“Attends births at a hospital I like.”
But what do mothers-to-be really know about the hospitals where that provider delivers?
Probably less than they think, especially if they get their information from the obvious places: general reputation, word of mouth, advertising and published and online resources, such as Consumer Reports, US News and World Reports and Medicare Hospital Compare.
It’s not the fault of the information gatherers. There’s an ever-growing deluge of data about many areas of hospital care such as cancer treatment, orthopedic surgery, cardiac procedures. And from that data flow 'report cards' and other scoring systems that are a good place to start, even if they have their limitations.
When it comes to childbirth, though — the largest single reason for inpatient hospital admission — the numbers are all over the map. Some states have a lot of information. Others have almost none. And there's no central, federal resource, either.
But you can find out quite a bit to meaningfully inform your choices if you look in the right places and ask the right questions.
In New York, the state Health Department provides a plethora of childbirth statistics. Finding them is tricky, but with a little work, you can get your hands on some very illuminating numbers.
Go to the Hospital Profiles website, choose and bookmark at least two hospitals, click on “Compare,” and then look for the teeny-tiny woman-in-a-dress icon, under “Compare a Different Measure.” Click that, and you get 32 different measures to choose from.
That’s more than you need, but don’t be overwhelmed. The California Maternal Quality Care Collaborative suggests looking at four things: Low-risk C-sections, Episiotomy, Exclusive breastfeeding before discharge and vaginal birth after prior C-section, also known as VBAC. (New York only provides data on primary C-section which is less meaningful than the standard California uses, but it’s still helpful.)
Taken together, this quartet of procedures and protocols are a pretty good proxy for patient safety. C-section and episiotomy are widely considered overused procedures that increase short- and long-term complications and healthcare costs; with them, you want to see rates as low as possible. VBAC and exclusive breastfeeding are considered beneficial, so the higher the rates, the better.
So look at how your neighborhood hospitals or prospective delivery sites elsewhere stack up against the rest of the state. SUNY Downstate has the highest primary C-section rate in the state, and White Plains Hospital’s off-the-charts episiotomy rate should give you pause, if you’re considering those places. NYU’s 94 percent exclusive breastfeeding rate is praiseworthy, though by itself it shouldn't be decisive. On the other hand, the single-digit scores of Bronx-Lebanon, Elmhurst and Kings County raises a red flag that you should ask prospective providers about.
If this all sounds a little convoluted, it is. Health officials in Albany for years have been pledging to make their maternity care information more user-friendly. Recently, the New York State Health Foundation has awarded a grant to two local non-profits, the Northeast Business Group for Health and Choices in Chilbirth, to create a more helpful tool in the next year or so.
Unfortunately, getting information on childbirth complications (as opposed to procedures) is close to impossible. Obstetricians generally agree on what the most serious complications are: hemorrhaging, clotting and untreated hypertension. But unlike their counterparts in cardiology, orthopedics and cancer care, they can’t agree on how best to measure adverse events and share the information with the public. New York uses a software program by 3M — the Post-It and Scotch Tape people — to generate “Potentially Preventable Complications.” There are up to 66 PPCs per hospital, including eight related to childbirth. But the state's web-based dataset is hard to navigate, the information is difficult to interpret, and as of early 2017, 3M was reconsidering some of its data criteria for obstetrics.
In New Jersey, good information is easier to access and interpret. Unlike in New York, where many hospitals refuse to participate, most in the Garden State respond to a voluntary survey by a hospital safety watchdog called the Leapfrog Group. Go here and click the tab for “Maternity Care.” Each hospital gets scored on five measures, including episiotomies, early elective delivery and the more rigorous C-section sub-category that California uses. There’s an “i” icon in each box that elaborates on what each scores means and why it’s important.
But what about getting information on individual doctors or midwives? You can get some of the basic profile information about their education and malpractice record online at Health Grades, as well as some patient ratings. But when it comes to hard numbers about C-section rates and the other measures above, you have to ask for them in person, and you may or may not get a meaningful answer.
There is a website called Amino that offers helpful information about individual physicians, but it doesn’t allow you to search for doctors by name. Instead, you put in your age, gender, location and insurance, and it generates a list for you, possibly a list with hundreds of names, depending on how densely populated your area is. Still, you can try to search around a doctor’s street address, and you might get lucky.
Numbers aside, you should be prepared to ask your prospective physician or midwife some incisive questions about their practice priorities, logistics and philosophy. Prepare by giving this extensive list of interviewing questions posed by Childbirth Connection a good once-over. It provides a useful framework for thinking about prenatal care and delivery, and you can circle the questions that sound the most relevant to your situation.
Over the phone or online, you can get the basics on the practice: how many providers they have, what their credentials are (including board certifications), where they deliver babies. When it’s time to sit down with the person who might help you bring children into the world, let them know you’ve done your homework. Be friendly but firm until you get answers that satisfy you!
“What Hospitals Deliver” was produced with support from the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.