If I wasn’t already nerdy about stats and numbers, becoming an Evidence Based Birth® Instructor really brought home for me how important it is to know what your hospital’s numbers really are, but they can be tricky to find and interpret. As an aside, you can sign up for one of my Evidence Based Birth® Childbirth Classes here.
One place to look for statistics is LeapfrogGroup.org, but reporting is voluntary and many hospitals do not report. In the case of Portland, OR and nearby Vancouver, WA, only Providence and PeaceHealth Hospitals are currently reporting their statistics. Other hospitals, like Oregon Health Science University (OHSU), Legacy Hospitals and Kaiser Hospitals all declined to respond.
So, the following numbers have been calculated from the State of Oregon Vital Statistics Birth Data, specifically the “Final method of delivery by county and facility” 2020 data. One caveat with these numbers is that since these report where the birth finally took place, births that were planned for home or birth center and needed to transfer, will be counted in the hospital numbers. Now, not all transfers to a hospital will result in a cesarean, but some will. In this way, I was not able to determine a cesarean rate for the home births or birth center births because the final location of those births was at a hospital. The other caveat is that I was not able to determine a Vaginal Birth After Cesarean (VBAC) rate, since Oregon does not report how many pregnancies had a previous cesarean. All I can tell is how many VBACs happened out of the TOTAL number of births, which can tell us which hospitals see more VBAC births in general.
Even with that said, here are some things that stood out to me from the 2020 statistics.
1) Legacy Emanuel Medical Center has by far the highest cesarean rate at a whopping 38%. They do have the highest level of NICU (level 4. OHSU also has a level 4 NICU). High level NICUs can draw higher risk pregnancies (even from out of the area), and high risk pregnancies are more likely to need a cesarean birth. This could account for some of the increase in cesareans. Another possibility is that perhaps Emanuel gets more of the home birth/birth center transfers, some of which will need a cesarean. Given that OHSU also has a level 4 NICU, but a lower cesarean rate by 4 percentage points, I’m not sure if high risk births and home birth transfers can truly account for this high of a cesarean rate. Emanuel, if you have someone who can explain it (with numbers, of course, please let me know!
2) OHSU’s cesarean rate was 4 percentage points lower than Emanuel’s, while also having a Children’s Hospital and the same high level NICU (level 4).
3) Legacy Good Samaritan had the same cesarean rate as OHSU (34%) despite not being known for having a high risk population and having a low level NICU. A cesarean rate of 34% is higher than the state and national averages and I’m really not sure what could account for it. They could do much better!
4) Providence Portland and Kaiser Sunnyside have level III NICUs and came in at 29% and 28% cesarean rates respectively. Providence St. Vincent, also with a level III NICU, trailed with a 31% cesarean rate.
5) Kaiser Westside and Tuality Hospital (now OHSU Hillsboro) tied for the lowest cesarean rates in the Portland area at 24%. Tuality Hospital only saw 578 births, however, while Kaiser Westside saw about 2.5x that amount.
Many hospitals look like they did a bit better on their 2021 numbers (not yet final). We’ll see what the future holds! You can always check national and state average cesarean rates and CesareanRates.org
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