Birth Complication Rates, Maternity Care Quality of Hospitals Varies Greatly

New research confirms that pregnant women who deliver at low-rated hospitals face a greater risk of suffering birth complications when compared to women who are treated at top-performing hospitals, but it is not always easy to obtain information about the quality of maternity care provided at different hospitals. 

In a study published this week in the medical journal Health Affairs, researchers highlighted how important the decision about where to deliver a baby may be in the health of the mother, focusing on the difference in maternity care quality between hospitals that perform badly and those which are higher-rated.

Dr. Laurent Glance, professor of anesthesiologist at University of Rochester medical school in New York, and the team of researchers compared hospitals nationwide and found women who delivered at low-performing hospitals suffered more than two times the rate of major complications for vaginal births. Women who underwent cesarean sections had an even greater rate of birth complications, with a near fivefold difference. 

The hospitals were not identified in the study, but researchers grouped the facilities into three quality categories: low, average and high, according to the rates of complications the mother suffered. They also adjusted for differences in the health status of mothers served by the hospitals.

Four million women give birth in the United States every year. For this study researchers analyzed billing data for more than 750,000 patients who delivered in 2010.

Pregnancy-related deaths are rare, yet complications involving pregnancy are as common as those for heart surgeries. To that end, having a baby is the most common reason for a hospital stay.

At low quality hospitals an average of 23% of women delivering vaginally experienced major complications. Only 10% of women at high quality facilities experienced a complication compared to nine percent at average quality hospitals.

Typical complications experienced were unusual bleeding and infection after a cesarean birth. Complications which, altogether, are not life-threatening, but can significantly affect a patient’s quality of care and can lead to further complications if not treated correctly.

Clearly the quality gap is large and can be quite elusive for new mothers who may not be able to determine the quality of a hospital before delivery. Currently there is no database available that shows which hospitals have higher ratings or better quality.

According to a study published in 2011, some hospitals are delivering more than 40% of babies early for no medical reason. Early delivery can put a newborn at increased risk for birth injury and lifelong health problems, including death. Some hospitals had 10 times the number of medically unnecessary early deliveries as others. Many had early elective delivery rates lower than 5 percent, but others exceeded the 40 percent mark.

Some medical groups, like the American Congress of Obstetricians and Gynecologists, are working to create a database which would use clinical data from medical records to indicate the quality of hospitals. Such a system is at least three to five years from becoming a reality.

There is a national effort to improve the quality of medical care, in turn reducing medical costs, by using medical data to compare hospitals and healthcare providers.

Researchers point out the study is limited since it is based on billing data and not clinical data. Using billing data does not reveal what actually happened to a patient. Clinical data would offer information closer to the source involving the patients, however it not currently available on a large scale.