Alaska Cesarean Rates by Hospital, 2008

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The State of Alaska reports their cesarean and VBAC data with exemplary forthrightness and transparency. The following tables are adapted from the consumer-friendly information available from the Alaska Bureau of Vital Statistics. 

	Total # C/S	C/S %	Total # Births
A Woman’s Place		0.0%	1
Alaska Family Health	0	0.0%	86
Alaska Native Medical Center	199	13.3%	1493
Alaska Regional Hospital	291	36.1%	807
Bartlett Regional Hospital	147	38.7%	380
Bassett Army Hospital	151	19.6%	772
Central Peninsula Hospital	90	23.7%	379
Elmendorf USAF Hospital	123	15.2%	808
Fairbanks Memorial Hospital	272	23.3%	1168
Geneva Woods Birth Center	0	0.0%	85
Home Births	0	0.0%	183
Juneau Family Birth Center	0	0.0%	32
Kanakanak Hospital	0	0.0%	43
Ketchikan General Hospital	54	21.5%	251
Kodiak Island Hospital	51	27.4%	186
Maniilaq Medical Center	0	0.0%	53
Mat-Su Midwifery	0	0.0%	125
Mat-Su Regional Medical Center	165	23.2%	712
Norton Sound Regional Hospital	0	0.0%	111
Petersburg Medical Center	0	0.0%	9
Providence Alaska Medical Center	921	33.9%	2714
Providence Seward Medical Center	0	0.0%	1
Providence Valdez Medical Center	3	7.1%	42
Samuel Simmonds Memorial Hospital	0	0.0%	62
SEARHC Mt. Edgecumbe	15	25.9%	58
Sitka Community Hospital	21	31.3%	67
South Peninsula Hospital	25	18.1%	138
Windsong Midwifery	0	0.0%	7
Woman’s Way Midwifery	0	0.0%	46
Wrangell General	0	0.0%	1
Yukon-Kuskokwim Delta Hospital	18	4.2%	427
Other Facility	38	20.0%	190
All Facilities	2584	22.6%	11437

	Vag #	Vag %	VBAC #	VBAC %	Total # Births
A Woman’s Place	1	100.0%	0	0.0%	1
Alaska Family Health	86	100.0%	0	0.0%	86
Alaska Native Medical Center	1223	81.9%	70	4.7%	1493
Alaska Regional Hospital	496	61.5%	16	2.0%	807
Bartlett Regional Hospital	231	60.8%	0	0.0%	380
Bassett Army Hospital	585	75.8%	11	1.4%	772
Central Peninsula Hospital	289	76.3%	0	0.0%	379
Elmendorf USAF Hospital	541	67.0%	14	1.7%	808
Fairbanks Memorial Hospital	877	75.1%	16	1.4%	1168
Geneva Woods Birth Center	85	100.0%	0	0.0%	85
Home Births	176	96.2%	3	1.6%	183
Juneau Family Birth Center	32	100.0%	0	0.0%	32
Kanakanak Hospital	43	100.0%	0	0.0%	43
Ketchikan General Hospital	190	75.7%	2	0.8%	251
Kodiak Island Hospital	133	71.5%	2	1.1%	186
Maniilaq Medical Center	52	98.1%	0	0.0%	53
Mat-Su Midwifery	124	99.2%	0	0.0%	125
Mat-Su Regional Medical Center	507	71.2%	15	2.1%	712
Norton Sound Regional Hospital	111	100.0%	0	0.0%	111
Petersburg Medical Center	7	77.8%	0	0.0%	9
Providence Alaska Medical Center	1777	65.5%	13	0.5%	2714
Providence Seward Medical Center	1	100.0%	0	0.0%	1
Providence Valdez Medical Center	38	90.5%	0	0.0%	42
Samuel Simmonds Memorial Hospital	60	96.8%	2	3.2%	62
SEARHC Mt. Edgecumbe	41	70.7%	0	0.0%	58
Sitka Community Hospital	46	68.7%	0	0.0%	67
South Peninsula Hospital	109	79.0%	4	2.9%	138
Windsong Midwifery	7	100.0%	0	0.0%	7
Woman’s Way Midwifery	45	97.8%	0	0.0%	46
Wrangell General	1	100.0%	0	0.0%	1
Yukon-Kuskokwim Delta Hospital	405	94.8%	0	0.0%	427
Other Facility	132	69.5%	1	0.5%	190
All Facilities	8451	73.9%	169	1.5%	11437

