 45,822 were cesarean sections and 2,486 of the births were vaginal births after a previous cesarean. The state’s overall cesarean rate in 2008 was 30.9 percent.

Fifty hospitals in Pennsylvania had a cesarean rate higher than the national average of 31.8 percent, with eleven hospitals performing cesarean sections on 40 percent or more of their patients. Two hospitals, The Children’s Hospital of Philadelphia and Clarion Hospital in Clarion County exceeded a 50 percent cesarean rate in 2008, reporting rates of 66 percent and 53.6 percent, respectively.

At Jennersville Regional Hospital in Chester, 78.8 percent of women delivered vaginally, giving the hospital the distinction of having the highest vaginal birth rate after freestanding birth centers and other out of hospital births.

 

 

Hospital Births Total C/S VBAC C/S Rate
  148,464 45,822 2,486 30.9%
         
Childrens Hospital of Philadelphia 94 62 1 66.0%
Clarion Hospital 375 201 0 53.6%
Allegheny General Hospital 1,316 638 23 48.5%
Bradford Regional Medical Center 305 139 0 45.6%
Geisinger Wyoming Valley 1,116 471 10 42.2%
Main Line Hospital Lankenau 2,220 929 19 41.8%
Lower Bucks Hospital 1,137 475 8 41.8%
Nesbitt Memorial Hospital 1,408 585 17 41.5%
Berwick Hospital Center 126 52 1 41.3%
Doylestown Hospital 1,327 544 3 41.0%
Ellwood City Hospital 285 114 1 40.0%
Elk Regional Health Center 197 78 0 39.6%
Main Line Hospital Paoli 2,232 859 17 38.5%
Montgomery Hospital 693 265 11 38.2%
Armstrong County Memorial Hospital 691 262 9 37.9%
St Clair Memorial Hospital 1,170 441 7 37.7%
Saint Vincent Health Center 2,389 899 46 37.6%
Hamot Medical Center 1,014 381 9 37.6%
Milton S Hershey Medical Center 1,709 640 29 37.4%
Geisinger Medical Center 1,677 628 19 37.4%
PA Hospital of the University of PA 4,986 1,864 99 37.4%
Evangelical Community Hospital 1,056 393 18 37.2%
Ohio Valley General Hospital 308 114 0 37.0%
Heart of Lancaster Reg Medical Center 244 89 1 36.5%
Tyler Memorial Hospital 209 76 1 36.4%
St Luke’s Hospital Bethlehem 2,788 1,002 54 35.9%
Mercy Suburban Hospital Norristown 640 230 2 35.9%
Dubois Regional Medical Center 1,026 368 8 35.9%
UPMC Bedford 290 104 6 35.9%
Heritage Valley Sewickley 888 318 9 35.8%
St Mary Medical Center 1,775 635 8 35.8%
Easton Hospital 636 226 4 35.5%
Holy Redeemer Hospital & Medical Center 2,842 1,008 30 35.5%
Hazleton General Hospital 614 216 3 35.2%
St Luke’s Hospital Allentown 1,417 496 23 35.0%
Bloomsburg Hospital 303 106 5 35.0%
Grand View Hospital 1,459 509 2 34.9%
Abington Memorial Hospital 5,143 1,778 85 34.6%
Mercy Jeannette Hospital 113 39 0 34.5%
Crozer Chester Medical Center 2,053 705 31 34.3%
Main Line Hospital Bryn Mawr 1,921 653 16 34.0%
Brandywine Hospital 239 81 0 33.9%
Carlisle Regional Medical Center 395 133 2 33.7%
York Hospital 3,065 1,031 57 33.6%
Grove City Medical Center 257 86 2 33.5%
Punxsutawney Area Hospital 135 45 0 33.3%
Moses Taylor Hospital 2,805 934 40 33.3%
UPMC Mercy 1,390 457 18 32.9%
Riddle Memorial Hospital 905 297 13 32.8%
Windber Hospital 312 102 3 32.7%
Williamsport Hospital & Medical Center 1,168 373 21 31.9%
Memorial Hospital Inc Towanda 193 61 0 31.6%
Uniontown Hospital 959 303 12 31.6%
