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Avoidable Childbirth Injuries Remain an Issue at Hospitals

Cheryl Clark, for HealthLeaders Media, June 18, 2009

Medical teams in hospitals caused nearly 158,000 avoidable injuries to new moms and their babies during childbirth in 2006, according to a new federal report that should be an eye opener for any health provider.

Not only do these tragic mishaps cause disability and anguish for patients, they add costly legal bills and extra days of expensive care that will never be fully reimbursed.

"Delivery of newborns (is) the most common reason for hospitalization," noted the Agency for Healthcare Research and Quality's report, which encourages providers to scrutinize their practices to better understand the reasons for such complications.

"Identifying which types of patient safety problems exist for different sub-groups of patients is an important first step in developing interventions to reduce disparities and achieve high quality of care for all patients," the report added.

The report was based on data submitted for 15 million discharges by 1,900 hospitals in 25 states, including the largest, California, Texas, New York, and Florida.

Against this backdrop of worrisome statistics, the report actually contained some good news.

Between 2000 and 2006, the rate of potentially avoidable injuries to women while giving birth vaginally without the use of instruments such as forceps declined 30%. For mothers whose babies were delivered vaginally with the use of instruments, injuries declined 21.3%. For mothers having a cesarean delivery, injuries declined 16.7%.

The report, however, doesn't explain what factors might have dropped the rates of injuries and study author Roxanne Andrews of AHRQ says it's an area for future study.

"It is possible that medical knowledge and practice has improved," she speculates. However, she quickly cautions a new study suggests improvements may not extend to the most serious maternal complications, which may have increased since 1998.

The report detailed the actual rates of injury, which were higher when instruments were used. For example, trauma to the mother during vaginal delivery occurred 160.5 times per 1,000 discharges when instruments were used, but only 36.2 times when instruments were not used. Obstetric trauma to mothers undergoing cesarean delivery occurred 3.9 times per 1,000 discharges. Injuries to the mother were most commonly perineum tears, which are usually preventable, the report said.

For the newborn, traumatic injury during childbirth occurred 1.6 times per 1,000 discharges. Injuries included broken collarbones, infections, and head injuries, many of which are very serious and sometimes debilitating and fatal.

The rest of the report was discouraging for the wide array of care disparities it disclosed for patients in wealthy versus poor communities, source of hospital payment, age, area of residence, race, and sex of the mom and infant. In many cases, the results were a surprise and counterintuitive.

For example, women giving birth who lived in the highest income communities suffered 44% more obstetric injuries during vaginal delivery than those from the poorest communities. And black and Hispanic mothers experienced fewer child-birth related injuries than whites. Asian-American and Pacific Islander mothers had the highest rate of injuries.

Mothers covered by Medicaid were far less likely to be injured while giving birth, 127 injuries per 1,000 deliveries, than women who had private health insurance, who incurred 185 injuries.

But injury rates for babies covered by Medicaid were higher than for those with private insurance, (1.7 compared to 1.5) the report said.

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