September 9, 2019 / 8:12 PM / 11 days ago

U.S. women with high-risk pregnancies often deliver at ill-equipped hospitals

Many American women with high-risk pregnancies are delivering their babies at hospitals without specialized maternity and neonatal care, a U.S. study suggests.

Researchers examined data on 845,545 deliveries at 556 hospitals and found most mothers - 85% - had uncomplicated pregnancies and could safely give birth at community hospitals with a physician or midwife. Another 13% ideally would have given birth at hospitals with obstetricians available around the clock because they were at moderate to high risk of developing conditions during or after delivery.

A small fraction of women - 2.4% - had high-risk pregnancies and needed to deliver at hospitals with specialized maternity and neonatal care.

While the vast majority of mothers gave birth at hospitals equipped to meet their medical needs, 43% of women with high-risk pregnancies gave birth at hospitals without specialty services in place, researchers report in Obstetrics and Gynecology.

“It matters to patients because there is a concern that some would be delivered and cared for at a hospital without adequate resources to be able to optimize outcomes,” said Dr. Aaron Caughey, chair of obstetrics and gynecology at Oregon Health & Science University in Portland.

“To be fair, sometimes that happens because patients present emergently and there is not time to transport them,” Caughey, who wasn’t involved in the study, said by email.

Overall, the results do suggest that regionalized maternity care, which is the norm across the country, works well for the vast majority of patients, said Dr. Sarah Rae Easter of Brigham and Women’s Hospital in Boston, lead author of the study.

“Our findings suggest that attempts to refer high-risk women to hospitals equipped with the resources to manage their unique needs will impact a very small number of women and delivery centers, which underscores the feasibility of this approach,” Easter said by email.

The goal of regionalized maternity care is to maintain and increase access by letting women with low-risk pregnancies deliver close to home and setting up clear protocols for sending women with high-risk situations to hospitals that can meet their needs.

Most women can deliver at a “level 1” birth center, which may have midwives or family physicians available and surgeons on call for cesarean sections, according to the American College of Obstetricians and Gynecologists.

Many other women need a “level 2” birth center with more advanced imaging services and an obstetrician available at all times.

Women with high-risk pregnancies, however, may need the more specialized services provided only at “level 3” or “level 4” birth centers that have an obstetrician and many other specialists on site at all times to help manage complications that can arise for mothers and babies.

In the study, nearly all women who needed level 1 or level 2 care got it, but many women who needed level 3 or level 4 care did not.

“The concern is that hospitals haven’t sorted out what types of patients they should be caring for and what resources they need,” Caughey said.

Women should plan ahead and discuss what level of services they might need as they plan where to give birth, he advised.

“In an emergency, generally that smartest move is to go to the nearest hospital, though a conversation before that happens to think about whether it would be smarter to go a bit further in an emergency to the hospital better suited to care for an emergency would be a great thing to discuss with your primary obstetric provider,” Caughey said.

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