Global measures of quality- and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates?

OBJECTIVE

The objective of the study was to propose a new measure of ideal childbirth outcome, based on the proportion of women delivering without maternal or newborn childbirth morbidity.

STUDY DESIGN

Using the 2002 California discharge dataset, we calculated rates of childbirth complications among women with singleton, term deliveries, stratified by pregnancy risk status, method of delivery, and parity. An ideal delivery (ID) was defined as a delivery without any complications. The distribution of hospital-level ID rates was calculated for laboring women stratified by parity.

RESULTS

Among 382,276 women, the ID rate was 78.5%. Rates, type, and severity of complications varied by risk group (high vs low risk), parity, delivery method, and across hospitals. Complications in childbirth were not rare; approximately 22% of deliveries had at least 1 complication. Women who delivered vaginally and multiparous women were more likely to have an ideal delivery.

CONCLUSION

The ID rate is a simple hospital-level measure of childbirth outcome that is easy to calculate and interpret.