Interactive Map: Comparing Childbirth At Mass. Hospitals

Compare the Massachusetts hospitals that perform deliveries in the interactive map below. The map contains five childbirth quality measures that WBUR selected after polling both experts and expectant moms. For more about the measures and how we chose them, see our companion story.

And if you think there are more important things to consider when choosing a hospital, please tell us in this survey.

Measures:
  • C-section Rate:
  • VBAC Rate:
  • Early Elective Delivery Rate:
  • Episiotomy Rate:
  • Exclusively Breast Feeding:

Measures:
  • VBAC Rate:
  • C-section Rate:
  • Early Elective Delivery Rate:
  • Episiotomy Rate:
  • Exclusively Breast Feeding:
Bold: Currently selected procedure

What is this? This is the rate at which women have a vaginal delivery after having had at least one C-section. Higher rates are better.

Why does it matter? A VBAC has the benefits of a vaginal delivery: a quicker recovery and less pain, fewer days in the hospital and a lower chance of infection. A VBAC also means one fewer scar on the woman's uterus.

What factors might affect the numbers? Most experts say women can consider labor and a vaginal delivery after one C-section. But because a VBAC could risk tearing a prior C-section scar, some hospitals and doctors might resist this out of concern for the mother’s health or their own liability. As with C-sections, there are cultural differences among hospitals but no firm proof that these explain the variations in rates.

What is this? The baby is delivered through incisions in the mother's abdomen and uterus. Lower rates are better.

Why does it matter? A C-section increases the mother's pain, recovery time and risk for infection. It may complicate future pregnancies. There is a small risk the scar could rupture or that the placement of the placenta will cause severe bleeding. C-section babies are slightly more likely to have breathing problems and be at risk for a few common chronic conditions than babies delivered vaginally.

What factors might affect the numbers?

  • These are rates for a mother’s first Cesarean section. Experts say preventing a first C-section will protect a mom against ruptures and severe bleeding that may occur with a second or third C-section.
  • Large hospitals, including teaching hospitals, often have higher C-section rates. They say it’s because they handle more premature and other high-risk deliveries.
  • There is no definitive reason for the big differences between hospitals. A mother’s age, patient choice or fear of malpractice lawsuits may help explain high rates overall, but have little effect on the gaps between hospitals. Researchers are looking at cultural differences among hospitals, time pressures and the impact of fetal health monitors on C-section rates.

What is this? Sometimes pregnant women or their doctors schedule an early delivery for convenience or to make sure the doctor who has been seeing the mom will handle her delivery. Lower rates are better.

Why does it matter? Many medical societies, child advocacy organizations and employer groups say hospitals should not schedule deliveries before 39 weeks to avoid complications, and because babies need the last two weeks for brain, lung, and other vital organ development.

What factors might affect the numbers? Most hospitals are trying to eliminate this practice and many have. Most hospitals above 0 are in the single digits. Hospitals say this reflects their goal of reducing, if not ending, early elective deliveries.

What is this? A cut made to enlarge the vaginal opening during birth. Lower rates are better.

Why does it matter? Most experts recommend natural tearing when needed. An intentional cut may prolong a mother's recovery and lead to urinary incontinence and muscle problems in the anus.

What factors might affect the numbers? Doctors may perform an episiotomy to speed a delivery if a baby is in distress. Some doctors say that younger obstetricians generally don’t perform episiotomies or that it’s more acceptable at some hospitals than others.

What is this? The percentage of babies fed nothing but breast milk from birth to hospital discharge, among mothers who say they want to breast-feed. Higher rates are better.

Why does it matter? Breast-feeding helps protect babies against allergies, Sudden Infant Death Syndrome and some illnesses. It may protect the mother against some forms of cancer and postpartum depression.

What factors might affect the numbers? Hospitals can help mothers with breast-feeding, but they can’t control whether they succeed. Larger hospitals -- those that perform 1,100 births or more per year -- are beginning to report this measure to a national accrediting group and appear to be making a greater effort to collect this information than some smaller hospitals.

 

Where did we get the numbers? These rates (table 31) were collected by the state Department of Public Health for 2010, the most recent year available.

Where did we get the numbers? These rates (table 31) were collected by the state Department of Public Health for 2010, the most recent year available.

Where did we get the numbers? Our numbers are from The Leapfrog Group, which monitors healthcare quality and safety through voluntary hospital surveys. Leapfrog shared its latest numbers from 1-31-14.

Where did we get the numbers? Our numbers are from The Leapfrog Group, which collects the information through voluntary hospital surveys. Leapfrog shared its latest numbers from 1-31-14.

Where did we get the numbers? WBUR collected this information directly from hospitals across Massachusetts. In January, The Joint Commission, a national hospital accreditation group, will begin collecting this information from hospitals that perform 1,100 or more births a year.


