What measurement means for cesarean deliveries

Cesarean delivery is an abdominal surgery that results in the delivery of a baby or babies through incisions made in the mother’s abdomen and uterus. There are short- and long-term consequences to cesarean deliveries, including the potential for surgical complications, increased blood loss, admission of the baby to neo-natal intensive care, and increased cost compared to vaginal deliveries.

Cesarean deliveries can by life-saving and medically-necessary for the mother and/or child; however, the increase over the past several decades has raised concerns that cesarean deliveries are being done unnecessarily without clear benefits to women or children. The result has been a push in recent years to lower the number of unnecessary cesarean deliveries in the United States.

In 2012, the national rate for cesarean delivery of first children was 22%, according to the Centers for Disease Control and Prevention. After having a cesarean with a first child, only about 10% of women have vaginal deliveries with subsequent children. Thus, efforts to reduce cesarean deliveries generally focus on first deliveries.

Recommended care for women during childbirth is to allow more time for labor to progress and for women to push, as well as to use techniques and instruments (such as forceps) to assist with vaginal delivery whenever possible. These steps can avoid unnecessary cesarean deliveries.

The statewide rate of cesarean deliveries by all reporting medical groups is 22%. This means 22 of 100 women in Minnesota and neighboring areas who gave birth to their first child (singleton, non-breech) after a full-term pregnancy (37 weeks or longer) had a cesarean delivery.

Lower rates are better, because they show that fewer cesarean deliveries are being done. The rate includes both medically-necessary and elective cesarean deliveries for first time moms. It does not include multiple babies, preterm deliveries (earlier than 37 weeks), or pregnancies where the baby was in a breech position.

Low rates of cesarean deliveries can be a sign of strong medical group performance in maternity care. In other words, medical groups with lower rates have better HealthScores. It’s important to note that small differences in percentages don’t necessarily reflect the quality of care you’ll receive with a certain medical group or clinic. It is more important to note the large differences between providers, and speak with your doctor if you have questions or concerns.

How we calculate the measure

We measure the percentage of patients where the delivery of their first child (singleton, non-breech) occurred by cesarean delivery. This report is based on information from patients who delivered between July 1, 2014 and June 30, 2015. It is evaluated annually. This information is collected under the measure name Maternity Care: Primary C-Section.

Risk-adjusted measures

The information reported about this measure on MNHealthScores is risk-adjusted.

Risk adjustment is a way to make it easier to compare clinics or medical groups by accounting for the differences of specific patient groups. The process should separate the clinic/medical group’s true impact on patients’ health and allow them to be compared more easily.

MN Community Measurement uses an actual-to-expected process, which is also known as a methodology. This process does not change a clinic/medical group’s result; the actual rate remains the same. Instead, each clinic/medical group’s actual rate is compared to the rate that we expected to see, based on the different types of patient characteristics seen at that clinic/medical group.

More details about our risk adjustment methodology and the variables used for the measures reported on MNHealthScores.org can be found in the most current Health Care Quality Report.