[2020] How to dramatically reduce your risk of having a cesarean section [wc]

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This is the woman-centric language version (e.g. “mother”, “pregnant woman”, “birthing woman”, “breastfeeding”).

Also available: gender-neutral language version (e.g. “parent”, “pregnant person”, “birthing person”, “breast/chestfeeding”).

 

This guide to C-section rates in the Chicago-area can help you minimize your risk of having a cesarean.

Most women would prefer to avoid a cesarean unless absolutely necessary. And yet many, many women end up having C-sections that are not medically necessary.

One of the ways we know this is that “primary C-section rates” vary dramatically from hospital to hospital, even where outcomes do not.

What is a “primary C-Section” rate? 

The primary C-section rate for an individual hospital looks only at the population of women who gave birth at that hospital in the reporting year who had not had a prior C-section.

For the data we use in this article, the rate is defined as: 

the number of low-risk* women in that population who ended up giving birth by Cesarean section   

divided by

the total number of low-risk* women in that population, including both those who ended up giving birth vaginally and those who had a first-time C-section.

*”Low risk” is defined by the Agency for Health Care Research and Quality (AHRQ) and means women who are at term, with only one baby, who is presenting normally, and no fetal death.

[Note: If this is your first baby, or if all your prior births were vaginal births, then the primary C-section rate is the rate you care about. If you’ve had a C-section in the past, then you should look at hospital VBAC rates instead.]

 

Here in the Chicago-area, primary C-section rates at individual hospitals range from 8.5% to 24%, but higher rates are not generally associated with better outcomes. This means that too many women are suffering the discomforts and risks of a major surgery that didn’t actually benefit them or their baby.

The good news here is that you can dramatically reduce the likelihood that you’ll have a cesarean simply by making a thoughtful choice about where to have your baby. 

Whether you will have a C-section with this pregnancy depends largely on where you give birth

The best way to understand why C-section rates are so important is to look at the data.

Let’s start by looking at the 9 Chicago-area hospitals with the lowest primary C-section rates. [These are the 9 hospitals with primary C-section rates at least one standard deviation lower than the mean for all hospitals in Cook, DuPage, Kane, Lake and Will Counties during the reporting period April 2018- March 2019.]

At these 9 hospitals, 7849 low-risk women gave birth who had not had a prior C-section, and 902 of those women ended up giving birth by cesarean. That’s an overall rate of 11.5%. 

Now let’s look at the 8 Chicago-area hospitals with the highest primary C-section rates. [These are the 8 hospitals with primary C-section rates at least one standard deviation higher than the mean for same group of hospitals.]

At these 8 hospitals,  8354 low-risk women gave birth who had not had a prior C-section, and 1695 of those women ended up giving birth by cesarean. That’s an overall rate of 20.3%.  (Note that these are risk-adjusted rates, which means that the differences cannot be explained away by risk factors in the populations served by each hospital.) 

 

That means that more than 40% of the primary C-sections at hospitals with high rates could have been avoided if those women had instead given birth at one of the hospitals with low rates.

Those percentages represent real individual women whose C-section was caused by their choice of hospital.

Imagine if all the 1695 women who had C-sections at hospitals with high rates had instead given birth at hospitals with low rates. Only about 11.5% of them — or 960 women — would have had C-sections. That’s 735 fewer C-sections (1695 – 960 = 735), which means that around 735 Chicago-area women could have avoided their cesarean section simply by choosing a hospital with a low primary C-section rate instead of a hospital with a high rate. 

This why it is so important to look at C-section rates when you are deciding where to have your baby. Putting it simply, your choice of hospital can cut your risk of cesarean nearly in half.

You can see the primary cesarean rate for any Chicago-area hospital by searching in the Home Birth, Birth Centers and Hospitals Directory.

C-section rates are generally lower for women who choose midwife care in a hospital. Rates are lowest of all for women who choose to give birth at home or at a freestanding birth center. Learn more about your options for midwife-attended and out-of-hospital birth below.

Which hospitals have the lowest c-section rates in the Chicago-area?

According to data reported by the Illinois Department of Public Health in 2020, the lowest cesarean rates for Chicago-area hospitals are:

Hospital/ Birth Center
Risk-adjusted Primary C-section Rate # of primary cesareans # of births to women with no prior C-section
Saint Anthony Hospital (Chicago)
8.6%
91 1,062
Ingalls Memorial Hospital (Harvey)
10.1%
54 534
¹Roseland Hospital (Chicago)
10.4%
10 96
²Holy Cross Hospital (Chicago)
10.6%
17 161
AMITA Health Adventist Medical Center Glen Oaks (Glendale Heights)
10.9%
30 274
³St. Bernard Hospital & Health Care Center (Chicago)
11.4%
55 481
NorthShore University HealthSystem Highland Park Hospital
11.9%
115 963
Advocate Sherman Hospital
11.4%
55 481
NorthShore University HealthSystem Evanston Hospital
12.7%
317 2,504
  1. very small volume
  2. small volume
  3. temporarily closed
Midwife practices at the following hospitals have self-reported primary C-section rates that are similarly low:
Hospital/ Birth Center Self-Reported Primary C-section Rate
SWEDISH COVENANT HOSPITAL (CHICAGO) [MIDWIFE-ATTENDED BIRTH]
8.4%
AMITA HEALTH ADVENTIST MEDICAL CENTER HINSDALE (HINSDALE) [MIDWIFE-ATTENDED BIRTH]
9.8%
UNIVERSITY OF CHICAGO MEDICINE (CHICAGO) [MIDWIFE-ATTENDED BIRTH]
10.4%
WEST SUBURBAN ALTERNATIVE BIRTHING CENTER (OAK PARK) [MIDWIFE-LED BIRTH CENTER]
10.5%
ELMHURST HOSPITAL (ELMHURST) [MIDWIFE-ATTENDED BIRTH]
12.0

 

Midwives do not perform C-sections, so these cesarean rates reflect the number of mothers who began labor in the care of the midwives and ended up having a C-section performed by a surgeon. These rates are not risk-adjusted, and should not be directly compared to the overall rates for Chicago-area hospitals reported above. But if you qualify for care and begin your labor with one of these hospital-based midwife practices, the likelihood that you will have a cesarean birth is as low as at the hospitals with the lowest rates.

Primary C-section rates are lowest of all for women who choose to give birth at home or in a midwife-led birth center

Here in the Chicago-area, women who plan to give birth at home or in a freestanding birth center like The Birth Center at PCC have a 3 – 4% chance of ending up with a cesarean. That’s two to four times lower than the lowest hospital rates (which range from about 8% to 13%), and six to eight times lower than the highest hospital rates (which range from about 19% to 24%).

Of course, women who qualify to give birth in these out-of-hospital settings are very low-risk to begin with, so they are less likely to need a c-section wherever they give birth. And since these out-of-hospital rates are self-reported and not risk-adjusted, they cannot be compared directly to the primary cesarean rates at hospitals.

Still, if you qualify to give birth at home or at a  freestanding birth center, these rates do give you a fair picture of how very low your cesarean risk could be.  If avoiding a C-section is a top priority for you, these could be good options to consider.

BirthGuide offers lots of information to help you decide. You can take the “where should I have my baby?” questionnaire to see if home birth or a birth center might right for you. You can also hear birth storieslearn more about the pros and cons of each settingcompare home birth and birth centers to hospital birth, and find home birth midwives and birth centers.