birth statistics – Doula Group of Evansville

We Care about our Statistics

We like transparency! 2023 was a weird year.

I like numbers, even though I’m really not that great at math to be honest. One of my favorite things to do every year is to look at how we as doulas are doing. Are we making difference for our clients? Does that difference show up in our outcomes in addition to what our clients say to us? Numbers don’t tell the whole story, but they certainly tell part of it. Here is part of our story from 2023.

Primiparas rule!

Whether expecting their 1st or 6th, we served all kinds of clients, but 2023 was full of MANY 1st time parents (primapara). Maybe it is the fact that we offer access to a full online childbirth education and partner support class. Maybe it is the fact that our clients all recommend us to their friends? Maybe our group is the first to come up in a Google search and then we wow potential clients in the interview? Whatever it is, we’re here for it and look forward to continuing to serve as many families as will have us!

Inductions GALORE!

We go all kinds of places, but The Women’s Hospital in Newburgh seems to be the most common. Maybe because we’re all on the approved list of doulas there, so we don’t count as visitors? Maybe because many providers there recommend us to their patients? Maybe because 2/3 of people who give birth in our area, give birth there? We’re happy to serve our clients in all kinds of places, including in their homes with a qualified midwife in attendance too by the way. That induction percentage blew me away when I saw that come through too. So many thoughts on that, but still ruminating on it a bit.

Transparency

Did you know that your provider can find out ALL of their numbers and share them with you too? I think transparency would be a great way to possibly change the way things are done. Transparency in statistics like primary NSTV cesarean rate, episiotomy, VBAC, and so much more would help not only patients make informed decisions about choosing a provider, but would also help providers to hold themselves accountable with DATA rather than just feeling their way through the dark about how they actually practice not just how they feel that they probably practice. Accountability is key in reducing unnecessary interventions, as supported by reams of scientific literature.

I digress…just show us the provider specific numbers! I’ll be looking at the hospital specific ones and posting about those too soon.

As doulas, we don’t promise any outcomes, but we know from the scientific evidence that having a doula does improve some outcomes and definitely patient experiences! Our job is to support our clients no matter what their choices are for themselves. We make sure they have the best information possible and support your unconditionally and without judgement. Everyone deserves to have someone in their corner!

Cheers to 2024 and being able to continue to serve families as they move from expecting to beginning.

The Latest Local Maternity Statistics

Statistics reflect the culture of a hospital and the institutional priorities. What has changed here since 2017?

Anyone who has met me can tell you that I’m a huge fan of data! Words and images can hide a multitude of things, and opinions can be influenced by those too. But basing ideas and approaches to things on DATA is honestly my jam. Seriously, I get very excited about this stuff. Every year, Leapfrog Group publishes data they collect from hospital surveys about standards of practice. They measure all kinds of things, but naturally as a doula I’m the most excited to learn about the maternity care statistics. I’ve been collecting this information for our area hospitals since 2017, which is exciting because we’re definitely seeing some changes in the data. If you’d like to read my previous posts, you can do so here, here, and here. Please note, I did not collect the 2019 statistics because they were published in April 2020, and well, you all remember that year right? Without further fanfare, here are the 3 data points I’m always interested in seeing for our local hospitals.

Episiotomy

data from https://ratings.leapfroggroup.org/

I’m REALLY excited to see the episiotomy rate in serious decline because the evidence has been telling us they aren’t an evidence based routine procedure since the late 1980s!! It shouldn’t take this long to change, but at least it is changing. Don’t take my word for it, this paper concluded that, “Our systematic review finds no health benefits from episiotomy,” in 2005. Despite that scientific fact that has been repeatedly proven, as a doula in 2021 I heard a provider at a local hospital say that cutting an episiotomy would help prevent my client from “tearing too much.” I’m not naming names here, but I will if you call me. I have heard that the hospital this doctor works at requires all their physicians to provide explanation for every episiotomy they cut, so this particular doctor must be quite busy with those reports.

Early Elective Induction

Defined as scheduled cesarean sections or induction of labor prior to 39 weeks gestation without a medical reason, early elective induction can happen for a lot of reasons, but there are definite consequences to it. Here is what the picture looks like in our local facilities:

Hospital Goal: 5% or less	2017	2018	2020	2021
The Women’s Hospital Newburgh, IN	1.4%	1.7%	6.8%	4.1%
Ascension St. Vincent Evansville	2.1%	.8%	0%	0%
Owensboro Health	2.1%	1.4%	.7%	1.6%
Memorial Hospital & Healthcare Center Jasper, IN	–	0%	5.9%	6.3%
Daviess Community Hospital Washington, IN	–	1.9%	0%	Declined
Deaconess Henderson Hospital	–	2.4%	0%	0.0%
Good Samaritan Hospital Vincennes, IN	–	–	4%	0%

Local Statistics for Early Elective Induction

Cesarean Rates: what everyone really wants to know

Before you look at this chart, I want you to know what the data is telling us. An NSTV Cesarean is defined as first-time low-risk mothers giving birth to a single baby at full-term in the head-down position delivering their baby by C-section. Hospitals should have a rate of C-sections of 23.6% or less according to Leapfrog Group. Some people will argue that this rate should be 10% according to the WHO, but honestly that isn’t true. So what does this data tell you then? This chart shows you how many people pregnant for the first time with a low-risk pregnancy with one head down baby delivered their baby via cesarean surgery. This is also retrospective data, so it really isn’t predictive of the future or exactly what will happen to you either, but it does at least give you an idea of the culture of a place and what their staff sees.

