The Connecticut Hospital Association should be commended for its release of a report citing statewide and hospital-specific Caesarean-section rates (June 27, p. 68). Knowing the C-section rate of hospitals in their community can help pregnant women and their partners make a more informed decision about where to deliver their baby and can facilitate discussions with obstetricians about C-sections and other medical interventions that occur during labor and delivery.
The article mentioned the University of Connecticut Health Center's John Dempsey Hospital in Farmington as having the highest C-section rate (50.8%) in the state. While the hospital's rate exceeded the expected range for the hospital as calculated by the CHA, a disclaimer said the high rate presumably was due to the hospital's role as a referral center for high-risk pregnancies.
We'd like to make two points regarding this situation: First, with a 50.8% C-section rate, John Dempsey Hospital has one of the highest C-section rates in the country. In Public Citizen's May 1994 study of unnecessary C-sections, we reported Caesarean rates for more than 3,100 hospitals in 41 states. John Dempsey Hospital ranked seventh-highest in its use of C-sections among all hospitals in the report. Furthermore, not all hospitals with high-risk patient populations have high C-section rates. Our study found that the overall C-section rate in hospitals with neonatal intensive-care units (hospitals that can be expected to have higher-risk populations) was 22%, less than half the rate at John Dempsey.
Second, the fact that John Dempsey serves as a referral center for high-risk patients does not explain why it exceeded the expected range of Caesarean rates for the hospital. In calculating expected ranges of Caesarean rates, the characteristics of the patient population regarding risk factors for Caesarean sections are taken into account, and the expected rate is adjusted up and down on that basis. Therefore, the "reason" for John Dempsey Hospital's high C-section rate undoubtedly lies elsewhere.
SIDNEY M. WOLFE, M.D.