Pottstown Memorial Medical Center 761 239 13 31.4%
Western Pennsylvania Hospital 2,684 841 66 31.3%
Meadville Medical Center 559 175 1 31.3%
Schuylkill Medical Ctr-S Jackson St 1,178 368 6 31.2%
Soldiers & Sailors Memorial Hospital 298 93 0 31.2%
Lancaster General Hospital 5,077 1,556 83 30.6%
Sacred Heart Hospital 291 89 3 30.6%
Thomas Jefferson University Hospital 2,123 649 53 30.6%
Temple University Hospital 2,493 761 45 30.5%
Western PA Hospital Forbes Regional Campus 944 286 10 30.3%
Lewistown Hospital 560 168 14 30.0%
Pinnacle Health Hospitals 4,344 1,302 15 30.0%
Millcreek Community 218 65 3 29.8%
Nason Hospital 546 162 7 29.7%
Central Montgomery Medical Center 349 103 1 29.5%
Good Samaritan Hospital 999 293 19 29.3%
Barnes-Kasson County Hospital 58 17 0 29.3%
Gnaden Huetten Memorial Hospital 456 132 6 28.9%
Chester County Hospital 2,550 734 47 28.8%
Heritage Valley Beaver 1,097 314 14 28.6%
Phoenixville Hospital Company LLC 1,020 291 29 28.5%
Excela Hospital Health Latrobe Hospital 256 73 1 28.5%
Albert Einstein Medical Center 2,810 799 91 28.4%
Hospital of the University of PA 4,326 1,211 149 28.0%
Shenango Valley Medical Center 660 184 7 27.9%
UPMC Northwest Seneca 500 139 8 27.8%
Hahnemann University Hospital 1,936 538 27 27.8%
Butler Memorial Hospital 763 212 4 27.8%
Ephrata Community Hospital 843 234 47 27.8%
Sharon Regional Health System 390 108 7 27.7%
JC Blair Memorial Hospital 372 103 14 27.7%
Reading Hospital & Medical Center 3,629 1,001 104 27.6%
Altoona Regional Health System 1,211 334 19 27.6%
Delaware County Memorial Hospital 1,729 476 48 27.5%
Conemaugh Valley Memorial Hospital 1,332 365 33 27.4%
Magee Womens Hospital of UPMC HealthSys 9,818 2,671 206 27.2%
Lock Haven Hospital 188 50 0 26.6%
Mount Nittany Medical Center 1,268 336 6 26.5%
Lehigh Valley Hospital 3,865 1,022 120 26.4%
Hanover Hospital 634 166 3 26.2%
Warren General Hospital 374 97 2 25.9%
Gettysburg Hospital 558 144 1 25.8%
Wayne Memorial Hospital 346 89 5 25.7%
Jameson Memorial Hospital 432 111 5 25.7%
Pocono Medical Center 773 197 14 25.5%
St Joseph Medical Center Reading 795 200 15 25.2%
Chambersburg Hospital 1,496 376 26 25.1%
Robert Packer Hospital 747 186 9 24.9%
Memorial Hospital York 791 195 6 24.7%
Chestnut Hill Hospital 804 189 21 23.5%
Charles Cole Memorial Hospital 254 59 2 23.2%
Holy Spirit Hospital 1,164 270 35 23.2%
Northeastern Hospital 1,820 420 15 23.1%
Clearfield Hospital 231 53 1 22.9%
Excela Health Westmoreland Reg Hospital 1,590 364 24 22.9%
Waynesboro Hospital 497 113 10 22.7%
Indiana Regional Medical Center 639 145 8 22.7%
Titusville Area Hospital 233 52 8 22.3%
Somerset Hospital 389 86 4 22.1%
Washington Hospital 1,096 241 18 22.0%
Jennersville Regional Hospital 373 79 13 21.2%
Alle-Kiski Medical Center 1 0 0 0.0%
UPMC Presbyterian Shadyside 1 0 0 0.0%
UPMC St Margaret 1 0 0 0.0%
Corry Memorial Hospital 1 0 0 0.0%
Southwest Regional Medical Center 1 0 0 0.0%
Frankford Hospital-Torresdale 4 0 0 0.0%
St Luke’s Miners Memorial Hospital 1 0 1 0.0%
Montrose General Hospital 1 0 0 0.0%
Excela Health Frick Hospital 1 0 0 0.0%
Freestanding Birth Center 1,525 0 28 0.0%
Other (Clinic, Doctor’s Office, Home) 2,375 1 83 0.0%

