Birth Injury and Fatality Risk Down Due to Health Care Initiatives: Report

Safety programs have greatly reduced the rate of infant and maternal injuries related to childbirth, but a consumer group indicates that the programs are still not widely implemented across the U.S., leaving many unprotected. 

The prominent watchdog group Public Citizen released a report, Solutions in Sight, which highlights how health care initiatives implemented over the past 15 years in many hospital maternity wards have greatly reduced birth injuries and deaths. However, the group points out that the practices are still not comprehensively implemented nationwide.

“News that certain institutions have made remarkable progress in reducing tragic events related to childbirth is cause for celebration,” said Taylor Lincoln, research director of Public Citizen’s Congress Watch division and author of the report. “The success of these programs suggests that otherwise avoidable fatalities and injuries are likely still occurring at health care facilities that have not instituted reforms like these.”

Four health care organizations implemented certain best practices and were able to find significant improvements in maternal and infant injuries.

The Hospital Corporation of America reduced maternal fatalities system wide from post-cesarean pulmonary embolism by 86%. They also reduced obstetrics-related litigation claims by two-thirds.

The New York Presbyterian Hospital-Weill Cornell Medical Center was able to reduce brain injury caused by oxygen deprivation by 98% more than the national average. It also reported that its obstetrics-related litigations was also reduced by 99%.

Ascension Health reduced national neonatal fatalities by half in the first two years after broadening its initiative to all 43 of its hospitals.

Premier Inc. reported a 74% reduction in preventable birth trauma to full-term newborns after the initiative was undertaken at 16 facilities.

Initiatives implemented at the four healthcare facilities included the use of simulations to conduct training during emergency situations and training to reduce communication problems, which are a component of catastrophic events during childbirth 65% of the time.

Facilities also implemented efforts to eliminate early elective deliveries, which are shown to pose significantly greater risk of complications, bundles, or groups of essential practices, and implemented policies to rely on the best scientific evidence in deciding to conduct cesarean deliveries, which pose health risks to mothers and babies.

Use of Best Practices Inconsistent

Experts say that use of best practices in the obstetrics’ profession are inconsistent. The American Congress of Obstetricians and Gynecologists told Public Citizen that adoption of updated and new best practices varies across the country.

One example of these inconsistencies included the use of cesarean sections. A 2013 national study found cesarean use varied by provider from 7% to 70%. Non-medical considerations, including convenience and compensation, contributed significantly to the heavy use of cesareans among some providers, according to the report.

Public Citizen recommends changing payment policies for cesarean deliveries to help ensure providers’ incentives meet the best interests of patients, as well as implemented best practices.

The U.S. infant mortality rate is among the highest in the developed world and the maternal mortality rate has risen in the past decade. Reducing the infant mortality rate could save more than10,000 lives a year, Public Citizen predicts.