Transitions Birth Services, LLC

If a mom has had a cesarean and is planning another birth, she has two options.  She can have a repeat cesarean or a vaginal birth after cesarean (VBAC).  There are risks and benefits of both options.  The main risk of having a VBAC is uterine rupture.  Uterine rupture happens about .8% of the time during a VBAC.  Most uterine rupures are not dangerous- many aren't even noticed until a cesarean or other abdominal surgery is done.  But occasionally, a rupture can cause serious consequences- the death of the baby or mother. 

On the other hand, having multiple cesareans poses risks too.  Cesareans increase the risk of placenta problems in future pregnancies such as placenta previa and placenta accreta.  The chances of these occuring increase with each cesarean.  These conditions are serious and can be life threatening.  Cesareans also increase risks such as breathing problems for the baby and NICU admissions.

In 2010, the National Institutes of Health held a conference on VBACs.  You can read their Consensus Statement, which includes information on the risks and benefits of VBACs and repeat cesareans. 

Another helpful resource is A Woman's Guide to VBAC, which explains the NIH Statement. 

The Internation Cesarean Awareness Network (ICAN) has lots of great resources about cesareans and VBACs.  The website includes information to help moms make the decision between repeat cesarean and VBAC, webinars, forums, and a listing of hospitals' VBAC policies. Recently, a chapter of ICAN was formed in Evansville.  You can find information about meetings on their Facebook page or on ICAN's website.

You can also watch vol. 4 of More Business of Being Born:  The VBAC Delimma.  The video is available on demand for $4.  You can also borrow the video from the Evansville Vandergurgh Public Library.  The video includes information about risks, benefits, issues that keep many doctors and hospitals from offering VBAC, and stories of moms who have VBACs. 

If you are a mom considering VBAC, please contact me.  I can provide information on local options for VBAC and give you tips for having a VBAC.  Several moms in the Evansville Birthnetwork have had VBACs and are willing to talk about their experiences.  EBN also has a yahoo group where you can post questions and get input from other local moms. 

Interested in knowing your hospital's cesarean rate?

The Indiana State Department of Health publishes yearly hospital discharge data.  The reports include information on each hospital stay for all kinds of conditions.  Although the reports are made public, they are in no way user friendly for the average person.  I have gone through the data using Microsoft Access and calculated cesarean rates for each hospital in the state for 2010.  I have listed the cesarean rates in an Excel file here-

Indiana Hospital Cesarean Rates 2010

Some highlights:

• The cesarean rate for Indiana was 31.4%.  There were 81,380 births in Indiana in 2010.
  
• The hospital with the highest cesarean rate was Scott Memorial Hospital, with a rate of 57.8%.
• The hospital with the lowest cesarean rate was St. Elizabeth Medical Center with a rate of 14.3%.
• 5 hospitals had cesarean rates lower than 20%.
• 2 hospitals had rates higher than 50%.*
  
• Local hospitals-
• St. Mary's Medical Center's cesarean rate was 39.6%.
• The Women's Hospital's cesarean rate was 35.9%.

*I am not including information for hospitals that had less than 5 births.

Want to lower your chance of having a cesarean?  Read 10 Tips for Avoiding a First-Time Cesarean.

Do you live in Kentucky and want to know your local hospital's cesarean rate?  Looking for information on Kentucky hospitals' VBAC rates?

The Kentucky Cabinet for Health and Family Services makes information on hospitals' quality indicators and rates of utilizations of certain procedures on its website.  This information includes number of cesareans performed, cesarean rates, VBAC rates, and cesarean rates for first time mothers.  To see the information on their website, go here:

Kentucky 2010 Quality Indicators: Childbirth 

It can be difficult to sift through all the data available on that website.  It includes information on all types of condtions and procedures.  So I have gathered some of the info parents and birth advocates may be interested in.  I have taken the information for risk-adjusted cesarean rates, risk-adjusted VBAC rates and risk-adjusted cesarean rates for first time mothers and put them into an Excel spreadsheet.  I also took the information from that website on the number of cesarean performed at each hospital and divided it by the number of births at each hospital (found here) to calculate the actual cesarean rate.  I was curious how the actual rates and the risk-adjusted rates compared.  For most hospitals, the risk-adjusted rates were 1-3% lower than the actual rates.

Kentucky Hospital Cesarean Rates 2010 (Excel Spreadsheet)

Some highlights from the data-

• Kentucky's cesarean rate in 2010 was 36.2%. 
  