 

Data from the report, Birth and Death Statistics, 1990-2008These data were provided by the Bureau of Health Statistics and Research, Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analyses, interpretations or conclusions.

 

Via Knitted in the Womb Childbirth Education and Labor Services

 

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Reader Comments (21)

CHOP needs to be taken out of the statistics. That are not even a birthing hospital. Prenatal conditions such as spina bifida, gastroschisis, oophalocele, or severe hydrocephalus benefit from a C/S. CHOP is one of the best pediatric centers in the country. I believe they also do fetal surgeries.

December 21, 2009 | Unregistered CommenterReality Rounds

Doctorjen, agreed that there must be some good stories behind those 1-birth facilities! But the out-of-hospital c-section, I might venture the guess that it's a misclassification. After working a lot with vital statistics last summer, I discovered their limitations... for example, there were dozens of births in our county entered as having occurred in zip codes that belonged on the other side of the country! Amongst thousands and thousands of births in a large population, typing and classification errors get made and missed, and because it's all population-level data no one really gets too nitpicky about relatively small errors. So I would bet that's the case here, although if it's for real I would be REALLY curious to know that story too!

CHOP sounds like a definite outlier, with good reason. I am curious about some of the other hospitals that are up there in the 40% range. I respect and understand that some hospitals will have high c-section rates for similar reasons to CHOP's. But when many hospitals are all claiming their "high risk" population in the same area, I wonder where the heck all the LOW risk women are. Similarly, it's nice to see those facilities with 20% c-section rates but you wonder if they're community hospitals who refer out anyone even a little bit high risk. Maybe some of those high-risk hospitals have a section rate for their low-risk patients that's better than the community hospitals, but it's being obscured by the rest. I've seen high-risk academic hospitals (well, OK, one) do a pretty good job with their low-risk patients.

I mean, if given no other info, I would almost always choose a facility with a low c-section rate over one with a high rate, because you figure at one with a high rate they're so used to sectioning people and treating high-risk patients, that even if you're not high-risk they'll treat you that way and be quicker to section. But it would be nice if, besides just asking around to get a fuller picture, there was more info - if there was some way to disaggregate the numbers by risk classification. That way it would be easier for both low- and high-risk classified women to assess their c-section chances at different hospitals. (It would also help distinguish who is accurate about their high risk population and who is not.) But of course you'd have the issues of how to define risk, classification/accuracy errors (as noted above, can be very prevalent!), and hospitals potentially coming up with ways to nudge patients into the high risk category to improve their stats. I'll keep dreaming my statistical analysis dreams... ;-)

December 21, 2009 | Unregistered CommenterRebecca

Totally agree that the statistics don't give the whole picture. They also can't capture widely disparate rates for individual provider. In the last 6 mos, my own hospital is above the national average, while a couple of providers are well below. It's hard to capture the "culture" of a place in just their statistics.
Bummed that you rained on my parade though on the home/dr's office/clinic c-section - I was wanting an interesting story!

December 21, 2009 | Unregistered Commenterdcotorjen

CHoP belongs in the stats or the PA Dept of Health wouldn't have included it in their birth data. Cesareans are cesareans and they get counted. I would hope that this isn't being read with the assumption that anyone is wagging their finger at CHoP.

December 21, 2009 | Registered CommenterJill

It is encouraging to see one hospital in Western PA, Washington Hospital, have such a low CS rate (22%!) AND comparatively large number of VBACs compared to hospitals with similar volume. They do as many VBACs as hospitals that do twice as many total births. As a doula, I'll be interested to look into this further...

