Early elective delivery the United States is at an all-time low of 1.9%, down from 17% in 2010, according to a report by a nonprofit group that monitors safety and care quality in hospitals.
Early elective delivery comprises Cesarean deliveries or inductions performed before 39 weeks without medical necessity, and higher rates are considered a barometer of poor labor management in hospitals. For its annual report on maternity practices, published Feb. 28, the Leapfrog Group, a Washington, D.C.–based nonprofit, collected voluntarily reported data from 1,859 hospitals, or about half of the nation’s hospitals, in 2016.
Episiotomies also fell last year, to 9.6%, from 13% of deliveries in 2012. However, the organization said that while the decline is heartening, it is still far from its target rate of less than 5%. “Hospitals should continue striving for the reduction of these often unnecessary interventions,” Leapfrog officials wrote in the report.
The rate of Cesarean deliveries among first-time mothers at 37 or more weeks of gestation with babies in the head-down position (NTSV C-section) was 25.8% of deliveries in 2016, with little change from the previous year. Leapfrog’s target rate for NTSV C-section is 23.9% or lower. The group reported considerable geographic variation in C-section rates, with 32.1% for Louisiana, the highest seen in the survey, and 17.1% for New Mexico, the lowest.
The group did not note significant differences across hospital type, finding that urban, rural, teaching and nonteaching hospitals saw similar likelihoods of meeting the organization’s target standards for early elective delivery, episiotomy, and NTSV C-section.
“This year’s Leapfrog data underscores that many of the conventional assumptions for how to pick a ‘good hospital’ do not bear out – rates among teaching hospitals that may care for ‘sicker’ patients are similar to those at nonteaching hospitals. Rates at urban hospitals are similar to those at rural hospitals,” Neel Shah, MD, of Harvard Medical School, Boston, wrote in the report.