The cesarean section rate in Iowa climbed again to 30.37 percent in 2010, and statistics compiled by the Iowa Department of Public Health showed huge disparities among hospitals in the percentage of live births done surgically.

Members of the International Cesarean Awareness Network requested the detailed Iowa birth statistics from the IDPH, and you can view the 2010 numbers at the ICAN of Northeast Iowa site. As has occurred for the last two decades, the statewide c-section rate in Iowa tracks closely to the national average.

C-sections can be life-saving procedures for mothers and babies, but women can reduce their risk of having a surgical birth in many ways, such as choosing a care provider carefully, developing a birth plan, having a doula present during labor, not agreeing to induce labor, and avoiding epidurals. Click here for a more comprehensive list of “Things You Can Do to Avoid an Unnecessary Cesarean.”

Any pregnant woman in Iowa who wants to avoid a surgical birth would be advised to look at these figures. Some hospitals have c-section rates well above or below the statewide average. At a rural hospital, a relatively small number of births per year might skew the statistics, but at larger hospitals the disparities are striking.

Why do both of the hospitals in Waterloo (Black Hawk County) have c-section rates below 25 percent, when the hospital in Mason City (Cerro Gordo County) has a rate of nearly 35 percent? Why is the c-section rate at the Mary Greeley Medical Center in Ames so much lower than the rates at hospitals in Boone, Marshalltown and Newton? Five Iowa hospitals have c-section rates above 45 percent, whereas many hospitals of comparable size are closer to or even below the statewide average rate. It seems that something must be going on either with hospital procedures or the care providers delivering most of the babies at those hospitals.

I contacted the IDPH to find out whether there is any state program designed to reduce the c-section rate, especially at hospitals where nearly 50 percent of live births occur surgically. Stephanie Trusty, a nurse consultant with the Statewide Perinatal Care Program, explained that the IDPH offers professional training and development to staff at all birthing hospitals in the state. Trusty estimated that the team visits each hospital approximately once every three years. The goal is to promote best practices in labor, delivery and infant nutrition. There is no particular focus on the c-section rate, or on hospitals where that rate is noticeably high. An OB/GYN I spoke with was not aware of any efforts by the Iowa Medical Society to address the high c-section rate statewide or at individual hospitals.

Trusty mentioned the decline in vaginal births after c-section (VBAC) as a contributing factor in the rising rate of surgical births. Many hospitals and OB/GYNs don’t allow women who have had a c-section to go through a trial of labor with subsequent pregnancies. Large numbers of women are therefore locked into repeat surgeries for every child, even if the mothers are good candidates for a VBAC. It’s probably no coincidence that the Iowa hospital with the lowest c-section rate (Mercy Iowa City at 15.7 percent) also has the state’s highest percentage of VBACs.

When choosing a place to give birth, a facility’s c-section rate would be well worth considering. For instance, the c-section rate is way higher at the hospital in Keokuk than at hospitals not far away in Fort Madison or Burlington. The hospital in Shenandoah had one of the highest c-section rates in 2010 (48.5 percent), whereas several facilities within an hour’s drive of Page County had rates closer to the statewide average.

You might think socio-economic factors would be correlated with c-section rates, but some high-poverty Iowa counties contain hospitals with relatively low c-section rates. In Polk County, the hospital with the lowest rate is Broadlawns, even though that county-owned facility tends to serve a lower-income population (who presumably receive less prenatal care). Of hospitals in and around Des Moines, Mercy Medical Center in West Lakes had the highest percentage of live births by c-section in 2010. That new hospital was built to serve patients in a wealthy suburban area.

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