Hospitals See 45% Increase in Serious Birth Complications
The rate of severe complications encountered during hospitals births has risen sharply over the last 10 years, according to a recent study released by the Agency for Healthcare Research and Quality (AHRQ). According to the report, the percentage of women who experienced serious complications – or “maternal morbidity” – while giving birth in U.S. hospitals rose 45 percent between 2006 and 2015. Rates of acute renal failure, shock, mechanical ventilation use and sepsis at delivery all more than doubled during the 10-year period.
The report additionally highlights a discrepancy related to ethnicity and other demographics for the mothers giving birth. For example, while the in-hospital death rate for all races declined, the rates of serious and often life-threatening complications were highest for minority ethnicities, women living in urban areas, and those uninsured or on Medicaid. Age also seemed to be a factor, with women over the age of 40 or under the age of 20 also exhibiting higher risk.
AHRQ’s statistical brief defined “severe maternal morbidity” as unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health. Often called “near-misses,” deliveries involving severe maternal morbidity include life-threatening conditions, such as acute myocardial infarction, pulmonary embolism, or sepsis. The study used 21 conditions when reviewing data from across the U.S., and among the key findings of the study were the following observations:
- The most common indicators of severe maternal morbidity were blood transfusion, disseminated intravascular coagulation (DIC), and hysterectomy.
- Some conditions often involved procedural intervention. For example, in 2015, over half of deliveries with shock, amniotic fluid embolism, sickle cell disease with crisis, and DIC involved a blood transfusion; one-third of deliveries with shock had a hysterectomy.
- Severe maternal morbidity was highest among women aged 40+ years and lowest for those aged 20-29 years. Women under 20 also had an increased risk.
- On average Black mothers were younger than White mothers. Yet the rate of severe maternal morbidity was 112-115 percent higher for Blacks than for Whites in 2006. Hispanics and Asian/Pacific Islanders also had higher rates of severe maternal morbidity than Whites in both years, but disparities decreased over time.
- Although deaths decreased for all races and ethnicities, the in-hospital mortality was three times higher for Blacks than for Whites in 2015 (11 vs. 4 per 100,000 deliveries). Compared with white women, severe maternal morbidity was 110 percent more likely among black women, 40 percent more likely among Hispanic women and 20 percent more likely among Asian/Pacific Islander women in 2015.
In response to these concerning statistics relating to severe maternal morbidity, AHRQ developed the Safety Program for Perinatal Care toolkit to help improve communication and the quality of care of labor and delivery (L&D) units, and to help reduce maternal morbidity and neonatal adverse events. The free online resource – built around the three pillars of Teamwork and Communication for Perinatal Safety, Perinatal Safety Strategies, and In-Situ Simulation Scenarios – includes an extensive database of presentations, videos, guides and checklists that can be shared with teams as training exercises. The toolkit also includes an interactive PDF outlining the implementation experiences of five L&D units that successfully implemented the program.
With these available tools and training, combined with the increased awareness of these concerning statistics, hospitals and their L&D units can drive down the rate of serious complications and help mothers and babies experience safer and smoother deliveries and recoveries.
AHRQ is the lead Federal agency charged with improving the safety and quality of America’s health care system. Learn more about the Agency at http://www.ahrq.gov.