To be fair, the only reason that someone would give birth at CHoP is if the child had a severe, life threatening condition. OTOH, I am so saddened to read that both major hospitals in the Erie County area (St. Vincent, and Hamot) have C-Section rates of almost 40%. I am not surprised by this at all. Women have NO WHERE ELSE to turn. It's sad.

Yeah - CHOP only does high risk births, from what I hear, so that cesarean rate doesn't really surprise me. Jennersville is in Chester County - there's a separate city of Chester about 30 miles away. Gets confusing :) Births there are primarily attended by CNMs - I think there's only one group that attends there with 1 OB/GYN and the rest CNMs. I have a friend who had a VBAC with twins there!

I understand that COHP only handles high risk situations, but just because the child has a high risk condition does not mean that a c-section is necessary. I can't imagine that even in the situation of high risk births a full 2/3 of them call for open-uterus surgery.

CHOP is a HUGE hospital that delivered less than 100 babies in all. Even high risk births would generally happen across the breezeway at HUP, there is a corridor for passing patients from one hospital to the other. The situation has to be crazy for the delivery to even happen there. It's not really a good hospital to get statistics from to judge PA births. Not making any excuses for anyone else, but I completely understand CHOP.

Sara - the reason why so many babies would be born via section at CHoP is that some of those babies could not handle labor/cannot stay in the womb until term - many are taken earlier then full term and for the health of the baby and the reduced stress levels on mama they often times do sections.
From what i understand there is only one or two OB groups that still deliver at (Chester County Hospital) CCH as everyone i know in the West Chester area seems to go to the same doctors for pregnancy before going back to their own GYN after the delivery...finding OB's in the CCH area is really hard to say the least....but i am glad to see that CCH is under the Commonwealth avg but i would love to see it go down even more...

Re: Children's Hospital of Pennsylvania's high C/s rate -- I can see that if a woman knew that her child was going to need immediate surgery after the birth, that she would give birth there. And since many conditions requiring urgent or immediate surgery as soon as the baby was born might make vaginal birth risky or downright dangerous for the baby (perhaps something like spina bifida?), that could be a reason for part of the high rate. Also, if the baby is going to need specialized care including surgery or trained nurses, it would make sense to ensure that the baby was born at a time when those doctors would be there (and not being woken up out of deep sleep and perhaps operating while groggy). If I knew my baby needed immediate heart surgery as soon as he was born, even if the labor or birth itself might not be a risk, I would be more willing to have a C-section just so he could have a smoother, quicker, and/or safer transfer into the pediatric OR, rather than waiting until midnight when a whole team of doctors would have to be assembled. Even if I were not already inclined that way, it would be very easy to see that women might be pressured to make that choice -- how many stories are there of women coerced into unwanted C-sections just because the OR is ready and the paperwork has been signed, even though the baby's heartbeat is fine and the mother is tolerating labor? -- how much more pressure must a woman feel to not inconvenience the team of doctors and nurses who will be working to save her baby's life?

I just moved to Erie about a year ago - all I can say is that I'm SO GLAD I started attending ICAN meetings there. Hope we get some new members from this, at the very least.

I think most births at CHOP would be for babies who have such a high risk condition that even delivering very close by would be too risky for them, so their cesarean rate makes good sense to me. They also likely do some of the more technical procedures that would involve babies going directly to surgery, or directly on ECHMO (like for diaphragmatic hernia) that aren't available anywhere else, and require very planned timing of the birth. Interesting that one of their vaginal births was a VBAC! There are several fetal conditions that make vaginal birth worse for baby - spina bifida being a big one that I think CHOP would handle a lot of. In my experience, in most congenital cardiac disese, they encourage vaginal birth if at all possible. Our congenital heart babies in my referral tertiary care hospital are almost always born vaginally.
I was fascinated, too, by all the hospitals at the bottom of the list with 1 birth. These must be hospitals with no labor and delviery unit, so these would be walk-in, or amublance-brought emergency births. Interesting that one of those was a VBAC, too - I wonder what that story is!
I assume the freestanding birth centers do not perform cesareans, not that their clients truly had a 0% rate. I was wondering about the 1 cesarean done at a clinic/home/dr's office, that must be a story too!

LOL. You "scooped" me. I was going to do this tonight. Spent much too many hours last night doing the analysis of my local hospitals. ;-)

BTW, I do want to confirm that the situation with CHOP is that women quite simply do not go there expecting to labor, I'd be willing to guess that the few vaginal births that occur are by accident. In 2007 they actually had a 100% cesarean rate--only 16 births.

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.

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... ;-)

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!

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...

"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 :-(

"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.

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.)

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.