How obstetric hospitalists impact maternal disparities

How obstetric hospitalists impact maternal disparities | Image Credit: © spotmatikphoto - © spotmatikphoto - stock.adobe.com.

Maternal outcomes differ significantly based on patient race but can be improved by obstetric (OB) hospitalist-based care, according to recent data by OB Hospitalist Group (OBHG).

The United States has the highest maternal death rate of any developed country, with 1205 deaths from pregnancy and delivery complications reported in 2021, according to the CDC. About 60% of pregnancy-related deaths have been estimated as preventable.

According to the CDC, maternal death rates were 2.6 times greater in Black women than White women in 2021, at 69.9 deaths per 100,000 live births in Black women compared to 26.6 deaths per 100,000 live births in White women. Research has indicated worse health care quality in Black women than White women, increasing maternal mortality risk.

A lower standard of care may be seen in pregnant women when they are sent to a labor and delivery unit without a physician. This issue is avoided in programs with an Obstetrics Emergency Department, which ensure an expert provides care to every woman in labor or with antepartum or postpartum concerns.

OB hospitalists are OB/GYN clinicians specializing in acute and emergency care. A recent study found decreased levels of severe maternal morbidity in hospitals with constant OB hospitalist coverage, making OB hospitalists a potential method of reducing racial disparities during childbirth.

From August 2022 to February 2023, OBHG analyzed racial disparities by collecting patient reported racial identification. Data was gathered from over 31,000 deliveries with an OBHG clinician, along with additional data from over 319,413 patient encounters.

Cesarean sections, which have been reported in 36% of US Black women and 31% of US White women, were examined by OBHG. Outcomes of cesarean sections were significantly below the national goal of 23.6% for all races in OBHG data. On average, OBHG had a cesarean section rate of 19.5% compared to the CDC’s reported average of 26.3%.

White OBHG patients had a cesarean section rate of 15% compared to a rate of 18.2% in Black OBHG patients. In CDC reports, these rates were 25.2% and 31.2%, respectively, showing reductions in cesarean section rates from OBHG implementations.

Lacerations and episiotomies, which can cause long-term complications in patients, were also evaluated. The national goals are 5% for episiotomy, 11.7% for third- and fourth-degree lacerations with instrumentations, and 1.7% for third- and fourth-degree laceration without instrumentations.

OBHG results were all below these goals for all races, except for Pacific Islander which was slightly higher in episiotomies and third- and fourth-degree lacerations with instrumentations, and Asian which was slightly higher in third- and fourth-degree laceration without instrumentations.

There are multiple factors which might explain improved maternal health disparities from OBHG which could be adapted by OB hospitalists. The first of these is workplace diversity, as maintaining a diverse clinical workforce benefits both patients and hospitals.

Training to address bias may also improve maternal health disparities. This can reduce cultural bias and encourage an inclusive culture. A 24/7 program also ensures readiness for emergency care at any time.

Evidence-based practices should also be implemented to ensure equal care. Standardized protocols encourage physicians to be agnostic to patient race, reducing maternal disparities. A data-driven approach can also lead to new opportunities to address inequality and improve maternal outcomes.

Disparities in maternal outcomes remain an issue among OB hospitalists, but methods implemented by OBHG show steps which can be taken to improve these disparities. Further research may lead to new approaches which can reduce maternal mortality.

Reference

Racial disparities in maternal outcomes: An analysis of the impact of OB hospitalist involved care on implicit bias. OB Hospitalist Group. Accessed May 8, 2023.