How Safe is U.S. Maternity Care? New Report Shows Considerable Variation in Quality, Outcomes

February 23, 2015

Nonprofit watchdog The Leapfrog Group today released its Maternity Care Report, an in-depth examination of hospital quality and safety for early elective deliveries, episiotomies and high-risk deliveries, with data analysis by Castlight Health. Though the analysis of hospitals nationwide demonstrates substantial progress in recent years, it also reveals significant room for improvement on maternity care standards. In fact, less than a third of hospitals meet Leapfrog’s 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.


Key findings from the Maternity Care Report include:

  • Many hospitals fail to meet standard for high-risk deliveries: The national rate of hospitals meeting the standard for high-risk deliveries 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 unprepared to care for their special needs.
  • Early elective deliveries continue to decline across the U.S.:  The national average for early elective deliveries—inductions or cesarean (C-section) procedures performed before 39 weeks gestation without medical necessity—hit its lowest rate since Leapfrog began public reporting on the measure: 3.4 percent. 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.
  • 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: As with early elective deliveries, there’s an unhealthy amount of variation in the episiotomy data, with 35 percent of birthing hospitals still permitting too many episiotomies. At the advice of its Maternity Care Expert Panel, Leapfrog’s 2015 target rate will change to five percent to encourage further improvement. Only 27 percent of hospitals would meet this new target rate today.

“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. “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.”

“Castlight is pleased to partner with The Leapfrog Group on this important series of hospital quality and safety reports, applying our advanced analytics capabilities to Leapfrog’s rich data set,” said Jennifer Schneider, M.D., M.S., Chief Medical Officer for Castlight Health. “Maternity care is top of mind for both employees and employers. It is one of the most common employee searches in Castlight’s Enterprise Healthcare Cloud platform, and maternity and newborn care can be costly for employers. The data comparisons outlined among hospitals in the Maternity Care Report can inform quality improvement programs in hospitals across the country, driving the movement toward more value-based care.”

The complete Maternity Care Report is available here

Today’s report is the first in a series of  six reports examining key quality and safety measures at hospitals nationwide based on data from the 2014 Leapfrog Hospital Survey of 1,501 U.S. hospitals and analysis provided by Castlight Health. Future publications in the report series will also be available.


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