Cesarean Section Deliveries - News Release

FOR IMMEDIATE RELEASE

PHC4 CESAREAN SECTION READER'S GUIDE

Harrisburg, PA - October 22, 1997 - Pennsylvania's rate of newborn deliveries by cesarean section (C-section) continued to decline, falling to 20.2% in 1995, according to statistics released today by the Pennsylvania Department of Health and the Pennsylvania Health Care Cost Containment Council. In addition, Pennsylvania hospitals reached the Healthy People 2000 national objective of a 35% VBAC rate (Vaginal Birth After a C-section) in 1995, five years ahead of schedule. These data also show that the amount charged by hospitals for a C-section was nearly twice that of a vaginal delivery.

The two state agencies combined their data for a comprehensive look at the issue of C-sections as reported by Pennsylvania hospitals, separated into nine geographic regions of the state.

"These data strongly suggest that hospitals and physicians are working diligently to reduce unnecessary C-sections by encouraging clinically-appropriate VBACs," stated Donald L. Zimmerman, Executive Director of the Pennsylvania Health Care Cost Containment Council.

The information being released covers Pennsylvania hospitals with more than 50 deliveries and includes the number of total deliveries, C-sections, VBACs, and repeat C-sections, each hospital's level of neo-natal care, and average charges and average lengths of stay for vaginal and C-section deliveries. Additional data according to type of insurer, county and selected communities are also reported.

C-section delivery is the most frequently performed major surgical procedure in Pennsylvania hospitals, with 30,489 performed in 1995. From 1970 to 1987, C-section births in PA increased more than four-fold, from 5.5% to 24.1%. The rate has decreased gradually since then.

For many years, physicians performed repeat C-sections routinely out of fear that a woman's uterus would rupture during labor. Today, almost all C-sections are done using a "bikini cut" (a horizontal incision low in the uterus), thereby greatly reducing the risk of rupture during labor in a subsequent pregnancy. Guidelines issued by the American College of Obstetricians and Gynecologists (ACOG) suggest that 50-80% of women who have had one or more low horizontal C-sections should attempt to deliver vaginally unless specific complications arise. Deliveries under these circumstances are categorized as VBACs.

Between 1989 and 1995, the VBAC rate rose from 20.5% to 35.1%, and the national objective of 35% or higher by the year 2000 already had been met by 64 Pennsylvania hospitals in 1995.

Since a C-section carries with it a greater risk of mortality and complications, a longer hospital stay and recuperation time, and costs nearly twice as much as a vaginal delivery, the two agencies believe that it is important for hospitals, doctors and patients to continue to work together to reduce the number of C-sections and increase vaginal deliveries after C-sections.

Other Highlights of the Report

• Those enrolled in Medicaid HMO plans had the lowest C-section rate - 17.2% - and those enrolled in the Medicaid fee-for-service program had the second lowest rate - 18.4% - of all insurance payer groups reported for 1995.
• In 1995, all payer groups had VBAC rates better than the national Healthy People 2000 objective of 35%. Medicaid HMOs had the best VBAC rates at 46.8%.
• The average hospital charge for a C-section was $7,300, while the average charge for a vaginal delivery was $3,700.
• The average length of hospitalization was 3.5 days for a C-section and 1.7 days for a vaginal delivery.
• In 1995, C-section rates showed wide variation throughout Pennsylvania, with rates ranging from 36.4% for Fulton County residents to 10.5% for Pike County residents.

Copies of Cesarean Section Deliveries in Pennsylvania, 1995 are free. Hard copies can be ordered by contacting the Pennsylvania Health Care Cost Containment Council (PHC4) at 225 Market St., Suite 400, Harrisburg, PA 17101; (Phone) 717-232-6787; (Fax) 717-232-3821.