PHC4 | C-section Deliveries in Pennsylvania 1999

C-section Deliveries in Pennsylvania 1999 - News Release

Contact: Joe Martin
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C-SECTION RATES RISING AGAIN AMID UNCERTAINTY REGARDING TREATMENT

Harrisburg, PA - April 20, 2001 - After declining for many years due to concerns over risk, invasiveness and cost, C-section delivery rates in Pennsylvania have begun to increase recently, mirroring an upward trend seen nationwide. A joint report from the Pennsylvania Health Care Cost Containment Council (PHC4) and the Pennsylvania Department of Health released today found that 21.1% of all hospital deliveries were C-sections in 1999 – up from 19.5% in 1997 and 19.9% in 1998.

Among individual hospitals there was considerable variation in the C-section rates, even after separating the deliveries by risk. The rates for women considered at low risk to have a C-section ranged from 8.6% to 28.2%. Rates for women who had a previous C-section, but were considered at low risk to have another, ranged from 33.3% to 95%. Also noteworthy is the span among hospitals for the rate of Vaginal Birth After Cesarean (VBAC): from 5.0% to 66.7%.

"The wide variation in rates among individual hospitals illustrates the lack of consensus among providers about the proper approach to C-sections," stated Marc P. Volavka, Executive Director for PHC4.

According to Secretary of Health Robert S. Zimmerman, Jr., "C-section and VBAC rates in Pennsylvania are still better than the national averages and they are closer to the national Healthy People 2010 objectives for reducing the incidence of C-section deliveries, although we have not yet reached that goal."

"While consensus among providers may be lacking, there remains a great deal of information available on delivery procedures," noted Zimmerman. "We encourage pregnant women to have an early discussion with their physicians about all options related to delivery."

Contributing to the increase in Pennsylvania was the rise in the low-risk repeat C-section rate from 57.1% in 1996 to 62.7% in 1999. The report notes that uterine ruptures (a potentially serious complication) occurred in only 0.1% of all deliveries in Pennsylvania in 1999; none of these complications resulted in fatality. Concern over the possibility of uterine ruptures has been noted as a factor leading to the increase in repeat C-sections.

"The increasing low-risk repeat C-section rate signals the need for additional discussion, research and potential action," stated Mr. Volavka. "Our data show that the primary factor in having a C-section is if you had one before."

C-section Deliveries in Pennsylvania, 1999 is a collaborative effort of PHC4 and the Pennsylvania Department of Health that pairs PHC4's detailed delivery information, such as C-section rate and average length of stay, with the Department of Health's Neonatal Intensive Care Unit (NICU) level and aggregate demographic data.

REPORT HIGHLIGHTS

The C-section rate in Pennsylvania hospitals rose from 19.5% to 21.1% between 1997 and 1999, an increase of 8.2%. From 1998 to 1999, the C-section rate increased 6.0%. The 1998 rate was 19.9%.
The VBAC rate in Pennsylvania hospitals has fallen from 39.7% in 1996 to 34.8% in 1999. This rate reflects the number of women who delivered previously by C-section, but had a vaginal delivery in a subsequent pregnancy. The lower rate means fewer women proportionally delivered vaginally after a previous C-section.
There is significant variation in C-section rates among hospitals even after separating the deliveries by risk.
The number of repeat C-sections for women at low risk for a C-section delivery in Pennsylvania was 9,322 in 1999. The statewide repeat rate for women considered to be low risk for a C-section was 62.7%.
The #1 factor leading to a C-section in Pennsylvania during 1999 was having had a previous C-section.
Uterine rupture (a potentially serious complication) occurred in only 0.1% of all deliveries in Pennsylvania in 1999; none of these complications resulted in fatality.
Even after separating patients into high and low risk categories, Medicaid recipients had the lowest C-section rate and the highest VBAC rate among major payor populations.