	Primary C/S #	Primary C/S %	Repeat C/S #	Repeat C/S %	Total # Births
A Woman’s Place	0	0.0%	0	0.0%	1
Alaska Family Health	0	0.0%	0	0.0%	86
Alaska Native Medical Center	129	8.6%	70	4.7%	1493
Alaska Regional Hospital	160	19.8%	131	16.2%	807
Bartlett Regional Hospital	83	21.8%	64	16.8%	380
Bassett Army Hospital	79	10.2%	72	9.3%	772
Central Peninsula Hospital	54	14.2%	36	9.5%	379
Elmendorf USAF Hospital	68	8.4%	55	6.8%	808
Fairbanks Memorial Hospital	141	12.1%	131	11.2%	1168
Geneva Woods Birth Center	0	0.0%	0	0.0%	85
Home Births	0	0.0%	0	0.0%	183
Juneau Family Birth Center	0	0.0%	0	0.0%	32
Kanakanak Hospital	0	0.0%	0	0.0%	43
Ketchikan General Hospital	25	10.0%	29	11.6%	251
Kodiak Island Hospital	36	19.4%	15	8.1%	186
Maniilaq Medical Center	0	0.0%	0	0.0%	53
Mat-Su Midwifery	0	0.0%	0	0.0%	125
Mat-Su Regional Medical Center	105	14.7%	60	8.4%	712
Norton Sound Regional Hospital	0	0.0%	0	0.0%	111
Petersburg Medical Center	0	0.0%	0	0.0%	9
Providence Alaska Medical Center	819	30.2%	102	3.8%	2714
Providence Seward Medical Center	0	0.0%	0	0.0%	1
Providence Valdez Medical Center	3	7.1%	0	0.0%	42
Samuel Simmonds Memorial Hospital	0	0.0%	0	0.0%	62
SEARHC Mt. Edgecumbe	7	12.1%	8	13.8%	58
Sitka Community Hospital	8	11.9%	13	19.4%	67
South Peninsula Hospital	20	14.5%	5	3.6%	138
Windsong Midwifery	0	0.0%	0	0.0%	7
Woman’s Way Midwifery	0	0.0%	0	0.0%	46
Wrangell General	0	0.0%	0	0.0%	1
Yukon-Kuskokwim Delta Hospital	16	3.7%	2	0.5%	427
Other Facility	32	16.8%	6	3.2%	190
All Facilities	1785	15.6%	799	7.0%	11437

	Not Rep’d #	Not Rep’d %	Total # Births
A Woman’s Place	0	0.0%	1
Alaska Family Health	0	0.0%	86
Alaska Native Medical Center	1	0.1%	1493
Alaska Regional Hospital	4	0.5%	807
Bartlett Regional Hospital	2	0.5%	380
Bassett Army Hospital	25	3.2%	772
Central Peninsula Hospital	0	0.0%	379
Elmendorf USAF Hospital	130	16.1%	808
Fairbanks Memorial Hospital	3	0.3%	1168
Geneva Woods Birth Center	0	0.0%	85
Home Births	4	2.2%	183
Juneau Family Birth Center	0	0.0%	32
Kanakanak Hospital	0	0.0%	43
Ketchikan General Hospital	5	2.0%	251
Kodiak Island Hospital	0	0.0%	186
Maniilaq Medical Center	1	1.9%	53
Mat-Su Midwifery	1	0.8%	125
Mat-Su Regional Medical Center	25	3.5%	712
Norton Sound Regional Hospital	0	0.0%	111
Petersburg Medical Center	2	22.2%	9
Providence Alaska Medical Center	3	0.1%	2714
Providence Seward Medical Center	0	0.0%	1
Providence Valdez Medical Center	1	2.4%	42
Samuel Simmonds Memorial Hospital	0	0.0%	62
SEARHC Mt. Edgecumbe	2	3.4%	58
Sitka Community Hospital	0	0.0%	67
South Peninsula Hospital	0	0.0%	138
Windsong Midwifery	0	0.0%	7
Woman’s Way Midwifery	1	2.2%	46
Wrangell General	0	0.0%	1
Yukon-Kuskokwim Delta Hospital	4	0.9%	427
Other Facility	19	10.0%	190
All Facilities	233	2.0%	11437

