AHRQ Releases Report on Potentially Avoidable Birth Injuries

The Agency for Healthcare Research and Quality (AHRQ) released the Potentially Avoidable Injuries to Mothers and Newborns During Childbirth, 2006, which uses statistics from the 2006 Nationwide Inpatient Sample. Here are the highlights from the report:

  • Between 2000 and 2006, rates of potentially avoidable injuries to mothers during childbirth declined by more than 20 percent.
  • Nearly 157,700 potentially avoidable injuries to mothers and newborns occurred during childbirth in 2006, and obstetrical traumas occurring during vaginal births with instruments accounted for the highest injury rates.
  • Newborns covered by Medicaid had worse (i.e., higher) newborn injury rates than newborns covered by private insurance, though there appeared to be no differences in the rates of newborn injury between the wealthiest and poorest communities.
  • For all delivery types, rates of obstetrical trauma for mothers were highest among women living in the wealthiest communities, and women with private insurance had higher obstetrical trauma rates than those with Medicaid.
  • In general, both blacks and Hispanics had lower childbirth-related injury rates when compared to whites, while Asian-Pacific Islanders had worse outcomes for most injuries.
  • Injury to the newborn occurred most often in those living in non-urban areas, while rates of obstetrical trauma for mothers were highest among women in large metropolitan areas. Although, the Northeast had one of the highest rates of obstetrical trauma with instrument assistance, it also had significantly worse rates of injury to the newborn.

 

The report includes provider-level measures for hospital admission rates for the following four potentially preventable hospital complications and iatrogenic events.

PSI 17:

Birth trauma-injury to newborn—How often a newborn infant experiences a problem during the birth process (labor or delivery) such as a broken collarbone, an infection, or a head injury. The reported rate is the number of births with injury to neonate per 1,000 live births (excluding preterm and osteogenesis imperfecta births). A definitional coding change for this indicator between 2003 and 2004 prevents the presentation of reliable trend information for this measure.

 

PSI 18:

Obstetric trauma for mothers-vaginal delivery with instrument—How often a woman experiences a tear (trauma) to her perineum—the area between her vagina and rectum—while giving birth, when a health care provider is helping to deliver her baby using a forceps or other medical instrument. The reported rate is the number of instrument-assisted vaginal deliveries noting obstetric trauma with 3rd or 4th degree lacerations per 1,000 instrument-assisted vaginal deliveries.

 

PSI 19:

Obstetric trauma for mothers-vaginal delivery without instrument—How often a woman experiences a tear (trauma) to her perineum—the area between her vagina and rectum—while giving birth. The reported rate is the number of vaginal deliveries without instrument assistance noting obstetric trauma with 3rd or 4th degree lacerations per 1,000 vaginal deliveries without instrument assistance.

 

PSI 20:

Obstetric trauma for mothers-cesarean delivery—How often a woman experiences a tear (trauma) in her perineum—the area between her vagina and rectum—or to any of the birth-related organs inside her body, during a cesarean (surgical) delivery of a baby. The reported rate is the number of cesarean deliveries noting obstetric trauma with 3rd or 4th degree lacerations per 1,000 cesarean deliveries.

 

Cesarean is traumatic by default to the “birth-related organs,” yet this report uses frequency of perineal lacerations as its measure of trauma to cesarean patients. Unless there is a separate report forthcoming that covers the specifics of increased morbidity and mortality in cesarean patients, this report offers a narrow view of birth trauma in an era in which many hospitals have 50 percent cesarean rates.

 

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