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Thursday
Jun252009

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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Reader Comments (3)

I whole heartedly agree with you that c-sections are WAY overdone and women need to consider going for a VBAC rather than automatically opt. for a repeat c-section. However, have you found any sites at all that DO share helpful information for moms that have to have a c-section? I ask because I can't seem to find more than one site besides my own that offers information to help women that are faced with a c-section. Everything I've seen has been more about the risks and trying to prevent c-section. I would love to see more information to help women like myself who know we will have to have a c-section.

June 27, 2009 | Unregistered CommenterMorgan

Hi Morgan,

I've wondered about that. I read a bunch of your posts about your c-sections a few months ago and I remember thinking they were really positive. I haven't caught up on your blog since then... I'll go read.

So, obviously the primary focus of this blog is the unnecessary and unwanted c-sections. It's hard to swim against the tide. I've always been under the impression that there was loads of c-section prep and recovery info available in this very pro-repeat cesarean climate. Message boards on SkeKnows, BabyCenter and The Bump always seem full of supportive pre-c/s posts.

What information would be helpful for someone who either needs or wants a c-section? I can see things like waiting until labor begins or scheduling as close to 40 weeks as possible per the March of Dimes being helpful. Maybe tips to help get breastfeeding started post-cesarean?

I'll put together a post with some info and maybe you can let me know what you think. Thanks for the idea.

Jill

June 27, 2009 | Registered CommenterJill

Hi Jill-

I thought I remembered visiting here before : )
There is tons of c-section information out there, BUT, it's all the biased medical mumbo jumbo stuff. Sometimes I wonder if the people that write that stuff have even had a c-section before. I am actually a group owner of a c-section board on one of the message boards you named, and it is a great place to get c-section support.

I guess what I would like to see somewhere is more information about how to make the best of things if you know you're going to have a c-section. Like you mentioned, more info. on waiting until you go into labor to do the c-section (if it's a second delivery), how to recover easier, bonding with baby after a c-section, and how to not let it get you down if your natural birth ended up as a cesarean. Even harder to find is information about moms that have had to have 4 or more c-sections. I've met plenty of moms that have had 4, some of them even have blogs that I follow. Yet, none of them write about their experience.

I would love some links to blogs or websites that can give positive info. to moms like myself without making us feel like we missed out on something. I think your site is a great place to give information out to moms on how and why they should avoid a c-section. If you ever come across interesting blogs about c-sections for moms that have to have one, you should have a link to them. I know that I have searched the web many times (including today) trying to find more sites like mine, yet all that's showing up on the first few pages of the searches is the dangers of c-sections (which I'm well aware of).

Anyway, thanks for writing back! I will be keeping your site in mind for giving out to moms on the fence about going VBAC or repeat c-section.

June 27, 2009 | Unregistered CommenterMorgan
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