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Where you have your baby matters

Where you have your baby matters

Picture of Danielle Venton

If you are a Californian having a baby for the first time, choose your hospital wisely. You might even wish to move. A recent report from the California Hospital Assessment and Reporting Taskforce revealed alarming discrepancies in outcomes for low-risk pregnancies at high-performing and low-performing hospitals. For example, a healthy woman with a low risk pregnancy has just a 19 percent risk of undergoing a cesarean section at a high-performing hospital. A similar woman has a 56 percent chance of having a c-section at a low-performing hospital.

The split in performance and the strong regional correlation is fascinating to me. What accounts for a good track record of some hospitals and not others? What policies are they using? Which hospitals have improved their care for mothers and infants and which have slipped?

A woman at a low-performing hospital is likely to experience worse care in several other ways too. She has a 46 percent chance of getting an episiotomy, a surgical incision meant to create more room for delivery that can lead to complications later. At a high-performing hospital there is just a 2 percent chance that she'll have this procedure. She's much more likely to breastfeed exclusively before discharge at a high-performing hospital (88 percent, compared to 19). If she had a c-section for her first child, she doesn't necessarily need to have c-sections with subsequent children. Yet at a low-performing hospital she has just a 1 percent chance of giving birth vaginally with subsequent children, compared with 27 percent at a high-performing hospital.

An interesting twist in these, frankly, alarming discrepancies: of the ranked hospitals, almost all of the high-performers were in Northern California (33 in total, accounting for 88 percent). However, all of the low-performing hospitals (12 in total) were in Southern California.

My project will ask how hospital policies lead to high-performance or low-performance, if it is more profitable to be a low-performing hospital and how the ACA is affecting hospitals' treatment of pregnant mothers and newborns.


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The rate of procedures doesn't mean much without corresponding mortality rates. There's nothing commendable if a hospital has a low C-section rate, but a high neonatal death rate as a result.

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I live in Canada where all the hospitals, medical clinics, birthing centres, physicians and midwives provide the best possible care regardless of a patient's income or other circumstances -- and the patient is never charged for anything. Unnecessary interventions are not the norm, as they seem to be in the U.S., thus "complications" are rare and everyone goes home happy. The situation in the U.S. is just so shocking -- and there seems to be little chance that it will ever get better.


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