The actual NSTV Cesarean Rates for 2021 are as follows:

36.6% Ascension St. Vincent
30.5% Deaconess Henderson
28.9% Owensboro Regional Health
24.5% Deaconess The Women’s Hospital
17.6% Good Samaritan
17.5% Memorial Hospital in Jasper
Daviess Community Hospital declined the survey this year.

What I Wish We Knew

As a doula, I always try to make sure my clients have the best most up-to-date information about their decisions. There is of course such a thing as having too much information, but I don’t think we’re anywhere near that right now with regards to choosing providers and birthing locations. These numbers honestly hide sooo much in the aggregated hospital data. How do I know what my provider’s rates specifically are for these things? They know them, but I have yet to find any providers willing to share that information readily with us. In fact, I’ve encountered a bunch of providers willing to say they don’t know them, when they get monthly reports from the hospital about their own statistics. What are they hiding & why? Why isn’t that information made public so that we can make more informed choices? I’d love to know about VBAC rates, induction rates, & percentage of high-risk vs low-risk deliveries. What about NICU admissions percentages and average length of stay in the NICU? Are there numbers you wish you could see when deciding on a provider and birthing location?

I’m going to keep watching to see how and if things change. I’m going to keep asking questions, as annoying as they might be. I’m a data geek after all. Transparency helps build accountability. Accountability can help push change and improvements. We’re all about improving the way things are done in our area, because seriously it is past time.

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Our 2021 Local Statistics

Every year hospitals submit specific measurements to Leapfrog Group to see how the they are doing, and this year’s aren’t looking great. We like to check in on our local statistics to see how we are doing, and you can read last year’s local statistics if you’d like. In this table, the numbers in bold are from 2021 & those in parenthesis are from 2018.

Hospital	NSTV Cesarean Rate	Early Elective Deliveries	Episiotomies
The Women’s Hospital Newburgh, IN	27% (22.9%)	5.2% (1.7%)	11.9% (14.8%)
Ascension St. Vincent Evansville	23.5% (27.2%)	0% (.8%)	5.6%(6.8%)
Owensboro Health	declined to respond (29.7%)	declined to respond (1.4%)	declined to respond (12.7% )
Memorial Hospital & Healthcare Center Jasper, IN	17.5% (12.8%)	4.5% (0.0%)	7.4% (9.8%)
Daviess Community Hospital Washington, IN	15.7% (15.2%)	2.9% (1.9%)	6.9% (13.1%)
Good Samaritan Hospital Vincennes, IN	24.2% [20.7%]*	3.8% [4.0%]*	5.2% [14.2%]*
Deaconess Henderson Hospital	27.6% (26.1%)	2.5% (2.4%)	2.6% (2.4%)

*numbers are from 2020, as we did not record the data for Good Samaritan Hospital in 2o18

Let’s take a moment to congratulate Ascension St. Vincent’s in Evansville for their success in reducing their overall NSTV cesarean section rate. Yes, there is room for improvement, but they are also the only local hospital that reported data and reduced their cesarean rate, as well as early elective deliveries AND episiotomies. Way to go StV!

Why does it matter?

The NSTV rate tells us the likelihood of a 1st time parent walking into a hospital with one head-down baby at 38+weeks gestation and walking out after having had major abdominal surgery to deliver that baby. This statistic doesn’t count surgical births for breech delivery or repeat cesareans or even first cesarean surgeries for your 3rd baby. From a population standpoint, we should be aiming to get that rate to between 10-15%, and huzzah Davies Community hospital is hovering right on top of that target. These reported NSTV local statistics have all gone in the wrong direction, and that matters for birthing families.

It matters because having one cesarean section increases the risks to you with each subsequent pregnancy. Is VBAC an option for you? Maybe, but only around 20% of people who have had a previous cesarean section will even attempt a Vaginal Birth After Cesarean, and then only if they can find a provider who is actually supportive. After a cesarean, your risk of things like placental accreta, increta, and percreta increase too. Surgical birth carries risk, and according to the evidence, we are doing surgery too often.

How can we change?

Hold OBs to their own standards. Yes, I mean us as consumers, but also hospitals and insurance companies too. ACOG gave some great ideas here, California has some ideas we could bring to the Midwest here & Dr. Neel Shah has been a leader in the call to figure out how to reduce cesareans. I have also read about hospitals publishing their own data publicly and privately nudging physicians to change by keeping them informed of their own professional statistics. I promise you that physicians have access to their personal statistics, whether they access them or choose to share them publicly (or even with patients) is another story all together. There has to be that push and pull if we are going to create true lasting change.

How can you reduce your own risk?

Choose a place to give birth with a lower NSTV cesarean section rate. I know that insurance plays a huge factor in this, so that isn’t always an option for everyone. We do know that your greatest risk of needing cesarean surgery is the location of your delivery.
Inform yourself! Know your options & be ready for what is to come for labor and delivery. You can’t prepare for all of it, but you can at least know what to expect and how the system can sometimes set you up to fail. Know what to watch for!
Hire a doula! Having a doula on your team reduces the likelihood of needing cesarean surgery to birth your child. No, we can’t prevent all cesareans, especially because some of them are very necessary and honestly can be beautiful and healing too. We can promise that having a doula on your team will help you ask great questions of your care team and hopefully feel like the most important person in the room with all the decision-making power. (Because really, you are!)