A Look at a Single Provider’s Primary C-Section Rate Over Multiple Facilities Over a Three-Year Period

Introduction: The number of cesarean sections performed each year continues to increase globally. In 2021, the World Health Organization (WHO) estimated that this route of delivery accounted for 21% of all births. The WHO anticipates that nearly 29% of all births will be born via cesarean section by 2030 and states that while cesarean section may be “essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is not medical need.” (Caesarean section rates continue to rise, amid growing inequalities in access). The Centers for Disease Control (CDC) continues to track cesarean section rates, and in April of this year, reported that the low-risk cesarean delivery rate (low risk is defined as nulliparous, term, singleton, vertex, and is often referred to as PC-02) was 26.6%. (Vital Statistics Rapid Release, Number 038 April 2025). There is generally no agreed upon optimal primary cesarean section rate. In fact, the American College of Obstetricians and Gynecologists (ACOG) explicitly states, “…no single cesarean birth rate goal can be prescribed for a single clinician’s practice or care setting…” (Calculation and Coding of Cesarean Birth Rates | ACOG) The primary cesarean section rate is likely due to a myriad of factors and not just solely the responsibility of the delivering physician. It has been proposed that the facility’s induction scheduling practice, duration of labor allowed before diagnosing arrest, use of hospitalists, nursing practices during labor, in addition to many other factors, may all contribute to the chance of a patient undergoing a primary cesarean section. We previously reported on the primary cesarean section rate of a single provider who delivers at multiple institutions over the period of one year. Here, we add to this data. Methods: Clinic data were reviewed from patients who saw a single practitioner, Jonathan Faro, MD, PhD, from October 1, 2021 through September 30, 2024. Patients were given the choice of where they would prefer to deliver: Memorial Hermann Hospital Memorial City, The Woman’s Hospital of Texas, or Memorial Hermann Hospital Texas Medical Center. As this was a retrospective chart review and no identifying patient data were obtained, no IRB approval was requested. As with our previous study, patients were excluded if they were not nulliparous, were not full term, did not have a singleton pregnancy, or if the fetus was not in vertex presentation. Results: From October 1, 2021 through September 30, 2022, a total of 105 patients were delivered by the physician. (This excludes patients that the physician delivered for any other physicians while on call.) 57 of these were delivered at Hospital A, 46 were delivered at Hospital B, and only 2 were delivered at Hospital C. Of these 105 patients, 19 met the criteria to be considered under the PC-02 criteria. Of the 9 patients delivered at Hospital A by the Physician, 11% resulted in C-section. Of the 8 patients delivered at Hospital B by the physician, 50% resulted in a C-section. Of the 2 patients who delivered at Hospital C, none underwent C-section. From October 1, 2022 through September 30, 2023 a total of 159 patients were delivered by the Physician. 133 of these were delivered at Hospital A, and 25 were delivered at Hospital B. (Hospital C had one patient, a multiparous vaginal delivery.) 72 of these 159 patients met the criteria to be considered under the PC-02 criteria. Of the 47 patients delivered at Hospital A by the Physician, 23.4% resulted in C-section (11 out of 47). Of the 7 patients delivered at Hospital B by the Physician, 28.6% resulted in C-section (2 out of 7). From October 1, 2023 through September 30, 2024 a total of 145 patients were delivered by the Physician. 126 of these were delivered at Hospital A, and 19 were delivered at Hospital B. Out of these 145 patients, 56 met the criteria to be considered under the PC-02 criteria. Of the 49 patients delivered at Hospital A by the Physician, 22.5% resulted in C-section (11 out of 49). Of the 7 patients delivered at Hospital B by the Physician, 71.4% resulted in C-section (5 out of 7). Discussion: With rates ranging from 0% to 71.4%, one can easily see that it may be anything but the provider responsible for determining the primary C-section rate. This data illustrates that other factors separate from the provider likely contribute to a patient undergoing a primary C-section. The total number of patients delivered by a provider at a specific facility likely has a major impact in determining the provider’s primary cesarean section rate, and it is likely that there exists a certain threshold in which this number becomes more reliable. Providers with low volume at a facility may be inordinately affected by factors that would not impact their rate otherwise.