This analysis was performed by Christian McDonald, an assistant professor of practice at the School of Journalism and Media, Moody College of Communication at the University of Texas at Austin.
The analysis used the Texas Hospital Inpatient Discharge Public Use Data File, [1q2016-4q2019], provided by Texas Department of State Health Services, Center for Health Statistics in Austin. The agency typically sells this data to hospitals and media, even though it is available for free in some other states. The four years of data used in this analysis cost in-state media $8,500 and out-of-state media $17,000. As a faculty member at a state university, McDonald was able to obtain the data for free to do the analysis, but per agency rules cannot not share or publish the raw data. No patients or doctors are identified in the analysis. Only non-identifying aggregate data has been published, as allowed.
The primary cesarean and vaginal birth after cesarean delivery rates referenced were calculated per the Agency for Healthcare Research and Quality Inpatient Quality Indicators: IQI 33 Primary Cesarean Delivery Rate, Uncomplicated and IQI 22 Vaginal Birth After Cesarean (VBAC) Delivery Rate, Uncomplicated. AHRQ is one of several organizations that work with the U.S. Department of Health and Human Services to ensure health care quality across the country.
Episiotomy rates referenced were calculated using The Leapfrog Group’s measure specifications from their 2020 Leapfrog Hospital Survey. The measure for episiotomies can be found on page 118.
In addition to the exclusions provided by each group for their measures, records that had missing data were excluded. At the advice of researchers at the UT System Population Health Office, we also excluded women outside typical child-bearing ages from our analysis.
All of the analysis was performed using the open-source statistical software package R and the code is available on Github, a popular platform for sharing data and code. The RNotebooks there fully explain the methods used for each calculation used in the articles.