Boston, Greater Boston, Cape Cod & RI Cesarean Rates By Hospital. Where Does Your Hospital Fall?

Did you know that 1 in every 3 American women delivers her baby via C-section? Did you also know that it's increased more than 500% since the 1970s, making it the most common surgery performed in the United States?

Let’s talk about cesareans (AKA C-sections). A cesarean is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. C-sections may be planned ahead of time due to twins, multiples, a pregnancy complication, or it may be elective, especially if the mother's had a previous one. Some C-sections turn into emergency situations where the baby needs to be delivered immediately, especially if the mother or baby's life is a stake. There are many valid reasons for having one, but are doctor's taking advantage of it?

(Pictured: My twin nephews being delivered via C-Section)

Many recent studies have been done that are indicating this very well may be the case. According to consumerreports.org, your biggest C-section risk may be your hospital, and the odds of having a C-section can be over 9 times higher if you pick the wrong one. According to Dr. Neel Shah, M.D., "the hospital a mother walks into and how busy it is may be the biggest risk factor yet". Research has estimated that almost half of the surgeries that are performed in the U.S. are not required, and performing a surgical birth can pose added risks to the mother and baby and also raise costs.

When C-sections aren’t medically indicated, they may be more likely to harm mothers and babies than to help them. Life-threatening complications are very rare whether babies are born vaginally or by C-section, but women with low-risk pregnancies undergoing their first C-section were 3 times more likely to die or suffer serious complications such as blood clots, heart attack, and major infections compared with women delivering vaginally, (according to a 14-year analysis of more than 2 million women in Canada published in 2007 and cited by the ACOG guidelines). Children delivered via C-section had a higher risk of asthma and obesity, and their mothers had an increased risk of uterine rupture, placenta previa, and stillbirth during subsequent pregnancies. Another reason to avoid a medically unnecessary C-section is that it multiplies the chance that a woman’s future births will also be delivered that way. “Right now in the U.S., if your first delivery is a C-section, you have a 90 percent chance of getting another one the second time,” Shah says.

So how can we reduce C-sections and improve birth outcomes? Dr. Neel Shah at Harvard T.H. Chan School of Public Health’s and his colleagues have launched a pilot program called the “Team Birth Project” that is being tested at several hospitals. The program was featured in a November 24, 2018 NPR article that chronicled the birth of twin boys at South Shore Hospital here in Weymouth, MA., which is one of the pilot sites. The Team Birth Project aims to overhaul how labor and delivery are handled at hospitals, from when women are admitted to how doctors and nurses communicate about the mother’s preferences and delivery plan. Uniquely, pursuant to the Team Birth Project, mothers are not admitted to the hospital until they are in active labor. The mother’s birth preferences, which would traditionally be referred to as a “birth plan,” are used to guide the labor team in what strategies they used when treating mom and baby, and lastly, the delivery plan is placed on a whiteboard in the patient’s room to provide to remind everyone of the goals and expectations for the birth. The plan is adaptive and evaluated for effectiveness when necessary — hence its presence on an erasable whiteboard. From there, the plan is separated into 3 categories to independently assess the needs of mom, baby, and the progression of labor. Another thing that makes this method exceptional is the “next assessment” section of the board that openly informs mom and loved ones about what is happening next and increases clear communication between the patient and the medical staff. Although it seems like it would be common sense to provide the mother in labor with thorough information on the plan of action for her delivery, many medical professionals don’t. This program has proven to work, and South Shore Hospital's C-section rate has dropped from 31% in April 2018 to 28% in August 2020.

So lets take a look at the hospital C-section rates in our area. I decided to visit leapfroggroup.org and gather the following information below ranging from the highest rate to the lowest (as of August 31, 2020):

Massachusetts:

1. St. Vincent Hospital (Worcester) - 33.4%

2. Beth Israel Deaconess (Plymouth) - 32.9%

3. Falmouth Hospital - 32.7%

4. Holy Family Hospital - 32.1%

5. Milford Regional Medical - 31.9%

6. Cape Cod Hospital - 31.6%

7. Newton Wellesley Hospital - 29.6%

8. Winchester Hospital - 29.4%

9. Beverly Hospital - 28.4%

10. Brigham & Women's Hospital - 26.7%

11. Anna Jacques Hospital - 26.7%

12. Metrowest Medical Center - 26.1%

13. Melrose-Wakefield Hospital - 25.9%

14. Steward Good Samaritan Medical Center - 25.6%

15. Sturdy Memorial Hospital - 23.4%

16. Emerson Hospital - 23.1%

17. Mount Auburn Hospital - 23.0%

18. St. Elizabeth’s Medical Center - 22.9%

19. Lawrence General Hospital - 22.8%

20. U Mass Memorial Medical Center - 22.3%

21. CHA Cambridge Hospital - 20.8%

22. Lowell General Hospital - 20.7%

23. Beth Israel Deaconess (Main Campus) - 20.7%

24. Boston Medical Center - 20.3%

25. Tufts Medical Center - 19.0%

26. North Shore Medical Center - 16.2%

Rhode Island:

1. Women & Infants Hospital of RI - 29.0%

2. Kent County Memorial Hospital - 25.0%

3. Landmark Medical Center (Woonsocket) - 21.9%

Declined to respond:

MGH

New England Baptist

Concord Hospital

Beth Israel Deaconess (Needham)

Nantucket Cottage Hospital

(I apologize if your hospital is not on here. If you would like to find your hospital's rate, visit leapfroggroup.org)

So here we are...I bet some of you are pretty surprised at your hospital's rate...I know I am! As we look at the list, some factors to consider when comparing rates...

• The hospital's review board and stance on performing C-sections

• Financial incentives

• The use of physicians or midwives

• The high risk population in the area

• If the hospital is a high risk patient hospital

… just to name a few.

A good example when comparing rates is Brigham & Women's Hospital and Anna Jacques Hospital in Newburyport, MA. Both have a 26.7% BWH is a 24 bed labor & delivery room with a level III NICU, and equipped to care for premature infants as young as 23 weeks gestation, where AJH is only a 12 bed unit with a level 1b NICU. Both great hospitals, 2 completely different levels of care. It's basically like comparing apples and oranges.

There is a lot that goes into what makes a C-section rate what it is, so with that said do your research and ask questions. Knowledge is power!!