"For the most part babies and the mothers do well, but we can do even better by studying the hospitals that perform well and following their best practices," says J. Christopher Glantz. (Credit: Jeremy Engleman/Flickr)

Complications during childbirth vary widely by hospital

A woman’s chances of having a complication during childbirth may depend on where her baby is born.

In the US, complication rates can vary as much as five-fold among hospitals. Researchers say the finding calls for the development of a national quality reporting system to improve maternal outcomes.

Women who delivered by cesarean at low-performing hospitals experienced lacerations, hemorrhage, clots, or infections at five-times the rate of high-performing hospitals—21 percent compared to 4.4 percent.

Women who delivered vaginally at low-performing hospitals were twice as likely to suffer complications, 22.6 percent versus 10.4 percent at high-performing hospitals.

Researchers determined the low, average, or high performing hospitals based upon a calculation of the relative risk that a patient would experience a major complication.

“The key finding is that there is significant variability in maternal outcomes across US hospitals,” says lead author Laurent G. Glance, health outcomes researcher and vice-chair for research in anesthesiology at University of Rochester School of Medicine and Dentistry. “This presents us with an opportunity to identify ‘best practices’ at hospitals with low rates of maternal complications in order to improve outcomes for patients in all hospitals.”

The American Congress of Obstetricians and Gynecologists and the American Society of Anesthesiologists  have launched an initiative to create a platform for measuring and reporting benchmarking information on maternal outcomes. The quality reporting initiative could become a powerful tool for improving maternal outcomes in the United States, researchers say.

Wide differences

Published in the journal Health Affairs, the study analyzes 750,000 deliveries in the 2010 Healthcare Cost and Utilization’s Nationwide Inpatient Sample.

However, Glance says he considers the findings preliminary because they’re based on administrative data which lack information on potentially important risk factors. It is also important to realize that most of these complications, although important, are rarely life-threatening.

Childbirth accounts for one in four hospital discharges, resulting in $100 billion in hospital charges in 2008 alone.

There’s great value in having this information to quantify the well-known variations in practice and its impact on maternal outcomes, says high-risk obstetrician J. Christopher Glantz, a coauthor of the paper who is working on an American College of Obstetricians and Gynecologists initiative to reduce pregnancy-related deaths from severe hypertension, thromboembolism, and hemorrhaging during pregnancy and childbirth in New York state.

“In the OB field, individual practice styles, training, and anecdotal experience shape how we practice, but we didn’t expect to see such wide differences in maternal outcomes, which is all we studied here,” he says.

“For the most part babies and the mothers do well, but we can do even better by studying the hospitals that perform well and following their best practices.”

Scientists from RAND Corp., State University of New York at Albany, University of California at Irvine, and Uniformed Services University of the Health Sciences also participated in the study.

Source: University of Rochester

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