episiotomy – Doula Group of Evansville

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!)

Statistics tell us part of the story of how a hospital cares for their patients and about the culture of a place. They do not tell us the entire story in any way shape or form, but they are a way to measure change and track goals. Leapfrog is a group that tracks statistics about hospitals around the country using a survey that 75% of hospitals participate in each year. Today was the day that they published this data for 2020.

You can find the 2018 Statistics in this post we wrote. I did not write a post for 2019’s statistics, but I think we all remember April 2020 right? You can look these statistics up for yourself here, because you really don’t have to just take my word for it.

Definitions & notes for you:

This Cesarean Section data is for NSTV (research speak for 1^st time parents, 38+ weeks pregnant, with a single head-down baby) cesarean rates and does not include repeat cesarean deliveries or 1st time cesarean deliveries in people who have had previous vaginal deliveries. This is an important distinction. Leapfrog Group uses the Healthy People 2020 goal of 23.9% for primary cesarean deliveries in this category. I want to note here that the WHO stated target NSTV cesarean rate is 10-15%, so that is something to also think about when looking at this data.
Early Elective Deliveries are defined as elective induction or cesarean sections before 39 weeks. This does not include medically indicated early deliveries, therefore the goal is for these to be less than 5%.
Episiotomies are a cut made to the perineum during the birth process. While sometimes necessary, routine episiotomies are not evidence-based practice, and Leapfrog sets their goal as less than 5%.
The numbers in (parentheses) are the previous numbers reported in 2018. I did not include numbers for Good Samaritan Hospital previously, so apologies to our friends in Vincennes for the lack of change comparison possible in this table.
New numbers that reach or exceed the Leapfrog goals are in blue.

Hospital	NSTV Cesarean Sections	Early Elective Deliveries	Episiotomies
The Women’s Hospital Newburgh, IN	26.2% (22.9%)	6.8% (1.7%)	11.5% (14.8%)
Ascension St. Vincent Evansville*	25.3% (27.2%)	0.0% (.8%)	5.9% (6.8%)
Owensboro Health	29.5% (29.7%)	.7% (1.4%)	5.7% (12.7% )
Deaconess Henderson Hospital**	25.5% (26.1%)	0.0% (2.4%)	2.8% (2.4%)
Memorial Hospital & Healthcare Center Jasper, IN	11.1% (12.8%)	5.9% (0.0%)	7.9% (9.8%)
Daviess Community Hospital Washington, IN	17.9% (15.2%)	0.0% 1.9%)	8.2% (13.1%)
Good Samaritan Hospital Vincennes, IN	20.7%	4.0%	14.2%

*Previously St. Vincent’s Medical Center of Evansville
**Previously Methodist Hospital of Henderson

What the Numbers Don’t Say

What these numbers don’t say is what an incredible strain 2o20 was on all hospitals, including in maternity care. While there were clearly jumps in early elective deliveries at Memorial in Jasper and The Women’s Hospital in Newburgh, we don’t know when those happened. Were those elective deliveries in March and April last year when everything was locking down due to the growing pandemic and people were truly scared for their lives? Conversely, maybe the pandemic was an easy excuse to push for early elective induction too. We can’t know that from the numbers. These statistics represent thousands of birth stories that we can’t know just by reading them.

These statistics are also not the only ones worth looking at when making decisions regarding your care. Other important factors such as VBAC success rates, availability of lactation help, availability of anesthesia, proximity to your home, provider access, insurance coverage etc. Sometimes that last one ends up being the deciding factor no matter what your preferences are on location.

How to Use These Numbers

First use them to think about where you want to deliver. You do have options and choices on where to go, and we would be happy to talk to you about our experiences at these places as well. Know that these are overall statistics that paint a generalized picture, and start there. Even if you don’t have a choice on where to go to birth, because we know that happens, these statistics can help you look at the norm where you will be delivering. They can help you know what to expect and watch for during your delivery.

Next use the numbers to start a conversation with your provider. Where do they deliver? What are their personal statistics compared to the facility? How do they feel about episiotomies?

We ALWAYS encourage everyone to have open, honest, and frank conversations with their providers. Don’t be intimidated by the white coats, they are people too. Keep it positive and be inquisitive, and go with your gut when it comes to making decisions regarding your provider and location for delivery.

We look forward to comparing 2020 with 2021 when those numbers come out!

What is the first question that comes to mind looking at this table?
Do any of these numbers surprise you?
Which of these statistics most line up with what you previously thought about these facilities?

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%)

Tag: episiotomy

Our 2021 Local Statistics