2017-2018 Nebraska Hospital Cesarean Rates
Every summer since 2017, I have been compiling all of Nebraska’s maternity care statistics from public sources and putting them in a single PDF for free so Nebraskans can make more informed decisions about their births. While I am still working to update my PDF (last year’s version still available for Professional email subscribers, this year’s version will be sent to all subscribers once it’s complete, scroll to the bottom to subscribe), here are the most recent, publicly available data on hospital-level Cesarean rates. For comparison, the US Cesarean rate for the 2017 calendar year was 32.0%, and Nebraska’s was 30.4%.
In this bar graph below, I have included Overall Cesarean rates for all 55 Nebraska hospitals that discharged any patients after any type of birth in the year from October 2017 through September 2018. Please note that all nine Nebraska hospitals with 0% and 100% Cesarean rates cared for 26 or fewer births in that entire year, and drawing conclusions on facility culture using data from such a small population is not advised. CHI Health Lakeside in Omaha has an overall Cesarean rate of 30.37% and Henderson Healthcare in Henderson’s rate is 30.43%, right below and above Nebraska’s average. Lexington Regional in Lexington’s rate is 31.62%, and CHI Health Good Samaritan in Kearney’s rate is 32.12%, right below and above the United States average.
Between October 2017 and September 2018, there were 22 Nebraska hospitals that cared for 100 or more births. I have created the following infographic showing only the Overall Cesarean rates for these 22 facilities, as the data is more likely to demonstrate facility differences in culture and reducing unnecessary surgical birth rates. Recall that the US Cesarean rate for the 2017 calendar year was 32.0%, and Nebraska’s was 30.4%.
To note here with this data. This is from the Nebraska Hospital Association’s Care Compare website, intended for consumers to price check procedures at different hospitals in their area. The tool is not intended for data on frequency of procedures, but according to representatives at NHA, it is accurate information with regard to number of patients discharged following each procedure. This data is free to the public without a log in required. To my knowledge, this is the only source of this information without directly contacting each individual facility. I had to catalog each facility’s number of Cesarean, vaginal birth with sterilization, and vaginal birth with no other procedures discharges and calculate the percentage of birth discharges that are following Cesarean, and my calculations are not exempt from error. Obviously I am not a medical professional which means I am incapable of giving medical advice, so do not construe this information as such. With all this in mind, please use this data as one piece of information out of many in a decision-making process. You can compare this year with the two years previous and see what has happened over time at your facility, 2015-2016 here, and 2016-2017 here (these previous years are July-June, NHA is updating their information sooner this year, so I am missing the data from June-Oct 2017). If you would like copies of my previous PDFs with the raw data please let me know using my contact form and I would be pleased to email those to you.
What I have calculated in years past are the same as overall Cesarean rates self-reported by some hospital systems in the state (ICAN of Omaha reported the same numbers as released to them by CHI Health’s Nebraska facilities last year), so if my data source is incomplete, it is fairly close to internal data. All facilities should self-report their Overall Cesarean rates, and develop and publish their plans to reduce them.
This is overall Cesarean rate, which is just one quality of care assessment of a hospital’s maternity care system. Overall Cesarean rate is the percentage of all births in the time period that were Cesarean births. Facilities that take a higher number of high-risk births, such as Children’s Hospital in Omaha, NE, will have a higher Cesarean rate than facilities that take primarily low-risk and normal-risk births. In order to remove this variable from facility quality assessments, we look instead at the NTSV or low-risk Cesarean rate. This is the Cesarean rate among Nulliparous (first birth), Term (between 37 and 42 weeks of pregnancy), Singleton (single baby, no twins or other multiples), Vertex (head down presentation) births. This population is at the lowest risk of birthing by Cesarean, so we can see facility variability outside of a higher-risk patient population by looking at this rate. This rate is not publicly available for Nebraska hospitals yet, though the Joint Commission announced they will begin reporting hospitals with high NTSV Cesarean rates publicly by July 1, 2020. Although the Joint Commission does not appear to plan on publishing exact numbers, this piece of information will be helpful to consumers nonetheless. Facilities should self-report their NTSV Cesarean rates, and develop and publish their plans to reduce them.
Other information that would be extremely useful in evaluating hospital quality in maternity care would be their induction rates, and their episiotomy rates. So why do I focus on Cesarean rates? The biggest reason is that I can find hospital Cesarean rates, and I cannot find these other pieces of information publicly available. The LeapFrog Group issues a hospital survey that asks hospitals to self-report their performance on a variety of quality measures, including Cesarean rates and episiotomy rates. Unfortunately, no Nebraska hospital has completed this survey for the last two years! Without this information, choosing a hospital is a shot in the dark. The next reason why I personally publish this publicly available (but tediously compiled and calculated) data on hospital Cesarean rates is that current research still indicates that your biggest Cesarean risk in your birth is which hospital you go to for birth.
Are you a consumer? Call your hospital, and let them know what you think about their Cesarean rate. If you have a choice of birthing hospital, and you want to avoid an unnecessary Cesarean, choose the hospital with the lowest rate, and tell them that is why you gave them your business. If you have had a Cesarean, get support as you heal and process your birth. ICAN is a great, safe place to do that.
Are you a maternity caregiver? Calculate your own Cesarean rate, as well as the rates of the facilities where you work. Look at the research examining why the Cesarean rate is so high. Educate yourself on the risks and benefits of both Cesareans and VBAC so you can adequately and truthfully counsel your patients to make an informed choice. If you choose not to offer VBAC care, refer your patients desiring VBAC to a provider who does.
Are you a hospital obstetric chair, nurse manager, or administrator? Seriously examine your facility's practices and procedures that may be interfering with the hormonal physiology of childbirth and contributing to unnecessary interventions and preventable Cesareans. You can help reduce your facility's Cesarean rate. Hoag Memorial Hospital Presbyterian in Orange County, CA did, you can do it too.
For those who are also searching for hospital-level information in their area, here are some other sources I utilized in my search process. These and their equivalents in other states may be useful for others: