(348) Hospital intrapartum practices and disparities in severe maternal and neonatal morbidity

To assess whether patients differ by race/ethnicity or insurance status in giving birth at hospitals that tend to use high-interventional intrapartum practices, and whether this may contribute to severe maternal and neonatal morbidity disparities.

Study Design:

The study included nulliparous patients with term, singleton, vertex live births at 185 hospitals in California during 2015-2018. Hospitals responded to survey questions on the use of a spectrum of interventional practices during labor and delivery (Lundsberg et al. 2018 Obstet Gynecol). Latent class analysis was used previously to classify hospitals as tending to use high- or low-interventional practices based on survey responses. In this study, patient demographics were collected on the birth certificate. Outcomes included severe maternal morbidity and severe unexpected newborn complication, defined using established measures, and were identified in patient discharge data. Causal mediation analysis was conducted to assess the role of hospital intervention status on disparities in the outcomes.

Results: Among 307,336 patients, 79% gave birth at a hospital that tended to use high-interventional practices, 1.6% had severe maternal morbidity, and 2.9% had a severe unexpected newborn complication (Table 1). A higher proportion of Black and Latinx/Hispanic patients and patients with public insurance gave birth at high-interventional hospitals (P < 0.001). Disparities by race/ethnicity and insurance type existed in severe maternal morbidity and severe unexpected newborn complication, independent of patient- and hospital-level confounders (Table 2). Further accounting for hospital variation in high-/low-interventional practices did not affect these disparities.

Conclusion: Delivery at hospitals that tended to use high-interventional intrapartum practices was most common among Black and Latinx/Hispanic patients and patients with public insurance in this nulliparous, term, singleton, vertex birth cohort. However, use of high- versus low-interventional intrapartum practices did not appreciably affect disparities in severe maternal and neonatal morbidity.