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
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% |
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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