About one in five hospitals in the United States last year met national performance targets for maternal care interventions like cesarean sections (C-sections), according to Leapfrog Group's 2019 Maternity Care Report published Wednesday.
The United States has one of the highest maternal mortality rates among wealthy countries, according to Modern Healthcare. Research has found that the U.S. maternal death rate in 2015 reached more than 26 deaths for every 100,000 births, Modern Healthcare reports.
Health care experts have linked higher rates of C-sections with longer hospital stays, increased risk of respirator issues, infections, and hospital readmissions among women, Modern Healthcare reports. In addition, research has shown that early elective deliveries, or inducing childbirth before 39 weeks for nonmedical reasons, can increase health risks for infants and mothers, according to Modern Healthcare.
Most hospitals don't meet maternal care performance targets, report finds
For its report, Leapfrog analyzed 2018 survey data on more than 2,000 hospitals to assess their performance on meeting national frequency standards for three maternal care intervention areas:
- C-sections rates;
- Early elective delivery rates; and
- Episiotomy rates.
According to the report, just one in five hospitals in 2018 met all three of Leapfrog's national performance targets for the intervention areas.
The report found that the average rate of C-section births among hospitals in 2018 was 26.1%, which is above Leapfrog's target rate of 23.9%. According to the report, the average episiotomy rate declined from 7.8% in 2017 to 6.9% in 2018, but the rate was higher than Leapfrog's target rate of 5% or lower.
However, the report found that the average rate of early elective deliveries at hospitals in 2018 was 1.5%, down from 17% in 2010 and well under Leapfrog's target rate of 5% or lower.
According to the report, 90% of hospitals that met Leapfrog's standard rates for early elective deliveries and episiotomies in 2017 also met the standards in 2018, while 70% of hospitals that met Leapfrog's standard for C-sections in 2017 also met the standard in 2018.
'Good and bad news'
The report "finds good and bad news for expectant mothers," Leapfrog CEO Leah Binder said.
According to Binder, the survey results demonstrate that hospitals have the ability to meet maternal care standards when the health care industry makes maternal care a priority, but "[w]hen they don't put their minds to a goal of improving maternity care we see stagnation," she said.
According to Binder, the stagnation could stem from cultural norms regarding C-sections and early delivery in certain facilities. "Even when one individual physician may have strong ideas about avoiding C-sections, if that physician is in a hospital setting where C-sections are more common they will probably end up there as well," Binder said.
However, Binder said it is encouraging that hospitals that have improved their performance on the maternal care standards were able to maintain those improvements over time. "It is this continued success year after year that will have the farthest-reaching impact in giving mothers and children a healthy start," she said (Bean, Becker's Hospital Review, 5/29; Johnson, Modern Healthcare, 5/29).
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