Toward more optimal birth outcomes

Women want to have a good birth, in which both they and the baby are healthy and happy at the end. For most women, the optimal birth outcome is a spontaneous vaginal birth (SVB), one without forceps or a vacuum. Some women may be surprised to learn that the hospital where they give birth has a significant effect on the kind of birth they will have. In a new study of nearly 500 hospitals in four states in 2016, Penn Nursing’s Eileen Lake and Rebecca Clark find that SVB rates vary widely, even for women at low risk for cesarean section.

Newborn baby with finger in its mouth swaddled in a blanket.

Using hospital discharge abstracts from California, Pennsylvania, New Jersey, and Florida, the researchers found that overall, the average SVB rate was 61.1%, which varied from 16.8% to 79.9% by hospital; for low-risk women (defined as having a single, at-term, head down fetus), the average SVB rate was 78%, which varied from 34.6% to 93.3% by hospital.

The variation in overall and low-risk SVB rates cut across all hospital characteristics. For example, hospitals where less than 60% of low-risk women had an SVB were found in all four states, in both rural and metropolitan areas, and among all bed size and birth volume categories. At the other end of the spectrum, hospitals where more than 90% of low-risk women had an SVB, were also found across all areas and hospital categories.

These findings suggest that poor maternal outcomes are found where excellence would be expected due to plentiful resources. They also suggest that excellent maternal outcomes are possible in all hospital settings.

The study is the first to assess hospital SVB rates rather that their corollary, cesarean rates. This is important for further work on interventions, because quality improvement initiatives that focus on encouraging SVBs may target different factors from those that focus on decreasing the cesarean birth rate.

Read more at Penn Nursing News.