The Average Cesarean Rate for Planned Community Births* in Oregon is astonishingly low… Can you guess it?

*Community Birth is the term for outside-of-hospital birth, in other words births that are planned for Home or Birth Center

When considering where to give birth, most pregnant people will be thinking about all the scenarios, particularly if something were to go wrong.

Cesareans are an incredible life-saving tool. The cesarean rate should never be 0%. But cesareans also come with risks, particularly for the birthing person. When the cesarean rate is too high, it results in a higher rate of complications (including death) in childbearing people. It is advantageous to keep cesarean rates low and can be achieved in low-risk populations. How do we know? Because we can compare Hospital Birth cesarean rates with Community Birth cesarean rates and the results are honestly shocking.

First, a little history: In 1970 the national cesarean rate was 5.5%, but by 1978 it had skyrocketed to 15.2%. A major driver of the increase is thought to the be the widespread adoption of External Fetal Monitoring, which seemed so promising, but has yet to move the needle on infant outcomes. The current national cesarean rate is about 32%. Even the “low-risk” cesarean rate (first birth, singleton, term, head down) is over 25%.

But do you want to know what the cesarean rate for planned Home Birth and Birth Center births in Oregon is?

5.2%

(averaged over 12 years)

This is the percentage of people who planned to give birth at home or in a birth center, but at some point in the pregnancy or labor transferred to a hospital and ultimately gave birth by cesarean.

Here are the yearly rates from 2012-2023. The average cesarean rate for Planned Hospital Birth over the 12 years is 29.3% vs 5.2% for Planned Community Birth.

I know what you are probably thinking. Hospital Births have the higher risk pregnancies and therefore it is appropriate that the cesarean rate is higher for Planned Hospital Birth. Completely true! And yet, it is unlikely that high-risk births account for the Planned Hospital Birth cesarean rate being over 5x higher than the Planned Community Birth Cesarean rate. The World Health Organization (WHO) estimates the ideal cesarean rate to be no more than 10-15%. If Planned Hospital Birth cesarean rates were in the WHO recommended range, they would still be 2-3x higher than the cesarean rates for Community Birth, but not 5x higher.

You might also be thinking that a low cesarean rate could be contributing to bad outcomes for babies in Planned Community Birth, but that would not be true. If you read my last blog article about the safety data for fetal and infant loss you can see that there is no excess risk of loss in a Planned Community Birth and the chance of loss is lower for a Planned Community Birth—appropriate for the lowest risk pregnancies.

Choosing where to give birth is incredibly personal and Community Births are not for everyone, whether because of risk factors, or personal preference. And when planning a Community Birth, one must always be prepared for the possibility that a higher level of care and/or more medical options (like pain relief!) might be needed or wanted at some point.

Lastly, now that the State of Oregon is collecting this information, I hope there can be some investigation about how Community Midwives are achieving this incredibly low cesarean rate at the same time as maintaining low fetal loss rates so that it might be (somewhat) replicated for planned hospital births.