• The hospital with the highest cesarean rate is Paul B. Hall Regional Medical Center with a 71.0% cesarean rate.  The hospital's VBAC rate was 0%.
  
• The hospital with the second highest rate is Three Rivers Medical Center with a 66.3% rate.
• The VBAC rate for Kentucky is 4.3%.  In other words, 95.7% of women who have a cesarean and then have another birth have a repeat cesarean.  The University of Louisville Hospital has the highest VBAC rate at 11.6%.
• 20.6% of first time moms gave birth by cesarean in Kentucky.
  
• Hospitals in our area-

• Methodist Hospital in Henderson had a 43.4% cesarean rate and a 1.3% VBAC rate.  21.7% of first time moms gave birth by cesarean
• Owensboro Medical Health System Inc. had a 42.6% cesarean rate and a 1.5% VBAC rate.  23% of first time moms gave birth by cesarean.
• Regional Medical Center in Madisonville had a 40.8% cesarean rate and a 8.9% VBAC rate.  25.9% of first time moms gave birth by cesarean.

These statistics are a great reason to have a doula at your birth.  Doulas lower a mother's chance of having a cesarean section and other interventions.

The Leapfrog Group, a non-profit organization that compares hospitals on national standards of safety and quality, released a Call to Action this week: Protect Mothers and Babies from Unecessary Harm.  From the press release:

 The employer-driven hospital quality watchdog, The Leapfrog Group, issued a Call to Action in response to its new data finding that thousands of babies are electively scheduled for delivery too early, resulting in a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit (NICU), and life-long health problems.

The group asked hospitals accross the country to voluntarily report their rates of early elective births- inductions or cesareans without a medical indication happening before 39 weeks gestation.  Some hospitals had a rate of zero, showing that it is possible to avoid early elective births all together.  Other hospitals had rates of 50% or higher.

The March of Dimes lists these possible complications for babies born too soon:

• the baby's organs might not be fully developed
• the baby can develop vision and hearing problems that last throughout life
• the baby can have a low birthweight, which leads to problems statying warm
• the baby may have problems eating and breathing at the same time, which makes it difficult to gain weight

The Leapfrog Group released this list of hospitals and their rates of early elective births.  You are encouraged to use the information when deciding where to give birth.  If your hospital chose not to respond, consider writing them a letter and telling them the public needs access to this information. 

 From Leapfrog's press release:

“Hospitals, health plans, providers, and communities need to do more to protect women and babies from this harmful practice,” said Leapfrog CEO Leah Binder. “And women need to protect themselves by refusing to schedule their deliveries before 39 weeks without a sound medical reason, and by knowing the facts about the hospitals they plan to deliver in.” She noted that currently only hospitals that report to Leapfrog’s annual hospital survey are making their rates of early elective deliveries public. “Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information,” Binder added.

One factor that can have a big impact on your chance of having a cesarean is the cesarean rate of the place you give birth.  Hospitals have different environments- some rush to do cesareans very quickly and some will be more patient.  Want to know your local hospital's cesarean rate?

Indiana's hospitals' cesarean rates  (for 2008) are listed on the Unnecesarean.  St. Mary's cesarean rate was 40.1% and The Women's Hospital's cesarean rate was 38.1%.  (Update:  For 2009, St. Mary's cesarean rate was 39.3% and The Women's Hospital's rate was 38.4%.)

Kentucky's Cabinet for Health and Family Services lists hospitals' cesarean rates in Kentucky.  Owensboro Medical Health System's cesarean rate was 35.2%.  Methodist Hospital's (in Henderson) cesarean rate was 43.7%.  The rates for Kentucky hospitals are risk adjusted, meaning the rates do not incude higher risk births such as multiples, preterm births or abnormal presentations.

There is a new video out called Reducing Infant Mortality.  It looks at why the U.S. has such a high infant mortality rate.  One of the big reasons for our infant mortality rate is the number of babies born prematurely (almost 13%).  One reason babies are born too early is because of the high rate of elective inductions and c-sections in this country.  When a labor is induced or a c-section performed, there is a chance the due date was miscalculated.  A baby thought to be 38 weeks along might only be 36 weeks.  Even those couple weeks make a big difference in how babies do after birth.  The video suggests that we use the midwifery model of care more often in this country.  The website urges you to contact your legislators and ask them to include midwifery care in the health care reform bill.

If you click on the video below you can view the trailer.  Go to the website to view the whole film (16 minutes.)