Women delivering babies in U.S. hospitals are far more likely to experience problems than previously known. Thirteen percent of them, or some 550,000 women a year, suffer serious bleeding, blood clots, infections, or other complications, according to a study out this week in the journal Health Affairs. That’s a complication rate comparable to heart surgery. And the risk varies widely from hospital to hospital: in the lowest performing hospitals in the study, 23 percent of women who delivered vaginally suffered complications, compared with just 10.4 percent of women in the highest-performing ones. Rates for C-sections varied from 21 percent to 4 percent.
“Obstetrical care is like every other area of health care in this country,” says study co-author Laurent G. Glance, M.D., vice-chair for research in the department of anesthesiology at the University of Rochester School of Medicine, in New York. “There are substantial variations in quality between hospitals and providers.”
Read our special investigation "What Hospitals Don't Want You To Know About C-sections." And use our hospital Ratings to compare hospitals in your area on C-section rates and other safety and performance measures.
Unfortunately, knowing exactly how a specific hospital fares in obstetrical care is tough, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. The current study does not list the hospitals analyzed, for one. And while a handful of states report infection rates for C-sections by hospitals, most do not, McGiffert says. Similarly, Consumer Reports now includes C-section rates for specific hospitals in our hospital Ratings. But that data is now available for only 22 states.
“What we want is a transparent, uniform system to evaluate quality and safety for mother and baby in all hospitals,” says John Santa, M.D., medical director of the Consumer Reports Health Ratings Center.
The American Congress of Obstetricians and Gynecologists and the American Society of Anesthesiologists are in the early stages of creating a national registry to establish performance benchmarks for obstetrics and obstetrical anesthesiology. And the Joint Commission, which accredits and certifies U.S. hospitals, has mandated that hospitals with 1,100 or more births per year report data on several core measures of perinatal care, including rates of elective delivery, C-sections, and hospital-acquired bloodstream infections in newborns. Some of that information should be available starting this fall.
In the mean time, read our article “What To Reject When You're Expecting” And here is what our experts say pregnant women should do to reduce their risk of experiencing a complication when delivering a baby:
Check hospital ratings. Our hospital Ratings include C-section rates for some 1,500 hospitals in 22 states, plus other information on more than 20 additional measures of hospital safety and performance for more than 4,500 hospitals in all 50 states plus Puerto Rico and the District of Columbia. “Our Ratings reflect how important safety is to a hospital and that may translate across the whole hospital,” Santa says.
Choose your provider carefully. Ask your primary care physician for a referral to one or get the names of trusted doctors or midwives from friends or relatives. Then interview the provider: Ask about her rates of C-section, early delivery and episiotomy, for instance, and when she typically induces labor, advises Maureen P. Corry, senior adviser for the childbirth connection program at the National Partnership for Women and Families. If she isn’t forthcoming, “perhaps she is not the right provider,” Corry says. (For more on choosing a caregiver and birth setting, visit childbirthconnection.org.)
Request complication rates. “Ask the provider and hospital for the rates of C-section hemorrhaging, laceration, surgical complications and blood clots—measures considered in the current study—and request the data to back up what I was told,” McGiffert says. If the provider or hospital can’t or won’t comply, she adds, “Don’t be afraid to go somewhere else.”
—Catherine Winters
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