RESEARCH
An Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals

https://doi.org/10.1111/j.1552-6909.2011.01262.xGet rights and content

ABSTRACT

Objective

To evaluate the distribution of births among United States (U.S.) hospitals in 2008 as part of the background for the Association of Women's Health, Obstetric and Neonatal Nurses' Guidelines for Professional Registered Nurse Staffing for Perinatal Units.

Design

Descriptive analysis of birth volumes in U.S. hospitals using American Hospital Association Annual Survey: 2008.

Methods

U.S. hospitals providing obstetric (OB) services were identified based on information in any of three fields: OB services, OB beds, or number of births. Data were verified via telephone and/or website for the top 100 hospitals based on volume, hospitals with “Healthcare System” as part of their names, hospitals reporting births but no OB service, and hospitals reporting <100 births. Hospitals with <100 births were queried regarding nurse staffing. Descriptive statistics were used to analyze data.

Results

Approximately 3,265 U.S. hospitals offered OB services in 2008. The top 500 hospitals based on volume (15.3%) accounted for almost one half (47.4%) of births, the top 1,000 for 69.2%, and the remaining 2,265 for 30.8%. Fourteen percent of hospitals with <100 births in 2008 reported discontinuing OB services in 2010, in part due to lack of physician coverage and costs. Most hospitals (n=159, 72.3%) with <100 births routinely maintained two OB‐skilled nurses in‐house in 2010.

Conclusions

U.S. births are unevenly distributed among hospitals; 15% have a disproportionate share of nearly one half of all births. Most hospitals (69.4%) are operating medium‐ to small‐volume OB units. Most hospitals (72.3%) with <100 births annually reported currently meeting minimum staffing guidelines.

Section snippets

Impact of Childbirth on U.S. Hospital Services

Childbirth is the most common reason for all hospital admissions in the United States (Wier et al., 2010), even though only approximately one half of U.S. hospitals offer obstetric (OB) services (American Hospital Association [AHA], 2009). Nearly all (99.1%) U.S. births occur in hospitals (Martin et al., 2010). When births occur out of the hospital, two thirds (66.3%) are at home and 26.9% in a freestanding birthing center (Martin et al.). Approximately one in four hospital discharges in the

Methods

The American Hospital Association Annual Survey: 2008 database was used to locate U.S. hospitals providing OB services. The AHA has been conducting a survey of U.S. hospitals since 1946. This comprehensive hospital survey database includes more than 800 data fields with information on more than 6,400 participating hospitals such as demographics, organizational structure, facilities, and services. Telephone numbers and contact information for each hospital are also provided. The survey database

Results

Based on the AHA Hospital Annual Survey, approximately 3,265 (51.5%) U.S. hospitals offered OB services in 2008. Birth volume ranged from 17,203 to none in one hospital reporting having an OB service but no births in 2008. Figure 2 displays the number of U.S. hospitals based on birth volume in 1,000 birth increments. The top 500 (15.3%) hospitals based on birth volume accounted for 2,013,302 or almost one half (47.4%) of the U.S. births in 2008. These 500 hospitals each have at least 2,475

Discussion

Births in the United States are unevenly distributed among hospitals, with 15% of hospitals having a disproportionate share of nearly one half of all births. All of those hospitals were located in urban areas. A large number of U.S. hospitals (69.4%) are operating medium‐ to small‐volume OB units with fewer than 1,000 births per year. Some of these hospitals were in urban areas and some in rural areas.

Despite reports in the literature of challenges with recruitment and retention of nurses in

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