OBSTETRICS: 1 million deliveries in U.S. hospitals studied

Statistics on over one million deliveries at 355 U.S. hospitals in 2008 and 2009 were studied based on Premier, Inc.’s Perspective database.  This provides a fascinating large-scale look at the obstetrics population in the U.S.  Let’s take a look (I’ve rounded the following numbers off and combined some categories from those given in the original article.)

How old are maternity patients?

• About half are in their 20s
• About 10 percent are teenage mothers

What kind of insurance do they have?

• 42 percent managed care
• 42 percent Medicaid
•   8 percent commercial – indemnity
•   3 percent self pay
•   6 percent other

How many patients…

• Delivered by C-section this time? 39 percent
• Have had a previous C-section?  18 percent
• Are of advanced maternal age?  16 percent
• Are delivering prematurely?  8 percent
• Are obese?  4 percent

What was the median length of stay?

• 2 days for vaginal delivery
• 3 days for C-section

What was the hospital risk-adjusted infection rate?

• 4.1 percent of all deliveries were complicated by infection

The authors found that “risk-adjusted infection rates following childbirth vary considerably across hospitals, and that key structural and organizational hospital features explain only a modest amount of this variation.”

Source: Goff, S.L., Pekow, P.S., and others. (2013, June). Patterns of obstetric infection rates in a large sample of U.S. hospitals. American Journal of Obstetrics & Gynecology, 208(6). Author manuscript free here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670964/pdf/nihms-443021.pdf  Posted by AHA Resource Center (312) 422.2050, rc@aha.org

How are babies delivered? About one-third by C-section

Over 1 million births that occurred in over 800 hospitals in the states of AZ, CA, FL, IA, MD, NJ, NC, WA, and WI in 2008 were studied.  Here is the distribution of how these childbirths occurred:

• 720,305 (54 percent) – normal spontaneous vaginal deliveries
• 424,224 (32 percent) – cesarean deliveries
• 174,036 (13 percent) – vacuum extractions
•     6,158 (0.5 percent) – forceps deliveries
•   19,582 (1.5 percent) – two or more attempted procedures
• 1,344,305 total

The authors raise the concern that the low volume of forceps deliveries in many hospitals may not provide enough opportunities for residents to learn how to do the procedure.

Source: Kyser, K.L., Lu, X, and others.  Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?  Academic Medicine;89(1):71-76, Jan. 2014.  Click here for access to the publisher’s website: http://journals.lww.com/academicmedicine/Abstract/2014/01000/Forceps_Delivery_Volumes_in_Teaching_and.26.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

C-section rate rises to about one-third of births: US 2009

Percent Cesarean Delivery Rate (Average): US 2009

• 32% small hospitals
• 32.3% medium hospitals
• 33.4% large hospitals
• 32.6% teaching hospitals
• 31.7% rural hospitals
• 32.8% ALL hospitals

This article provides similar breakdowns for the rate of lower-risk C-section deliveries, which averages 12 percent for all hospitals.

These rates are drawn from a nationally representative sample of hospitals that had 100+ births in 2009.  The data source is the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project.  The C-section rate has been increasing–it was 20.7 percent of all deliveries in 1996. 

Source: Kozhimannil, K.B., Law, M.R., and Virnig, B.A.  Cesarean delivery rates vary tenfold among US hospitals: reducing variation may address quality and cost issues.  Health Affairs;32(3):527-535, Mar. 2013.  Click here for full text: http://cfpcwp.com/MCDG/wp-content/uploads/2013/02/Health-Aff-2013-Kozhimannil-527-35.pdf  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org