Hospital Maternity Care Underperforms, Study Finds

WASHINGTON — Maternity care at hospitals nationwide is progressing although there is still room for improvement, according to The Leapfrog Group, a Washington-based nonprofit that provides analysis for the health care industry.

The organization released its annual Maternity Care Report on Feb. 23. The report provides an examination of hospital quality and safety for early elective deliveries, episiotomies and high-risk deliveries. Leapfrog developed the report together with San Francisco-based Castlight Health, a health care information company.

In its analysis, Leapfrog found less than one third of hospitals meet its standard for high-risk deliveries of very low birth weight babies, while rates of episiotomies are still too high at 35 percent of birthing hospitals.

The research also found that many hospitals fail to meet standards for high-risk deliveries. In fact, the national rate of hospitals meeting the standard remains “dangerously low,” with only 24.4 percent of hospitals meeting Leapfrog’s standard, indicating too many very low birth weight babies are born in hospitals that are unprepared to care for their special needs.

Early elective deliveries are also continuing to decline across the country. The national average for early elective deliveries — inductions or cesarean (C-section) procedures performed before 39 weeks gestation without medical necessity — hit 3.4 percent, the lowest rate since Leapfrog began public reporting on the measure. That is down from 4.6 percent in 2013 and 17 percent in 2010. However, some hospitals maintain high rates of early elective deliveries; while nearly 750 reporting hospitals achieved the Leapfrog standard for early elective deliveries, hospitals in some regions of the country consistently perform too many of these procedures.

On a positive note, episiotomy rates are improving. Sixty-five percent of hospitals achieved the target rate of 12 percent or less for episiotomies, a once routine incision made in the birth canal during childbirth that is now recommended only for a narrow set of cases. However, considerable variation in episiotomy rates exists, according to research. There is an unhealthy amount of variation in the episiotomy data, with 35 percent of birthing hospitals still permitting too many episiotomies.

“The Maternity Care Report reveals that hospitals are making continued gains in the quality of maternity care offered, yet the data also demonstrates that there is substantial room for improvement,” said Leah Binder, president and CEO of Leapfrog, in a statement. “For many employers, labor and delivery account for nearly 25 percent of all hospitalizations, which makes these maternity metrics extremely valuable, as they have the power to help employees make smart health care choices.”