Most mothers deliver their babies at just one hospital, so it’s easy to forget that practice patterns actually vary quite a bit, depending on your hospital. A group of Cedars Sinai affiliates and employees of AMF Consulting published an interesting review of trends in childbirth at hospitals in California. They conducted a survey of the nurse managers of all nonmilitary hospitals in California that offer childbirth services. They had a tremendous response rate of 96% including 187 community hospitals, 27 teaching hospitals, and 25 “integrated delivery systems,” by which I assume they mean Kaiser Permanente.
The authors looked at a number of metrics, such as staff availability and level of care capabilities. If you are in labor and want an epidural, 50% of community hospitals and 100% of teaching hospitals and integrated delivery systems have 24 hour anesthesia availability. If you need a doctor, 24 hour in-house Labor & Delivery physicians are available at 100% of integrated delivery systems hospitals, 48% of teaching hospitals, and 5% of community hospitals. If you need an emergency c-section in 30 minutes any time day or night, 56% of community hospital can do that for you, 100% of integrated health systems, and 85% of teaching hospitals. Finally if you need a NICU, they have one at the ready at 56% of community hospitals, 88% of integrated health systems, and 96% of teaching hospitals. This chart shows a summary of all the study’s findings, comparing the services available 24 hours a day at the three types of hospitals.
The authors of this study published a second article analyzing their results and the implications for classifying Labor and Delivery units. In 2007, two regional summits funded by the March of Dimes published a set of professional standards for categorizing Labor and Delivery units. The authors of this study tried to apply the responses to their survey with these standards. The authors found that they could not categorize two-thirds of the hospitals because their capabilities didn’t fit into the basic categories, mostly because many could not provide an emergency c-section within 30 minutes all the time (36%) or have a pediatrician available any time (44%). It seems we need some other way to categorize hospitals’ ability to provide maternal and neonatal services given such wide variation. This revealing research certainly gives us evidence of the need for better configuration of existing services so patients end up in the best hospital for their needs.