The Leapfrog Group, which collects data on a voluntary basis from hospitals and compares results with national standards in order to evaluate quality of care, opens its 2015 report on U.S. maternity care with: “[T]here is substantial evidence that U.S. hospitals overuse medical interventions, exposing mothers and babies to unnecessary health risks from C-Sections, episiotomies, and early elective deliveries.” With nearly half (1750) of U.S. hospitals responding:
- 16% delivered more than 5% of babies electively before 39 weeks, although that being said, the national average early elective delivery rate has fallen from 17% to 3% since Leapfrog first reported this measure in 2010,
- 60% had cesarean rates exceeding 23.9% in low-risk 1st-time mothers (one, head-down baby, 37 wk gestation or more), a target rate much higher than optimal, and
- 68% had episiotomy rates greater than 5%.
Furthermore, cesarean rates varied widely among hospitals. In one East Coast city, they ranged from 10% to 54%; in a Midwest city, the range was 12% to 40%; and a West Coast city reported rates ranging from 19% to 40%–and that was after excluding hospitals reporting rates greater than 55%.
In addition, 78% of hospitals failed to meet standards for handling high-risk deliveries, which were that 80% of mothers delivering babies weighing less than 1500 g (3 lb 5 oz) received steroids prior to delivery (to mature fetal lungs), and either the hospital delivered at least 50 such babies per year or the hospital maintained a lower-than-average morbidity/mortality rate among these babies. All in all, only 1% of responding hospitals met all four targets.
The Take-Away: Hospitals and care providers are far from alike. Ask questions. Choose carefully.