2018-2019 Nebraska Hospital Cesarean Rates
Every summer since 2017, I have been compiling as many of Nebraska’s maternity care statistics from public sources as possible. I include all those statistics in a free PDF for my email subscribers, which you can join at the bottom of this page. Here are the most recent, publicly available data on hospital-level Cesarean rates for the year beginning October 2018 and ending September 2019. For comparison, the US Cesarean rate for the 2018 calendar year was 31.9%, and Nebraska’s was 29.89%.
In this bar graph below, I have included Overall Cesarean rates for all 51 Nebraska hospitals that discharged any patients after any type of birth in the year from October 2018 through September 2019. Please note that all six Nebraska hospitals with 0% and 100% Cesarean rates cared for 37 or fewer births in that entire year, and drawing conclusions on facility culture using data from such a small population is not advised. Further, all hospitals that reported fewer than 100 births in this year have an asterisk in the graph below, and I caution the reader about drawing conclusions on these facilities and their level of support for avoiding unnecessary Cesarean birth as well.
Between October 2018 and September 2019, there were 21 Nebraska hospitals that cared for 100 or more births. I have created the following infographic showing only the Overall Cesarean rates for these 21 facilities, as the data is more likely to demonstrate facility differences in culture and their dedication to reducing unnecessary surgical birth rates. Recall that the US Cesarean rate for the 2018 calendar year was 31.9%, and Nebraska’s was 29.89%.
This information 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 with no 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 discharges following Cesarean birth, vaginal birth with sterilization, and vaginal birth with no other procedures and calculate the percentage that are Cesarean births, 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.
You can compare this year with the three years previous and see what has happened over time at your facility, 2015-2016 here, 2016-2017 here (these years are July-June, so I am missing the data from June-Oct 2017), and 2017-2018 here. 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.
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 those with higher level NICU units, 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 in the low-risk patient population by looking at this rate. Unfortunately, these rates are not publicly available for Nebraska hospitals yet! The Joint Commission announced they will begin reporting hospitals with high NTSV Cesarean rates publicly by July 1, 2020, however as of September 29, 2020, this information does not seem to be available yet. Although the Joint Commission does not appear to plan on publishing exact numbers, this piece of information will be helpful to consumers nonetheless.
Other information that would be extremely useful in evaluating hospital quality in maternity care would be their induction of labor rates, and their episiotomy rates. So why do I focus on Cesarean rates? In short, because I cannot find these other pieces of information. 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, only Great Plains Health in North Platte, NE has completed this survey for the last 3 years! Without this information, and more, choosing a hospital is still largely subjective. However, hospital Cesarean rates is still an important piece of information because current research still indicates that your biggest Cesarean risk is which hospital you choose.
What do I hope that you, my reader, will do with this information?
I hope that families who will give birth will take this data and discuss it with their caregivers. I hope that consumers use this data as one piece of information out of many in a decision-making process on where and with whom to give birth. I hope that birthing people will consider the Cesarean birth rate when planning their birth experience, and equip themselves accordingly. I hope that families who choose a hospital with a high Cesarean rate, but want to avoid an unnecessary Cesarean birth themselves, will learn how to maximize their own chances at a vaginal birth I hope that families who want to avoid a Cesarean will hire doulas to reduce their risk of Cesarean. I hope that consumers will educate themselves on evidence-based indications for Cesarean birth. I hope that people who do give birth by Cesarean seek out and find support to recover well, both emotionally and physically.
I hope that nurses, midwives, and physicians will dig deeper into their own statistics. Where can you learn more about preventing unnecessary Cesareans? What do you need to change in your practice to decrease the number of preventable Cesareans? What barriers prevent you from decreasing your own Cesarean rate?
I hope that hospital administrators challenge themselves to better compete in a changing healthcare market, where consumers are more aware of the state of maternity care in the US, and are asking more questions to ensure they are receiving a high quality of care. If your facility has excellent statistics, publish them and share how you intend to continue improving the care your facility provides! If you are less enthusiastic about your facility’s statistics, publish them anyways, along with an actionable plan to improve them.
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: