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, 1990-2008. These 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

       

Comments

[Reality Rounds]

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.

[Rebecca]

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... ;-)

[dcotorjen]

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!

[Jill]

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.

[Vanessa Manz]

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...

[Rebecca]

"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 :-(

[Ladydilee]

"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.

[drp]

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.)

[Vanessa Manz]

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.

[Helena]

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

All the Best,
Helena