Ohio Hospital Compare includes (some troubling) data on c-sections
I recently came across a helpful (and birth-relevant) website created by the Ohio Department of Health: Ohio Hospital Compare. On this site, users can search by county and/or by hospital to compare data on various hospital performance measures from all of the state
Based upon data from January 1, 2008 to December 31, 2008, these performance measures include the following information:
1) the rate of surgical site-infection in c-section patients at each particular hospital and
2) the rate of c-sections for moms having their first baby with no complications (i.e. the data excludes breech births, twins, and pre-term births).
According to the data, rate of surgical site-infection ranged anywhere from 0.00% to a whopping 6.93%, with the average rate of infection at all Ohio hospitals being 1.12%.
While this data serves as a helpful reminder that there is a risk of infection for any woman undergoing a cesarean section, it also illuminates the fact that some Ohio hospitals have troubling rates of infection in mothers who have had c-sections. And this is worth knowing if you are planning to give birth in an Ohio hospital!
Perhaps even more troubling than a few hospitals with troubling infection rates, however, is the data on the rate of cesarean sections for ”uncomplicated” first births. According to the explanation on the Ohio Hospital Compare website, this data is meant to convey:
the percent of babies delivered by c-section to moms having their first babies with no complications (i.e. babies [were] not breech, delivery was at full-term and mom was not having twins or multiples).
In other words, the percentage reported in the data on the website excludes moms who are having their second, third, etc. babies, it excludes repeat cesareans, it excludes pre-term babies, and it excludes babies born via cesarean section for breech or multiple births.
It excludes a whole lot of births. And it includes only “uncomplicated” primary cesarean sections for moms having their first babies.
And what sorts of percentages or “scores” does the Ohio Health Compare site report?
With rates ranging anywhere from 6.69% (GO Miami Valley Hospital in Montgomery County!) to a ghastly 61.82% (what’s the deal, Wyandot Memorial Hospital?!), the average rate of primary cesareans for first-time moms with uncomplicated births at Ohio hospitals is 27.10%.
Let’s put that number in perspective.
According to the CDC, the national cesarean delivery rate was 31.8% in 2007. That percentage includes breech, multiple, and pre-term births. It includes repeat cesareans. It includes moms having their second, third, fourth, etc. babies. It includes all of those births that the data on the Ohio Health Compare site excluded.
And with an average rate of c-section for first-time moms with “uncomplicated” births standing at 27.10% in the state of Ohio–a rate that excludes all of the other c-sections mentioned above–I fear that the national cesarean delivery rate will rise (and probably has already risen) dramatically from the already-troubling 31.8% rate in 2007.
That’s why it’s so important that the Ohio Health Compare website includes the following information when you click for an explanation of this particular hospital performance measure:
This information is important because c-section delivery is associated with an increased risk of postpartum (after delivery) maternal death when compared with vaginal delivery. Also, women who have c-sections are at an increased risk for fatal blood clots, infections, and complications of anesthesia. Some hospitals now have c-section rates over 50%. The goal should be to manage the first delivery well, so it can result in a vaginal delivery and avoid repeat c-sections in future births. Research has found that many of these c-sections can be related to inducing labor and early admissions.
Lower percentages are better.
Preach it, Ohio.
I was going to ask you about this – I checked out the study when I saw you Twitter it and at first I said “whoo hoo” MVH low c-section rate but then I realized all the stuff it was missing. So is the 6.9% at the Valley basically for elective c-sections since it doesn’t include breech births etc? I wondered why they don’t report the rest of the information as I would think that it would be relevant too.
I’m guessing the 6.9% rate includes c-sections for fetal distress, “failure to progress,” failed inductions, and “suspected macrosomia.” There might be a few patient-chosen elective c-sections in there, and there could also be some doctor-directed elective c-sections (like the ones for suspected macrosomia, or “big babies”). There could be other reasons for the c-sections in that group, of course, but a 6.9% rate seems very, very good, especially when compared with the other hospitals in the state.
As far as their reasons for not reporting the other data, my guess is that it is simply very difficult to get hospitals to give reports on lots and lots of information. (And they might be reporting overall cesarean rates to the CDC anyway.) I haven’t looked yet into why the state of Ohio chose to report (or even to collect) this data as opposed to other hospital performance measures, but I’m glad that they are at least reporting some of it!
I also wonder, however, if they do have info available on the overall c-section rates per hospital, especially since they remarked about the 50%+ cesarean rates in some individual hospitals. Nonetheless, I like how the state used the info on first cesareans to shed light on how maternity care providers need to do a better job of “managing” these first births so that women can avoid all of the complications that come with c-sections (including FUTURE c-sections).
Did they post anything on induction rates and reasons? There can be some good reasons for induction (Past 42 weeks when you are sure of dates) and some very stupid reasons – a lot of very stupid reasons.
I wonder . . .
@Mrs. Spit – No, they didn’t report any information on induction rates and reasons, although they did mention that inductions are associated with higher c-section rates. It makes me wonder if the state does have a lot more data on maternity care in Ohio that they simply haven’t reported yet. Perhaps they felt as if c-section infection rates, c-section rates for first time moms, etc. were some of the best ways to characterize a hospital’s performance measures in terms of maternity care. (For what it’s worth, the website also reported on pre-term infants who were delivered at hospitals with Level II NICUs and mothers of pre-term infants who were given steroids before their babies’ births, so the maternity-relevant performance measures weren’t solely related to cesarean section.)
This is an interesting report, I wish they had included all the other cesareans so we could have a more accurate view of the true rates.
I would love to see a survey of all the women who left the state to have a birth safely away from the surgery happy hands of Ohio’s OBs. I had a birth center VBAC after an Inv T in MI in 2007 because none of the care providers (OBs or home birth midwives) in NW Ohio would assist me.