December 21, 2009 | Unregistered CommenterVanessa Manz

"I would hope that this isn't being read with the assumption that anyone is wagging their finger at CHoP."

No wagging here...just feeling so bad for those 94 moms/babies who had a reason to deliver there :-(

December 21, 2009 | Unregistered CommenterRebecca

"I mean, if given no other info, I would almost always choose a facility with a low c-section rate over one with a high rate, because you figure at one with a high rate they're so used to sectioning people and treating high-risk patients, that even if you're not high-risk they'll treat you that way and be quicker to section."

I can attest to this very phenomenon. During my most recent pregnancy, I was confirmed as in labor at 28 weeks. The local hospital, which only has a level 2 nursery air lifted me out to Albequerque to be in a hospital with a full NICU. When asked why there (4 hours away) instead of El Paso, less than an hour away by ambulence, the vague answer I got was that the staff that had been sent to the two hospitals agreed that the one in Albequerque was more "friendly" or that they liked it better, and that El Paso had somewhere between a 50% and 70% C-Section rate. When I got there, I found the staff to be very supportive, sympathetic, and willing to listen. We even got a doctor to come in and sit and talk to us and answer all our questions in a more conversational manner, which really helped draw out everything we wanted to ask. I loved it there. But, with a 2 year old at home, my labor stopped, and with no definitive answer about why it had happened or if it would come back, I left AMA planning on bed rest at home. The next time I went into preterm labor at 29 weeks, I requested being sent to El Paso, for the fact that I could stay there and it was reasonable for my husband to come visit me. The difference was immediate. Before I was off the gurney, the tech assisting points to the bag containing my magnesium and says "So, this is the pitocin?" I'm the one who had to answer, and tell him that no, we were trying to keep this baby in, not make it come out faster. Two minutes later, in walks the Anestetist (sp?) to have me sign a consent form for the epidural. I said I didn't want it and wouldn't need it, as I wasn't having the baby. She replied that it was better to do now than later when I was in pain and I could read it, and insisted it be signed. In talking to the nurses over the week I was there, I learned that nearly everyone has an epidural, nearly everyone is induced, etc. When I asked the doctor about this, he said the C-section rate was higher because of cases like mine, where the local hospital was "too scared" to deal with it. (As a side note, the doctor invariably did his rounds between 4 and 6 am, when most of the time I was too tired from being woken up to properly ask questions about what was going on). Personally, I think this is BS, given what I learned from the nurses. There was one night nurse there who nearly confirmed my suspicions when she evaded my questions about the C-section rate. She was the one I liked best, because she actually seemed to understand and listen to my concerns.

Anyways, I also wanted to say that I found the best people to interview for how you will be treated are the ones actually in the hospital, the nurses who will be taking care of you. I found that they were the best indicator of how I was treated and the atmosphere of the hostpital as far as how well they listen and work with you.

December 22, 2009 | Unregistered CommenterLadydilee

Ouch.
But thanks for putting the data out there, Jill. Anybody facile with GIS? It would be interesting to match up hospital CS rates with median income in the relevant areas. I'd bet money that higher income populations = higher CS rates, though there's no medical reason for that connection. (CHOP is an outlier. They won't accept for delivery any woman who isn't carrying a fetus with significant anomalies, some--not all--of which would complicate or contraindicate a vaginal delivery.)

December 28, 2009 | Unregistered Commenterdrp

As a follow up, I just wanted to say that this is starting to get attention. I was contacted by a reporter because I've done a birth at Clarion and they have a 50% CS rate. He is looking into why it is so high comparatively. I will be interested to see where he goes with it. I tried to give him a start without seeming to radical. Its hard when the evidence is so radical.

January 9, 2010 | Unregistered CommenterVanessa Manz

Hmm. I agree with this data. It is important that every hospital has good facilities and staff.

All the Best,
Helena

September 2, 2010 | Unregistered CommenterHelena
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