Correction: An earlier version of this interactive included an incorrect early elective delivery rate for Holyoke Medical Center. Its correct EED rate is 0 percent. We regret the error.

Editor’s note: Thanks to Jessica Martin at The Boston Foundation for her early assistance with vetting data and project design.

More:

Please follow our community rules when engaging in comment discussion on this site.
  • Elizabeth A

    Was any consideration given here to maternal or neonatal morbidity and mortality rates for these hospitals? C-section and episiotomy rates don’t mean a lot to me in the absence of morbidity and mortality data.

  • 1humanwoman

    The hospitals that are higher on cesarean are generally higher on episiotomy as well–the correlation isn’t perfect, but most of the hospitals at the lower end of cesareans are also at the lower end of episiotomy. There is nothing about vaginal births that should make episiotomy rates vary much, so we should expect more or less the same low rates from all facilities. You can read more about this correlation here: http://humanwithuterus.wordpress.com/2014/01/04/episiotomy-female-genital-mutilation-american-style/

  • Jessica Homa Greenwood

    South Shore MA expectant mothers should know that Jordan Hospital in Plymouth does support VBAC’s- this is not reflected in the data. Jordan was also recently acquired by BID so the name may be changing around- hopefully the hospital will remain supportive of VBAC/TOLAC

    From the Jordan Hosp, website:

    Birthing options, including TOLAC for women who have has previous c-sections, and Water-birth, and option for low-risk mothers seeking an alternative delivery option
    http://www.bidplymouth.com/birthplace

  • Rinat Sergeev

    Have there been taken into account that the people with more complex cases of delivery are usually directed to go to more recognized hospitals? It is strange to see Tufts and Brigham at the end of a quality list. The usual mistake of a beginning statistician is to mix together apples and oranges, without comparing them in separated well-defined categories.

    • Martha Bebinger

      Hi Rinat – the numbers hospitals submit to the Department of Public Health are not adjusted for risk. The Joint Commission is beginning to collect C-section rates that are adjusted for risk. We hope to update the map sometime later this year with this information.

      • Rinat Sergeev

        Thank you for the clarification!
        Otherwise I had a concern that unadjusted mix of data might have led to misinterpretation.
        Looking forward to adjusted dataset.

      • Elizabeth A

        I share Rinat’s concern. In particular, I note that some of the lower c-section hospitals on your chart transfer high-risk cases to hospitals with higher rates.

        I do think that “Lower is better” is a misleading caption for this chart. I am only alive to write this today because a hospital your chart implies is “better” transferred me to a hospital your chart ids as “worse,” where I could have an emergency c-section and my daughter could be treated in a Level III NICU (which the “better” hospital didn’t have). I believe you have badly misrepresented a complicated situation.

        • Martha Bebinger

          Hi Elizabeth – it would be great if hospitals submitted adjusted rates to the state, but they don’t. As I said to Rinat, larger hospitals are now sending adjusted rates to The Joint Commission and those will likely be available later in the winter.

          “Lower is better” is the assessment of groups that establish and use childbirth quality measures. We are adopting their language, this is not our judgement. C-section rates are not the only way to judge which hospital is best for you. They may not even be something you want to consider. The goal here is to give women the best data that is available publicly, and let them decide how to use it. I think we need better data, and I hope this project signals that message to hospitals.

          I completely agree, and my own experience supports, the life saving need for a C-section in some cases.

          I hope all is well with you and your daughter.

          • Elizabeth A

            “Lower is better is the assessment of groups that establish and use childbirth quality measures”

            Would you consider sharing which groups those are? Fewer is better is not the stance of the ACOG.

            When you adopt someone else’s language without identifying your source or stating an alternative, you might as well be approving their judgment.

            The idea that fewer c sections are better then more c-sections requires some critical examination, and is a deeply flawed approach to assessing hospitals.

          • Martha Bebinger

            Hi Elizabeth – the National Quality Forum endorsed C-sections as a childbirth quality measure in 2012 with the goal of reducing C-section rates. The US government, through its Healthy People initiative, asked hospitals to lower their C-section rates to 15% as of 2010. That goal was not reached and has been adjusted up for 2020.

            The source for each data set is at the bottom of each measure on the map. For Cesarean sections, the source is the Massachusetts Department of Public Health. There is a link to state’s full Births Report below the map and bar chart.

            Thanks again for your comments.

  • Warren Bennett

    Is there any relationship between c-section rates in Labor and Delivery Suites where Nurse Midwifes are primarily delivering babies, and Labor and Delivery Suites where Physicians are primarily delivering babies?; are the physicians more likely to perform a c-section than a Nurse Midwife requesting a physician perform a c-section?

    • Martha Bebinger

      Hi Warren – Cambridge Hospital and other facilities where midwives handle a lot of deliveries will tell you that using midwives is tied to lower C-section rates, but there are no statewide numbers that I’ve been able to find that shed light on your questions.