Journal of Obstetric, Gynecologic & Neonatal Nursing
RESEARCHAn Overview of Distribution of Births in United States Hospitals in 2008 with Implications for Small Volume Perinatal Units in Rural Hospitals
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
REFERENCES (28)
Health disparities for rural women
(2009)Optimal goals for anesthesia care in obstetrics
(2009)American Hospital Association annual survey: 2008
(2009)Guidelines for professional registered nurse staffing for perinatal units
(2010)H.R. 2015
(1997)- et al.
Fertility, family planning and reproductive health of U.S. women
Vital and Health Statistics
(2005) - et al.
Declining trends in the provision of prenatal care visits by family physicians
Annals of Family Medicine
(2009) - et al.
Income, poverty, and health insurance coverage in the United States: 2009
(2010) Complete list of critical access hospitals as of September 2010
(2010)- et al.
Factors influencing rural residents' utilization of urban hospitals
National Health Statistics Reports
(2010)