Patient Safety Highlight: Is Maternity Care Unnecessarily Dangerous?

Everybody knows that American healthcare is the most expensive in the world. You’d think that those higher costs pay for safer births, right? Wrong. The US has one of the highest rates of infant and maternal deaths in the industrialized world (though some social factors do contribute to that statistic, like the increasing age of the average American mom).

This is a topic that seems important for Patient Safety Awareness Week, which is taking place this week.

The statistics around unnecessary, and even harmful, medical interventions in hospitals are terrifying. Ask any group of moms, and they know exactly which hospitals - and which doctors, even - to avoid in their local areas. They know who is going to suggest scheduled c-sections that are medically unnecessary, who is going to perform routine episiotomies, and they know who is going to try to convince them that their baby will die without the latest “greatest” technological intervention. As someone who used to dream of becoming a midwife, I was scared to death of delivering in a hospital for exactly these reasons. However, since my (admittedly excellent) insurance wouldn’t cover home births or birthing centers, I had no choice.

What’s a mama to do? In my case, a TON of research helped, and I was able to choose a hospital that gave me I had exactly the birth I’d wanted, with amazing hospital staff, a wonderful midwife, and no medical surprises.

On February 23, national healthcare watchdog The Leapfrog Group released its most recent Maternity Care Report, which dives into hospital statistics to determine how many (and which) hospitals in the U.S. are meeting maternity care safety standards. Factors that weigh in on the report are elective early deliveries, episiotomy rates, and high-risk deliveries. The Maternity Care Report is exactly what I needed, and I wish I’d known about it when I was frantically trying to decide who to trust to safely deliver my daughter (luckily, my research held true, and the hospital I chose has great Leapfrog ratings). This research is an incredible resource to new parents looking for a safe haven for delivery.

A lot of moms aren’t so lucky, though. The Leapfrog report found that although great strides have been made toward improving maternal and infant patient safety, there is still a lot to be improved. Less than a third of the hospitals meet Leapfrog’s standards for high-risk deliveries, and 37% of hospitals have episiotomy rates that are still too high.

This is insanely frustrating to me. It might be more understandable that maternal and infant death rates are high if we didn’t know what the problems are, and we didn’t know how to fix them. What gets me though, is that we DO know what causes a rise in mortality rates. We know what procedures to eliminate, we know what education to provide, we know what standards to enforce… but we don’t do it. Sure, some mothers and babies will die in childbirth. That’s the way it’s been since the beginning of time, and my heart aches for the families of those that have passed. But for Pete’s sake, in this day and age, it doesn’t have to be so many.

What can we do about it?

We need to get hospitals learning, improving, and talking. For every hospital that meets safety standards determined by groups like Leapfrog, there are two that don’t. I’m sure they have their reasons for not meeting standards - no hospital (or doctor, or midwife, or nurse) wants to harm or kill patients. What could their reasons be? Maybe...

1. There are plenty of old habits, and “the way we’ve always done things” is a powerful force

2. Their patient population isn’t educated about what THEY need to do to stay safe, therefore they don’t demand certain standards get followed

3. Physicians, staff, and leaders aren’t educated about new best practices

4. Hospitals lack the tools they need to spread best practice information internally, and with each other

I’m sure the list goes on and on, but these reasons have answers!

Hospitals like the one my daughter was born in have figured out the answers to some of those problems, and their safety scores and results show it. I’d bet that they could give some sage advice to those hospitals that are still struggling to meet minimum standards. Why aren’t the improvements made by safer hospitals spreading like wildfire throughout the medical community?

If one hospital has figured out how to educate patients about the benefits of breastfeeding, saving both the patient and the hospital money, why don’t all hospitals have access to the same education materials and practices? If one hospital knows how to better educate their patient population about ANYTHING, why don’t all of them have that information? If someone implemented an improvement idea that saves the hospital - or patients - money in maternal care, why don’t they all do it? Why aren’t all hospital staff educated about all new best practices?

Why don’t hospitals act like we’re all in this together? Because when it comes down to the safety of our women and infants, the fact is, we are; 80% of American women will have at least one child by the age of 44. It’s time we get hospitals improving and communicating, to start saving lives.