Every summer, I compile the latest statistics on childbirth in Nebraska. Here is my latest update, conducted July 2024, primarily summarizing 2022 birth data from the CDC, the Joint Commission, and the Leapfrog Group. In the full PDF, available free to email subscribers, I have included past years’ data to show trends over time.

More Nebraska hospitals completed the Leapfrog Group survey this year! All of the CHI Health hospitals, Grand Island Regional Medical Center in Grand Island, Great Plains Health in North Platte, Kearney Regional in Kearney, and Ogallala Community in Ogallala all completed the survey, which is currently the only place where hospitals must publicly report their episiotomy rates and their NTSV Cesarean rates.

Nebraska’s Cesarean rate is still trending down, the rate peaked at 31.1% in 2015, and was 28.88% in 2022, although the rate has been staying around 28-29% since 2019. Additional measures to decrease unnecessary and preventable Cesareans need to be taken.

Nebraska’s VBAC rate is still improving, however, in 2022 it was 18.59% following a low at 10.8% in 2014 when I first began tracking the information, and a high of 19.17% in 2020. Nebraska still has plenty of work to do in increasing access to and support for VBAC for all VBAC candidates, as this is one evidence based way to decrease the overall Cesarean rate. Research shows that for those who plan a VBAC, approximately 60-80% of them will have a vaginal birth. My professional experiences with families desiring VBAC are that care providers are likely to counsel extensively regarding the potential risks of VBAC, but not counsel regarding the potential risks of repeat Cesarean birth, a phenomenon known as steered decision making, patient steering, or implicit persuasion, rather than providing adequate informed consent counseling including the potential benefits and risks of both options.

Nebraska’s induction of labor rate continues to rise at a rapid pace. In 2022, 41.75% of all births were induced! When I first began tracking maternity care statistics with 2014 data, only 29.6% of Nebraska births began with induction of labor. The rise of elective inductions at 39 weeks beginning with the ARRIVE Trial’s publication in 2018 has led to a huge rise in inductions across the country, with no commensurate decrease in Cesareans, as the ARRIVE Trial results suggested. From 2018 to 2024, Nebraska’s overall induction rate rose from 34.82% to 41.75% in 2022, while the state’s overall Cesarean rate was 29.9% in 2018, and was 28.88% in 2022. Families who wish to wait for spontaneous labor will need education on medical indications for induction of labor, and advocate for themselves strongly if they are feeling pressured into an elective induction (no medical indication).

Hospitals, OB and Midwife practices, and state agencies should publish all of the statistics I have reported here, and more. While all the information I have compiled is publicly available and hypothetically available to consumers, the time and effort required to locate each statistic makes this information unattainable to most. If an organization is proud of their statistics, they should be reporting them and praising their staff. If an organization sees room for improvement, they should determine and publish action steps to improve their quality of care. For example, on January 11, 2024, the CHI Health Birth Center at Lincoln shared their 2023 practice outcomes on their social media!

The state of Nebraska released their second report on maternal mortality and morbidity in December 2023, https://dhhs.ne.gov/Reports/Maternal%20Death%20Review%20Team%20Annual%20Report%20-%202024.pdf. How many Nebraskans die in pregnancy, childbirth, and the first year postpartum, and why they die, is important information that can help identify ways we can prevent maternal deaths. This is extremely important, as the Nebraska committee found that 93% of pregnancy related deaths were preventable.

The state of Nebraska does not seem to collect and/or publish statistics on neonatal mortality. The number of babies who die in pregnancy, during childbirth, and in infancy, as well as why they die, is important information that can help identify ways we can prevent neonatal deaths.

Nebraska’s Department of Health and Human Services has not released a Vital Statistics Report since 2017, which included a summary of many of these same statistics I report here. The Department had previously released a Vital Statistics report annually, and they should do so again.

In 2015, the Nebraska Perinatal Quality Improvement Collective was founded to improve the quality of care to Nebraska mothers and babies. They have a variety of quality improvement projects in their pipeline that look extremely promising. Publicly publishing their findings, progress reports, and other quality information would be beneficial. Some changes they should make to their board would be increasing the racial, ethnic, and cultural diversity, inclusion of a Certified Nurse Midwife, and including consumers. http://www.npqic.org/

Amino.com used to publish individual physician Cesarean rates, but they have changed to a membership service. Amino should make their quality care data public again.

At this time, only 9 out of nearly fifty Nebraska hospitals have responded to the Leapfrog Group Hospital Survey. You can urge your local hospitals to respond by using the form letter provided by The Leapfrog Group, https://www.leapfroggroup.org/sites/default/files/Files/Survey%20Participation%20Request%20Letter.docx.

Hospital and provider Induction Rates, Augmentation Rates, Epidural Rates, Episiotomy Rates, Primary Cesarean Rates, and NTVS Cesarean Rates would be excellent information to help consumers evaluate maternity care options in their areas.

What further information do you want to see available to the public?