Comments

[Maegan]

What I like about this. There are locations that have a 100% vag delivery rate. Maybe its just the type of facility/provider thats the cause. Like someone who only accepts low risk pregnancies or something...but even still, that kind of shows how low risk can actually mean 'not at risk for anything that would require a c-section' instead of 'just waiting to be cut open'.

[Rebecca S]

I wonder which of these hospitals (if not obvious, as in, other than the one named Alaska Native Medical Center) are part of the IHS/Alaska Native health service. I would think that the factors that contribute to the low cesarean rates in the IHS as described in the article about Tuba City Arizona, including midwife-led maternity care, salaried OBs, and federally-insured malpractice, would also be applicable to Alaska and lead to this comparatively low c/s rate.

Thanks for posting Jill! Glad that Alaska has such a user-friendly website.

[Jessie]

Taken from IHS: IHS-funded, tribally-managed hospitals are located in Anchorage, Barrow, Bethel, Dillingham, Kotzebue, Nome and Sitka. There are 37 tribal health centers, 166 tribal community health aide clinics and five residential substance abuse treatment centers. The Alaska Native Medical Center in Anchorage is the state-wide referral center and gatekeeper for specialty care.

So Alaska Native Medical Center in Anchorage is the biggest hospital but I believe they have more doctors than midwives like Tuba City, A lot of the hospitals listed are in rural areas where there are less surgeons. If for some reason a surgeon is not available, the patient is medivaced down to Anchorage for care. Depending on their nationality they are sent to different hospitals because they might not be native...so they go to Providence or Alaska Regional if they are not. If they can, they choose their hospital..but that is only if they are on medicaid. Most of the mothers in rural areas are on Medicaid. (Denali Kid Care). If they are Native, they can choose either or, most are signed up at their first OB appointment.

I don't think 22% is low, considering there are less people there and obviously men outnumber the women..I mean compared to the almost 50% some hospitals have it is low, but it should be lower...I do think they need more birthing education up there than what is offered in the hospital, with a free tour. Its nice to see free standing birth centers though, which are for low risk births.

I love this post being from Alaska. I just recently started diving into the birth world and I am facinated and confused on why birth has gone wrong. I see the definate changes that have presented themselves throught our recent history. We are scarring and scarring women and when does it stop? Thank you for posting this, this post and my comment have inspired me for some writing. I will continue my rant on my blog. Thank you again.

[Leah]

The locations with a 100% vag delivery rate are either midwife-run birth centers or extremely rural hospitals (except for Seward, but that was based on one birth). By "rural" I mean: serving villages that may not have indoor plumbing. Bush Alaska would be completely alien to most Americans. I think it really says something about modern American culture that the hospitals with the highest c-section rates are those in large urban centers. Like, when there are fewer resources, people are more content to let birth take its own time instead of medicalizing it unnecessarily.

[Leah]

Also, after the 2000 Census, there were 107 men to 100 women in Alaska. While substantially higher than the nearest competitor (Nevada, 103.9/100), it's not enough of a discrepancy to be "obvious."

[Cheryl @ CrunchyBusiness]

I love seeing statistics like this. Being Canadian, we traditionally speaking have a lower c-section rate because of our government health care... The government just doesn't like paying for "unnecesareans" - but even here, we have hospitals with higher c-section rates than others. These are typically the hospitals with 24/7 OB's and anaesthesiologists, and NICU's - which many of the smaller community hospitals don't have.

Our hospital here has OBs & anaesthesiologists on call, and a nursery "if needed" - but they only have ONE operating room available for c-sections. Their c-section rate is still higher than what is probably necessary, but lower than many other hospitals in our area just because they don't have the facilities to handle too many of them.

The scary part about our hospital? The c-section rate is a bit high for a Canadian hospital, yes, but the infection rate from c-sections is disgusting. Greater than 25%, when you include minor infections. More than 1 in 100 women actually DIE from hospital acquired infections after c-sections at our hospital.

Hence why I'm planning a home birth! LOL

But seriously, thanks for sharing. It is nice to be able to compare lots of different areas to the rate in your own, and see how your local hospitals are doing. Great post!

[Kim]

Hi! Alaskan here, so I thought I'd throw my perspective in a bit...

All of the 100% vaginal births are birth centers or rural health centers. One thing I DON'T like about these stats is that it doesn't say anything about the women who have started out receiving their care from one of the places w/ 100% vaginal birth rates but had to transfer to the hospital at any given point in the process because of "risking out" of the birth center for one reason or another. Mostly what I don't like is that I feel these stats are skewed because of that...especially for two reasons. 1. There is no mention made of hospital transfers. A significant number of the c-sections that happen at the large urban hospitals are women that have transferred from somewhere else, I would like this to be reflected in the stats both in terms of from where the transfer and to where they transfer. 2. Many of the freestanding birth centers and some of the smaller regional facilities ARE run and staffed by providers who attend VBACs, they just happen to have hospital privileges (at the bigger facilities) too since state licensing currently requires that all VBACs take place in a hospital setting where surgeons are available... I wish these stats reflected that fact that those specific care providers account for a pretty big percent of the VBACs in this state...

The one and only factor that contributes to the low/no section rates for a lot of these facilities is that nearly all women who are pregnant in the villages "risk out" of care at their local facilities and are flown into Anchorage, Fairbanks or Juneau weeks before their due date to deliver their babies in the city. This includes women who happen to live in the bigger hub villages that do have "large" regional medical centers (large being a relative word.) Jessie, it really isn't that people are more content to let things take their natural course in the villages...it IS that they are much LESS willing and thus you have women flown "into town" literally weeks before their due dates, and often w/ not family to accompany them, so that they will be near the hospital when the time comes, "just in case."

I've got a good friend who is doing some dissertation work with the midwives and women in Kotzebue (Maniilaq Medical Center) and the impact "flying out" to have their babies has on the community. It should be interesting when everything is said in done...

And ANMC in Anchorage does have more doctors than midwives. Most of the midwives do a lot of prenatal and post natal care through the out-patient care services, but don't attend many births.

All that being said...Alaska has long had a reputation for being a really midwife friendly state. We have a lot of free-standing birth centers (in the cities) on a per-capita bases...and my understanding is that we were an early state to allow and license direct-entry midwives.

[Sarah Vine]

I grew up in one of those remote villages (Naknek) where there is no hospital. My mom was flown to Anchorage for my little sister's birth, because there were NO birthing facilities for our village of 500, or the other nearest villages. It's an hour's flight away. She was there 4 weeks, and birthed on her own, because we couldn't afford to stay in the city and my dad had to work. There was no birthing ethics available in that village, it's not like it's something that's been handed down. Everything is still ruled by the government Native Health (or non-Native status) Service in the villages.
I do have a friend who is a midwife in the Mat-Su Valley, and the midwifery services in the more 'urban' areas (where there is road access to the outside world!) is much more current, and inspiring. If only they could do VBAC's in the midwifery......
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