HAP is committed to supporting Pennsylvania hospitals in their work to provide high-quality maternal and infant care throughout the commonwealth. This includes both identifying and supporting high-quality care within the hospital and positioning hospitals to be leaders in addressing factors that affect maternal and infant health before and after birth.
HAP’s Board of Directors has identified maternal health as a priority area of focus for quality improvement efforts and public policy. HAP has created a member Taskforce on Maternal and Infant Health, to guide initiatives that support hospitals in providing high-quality care and eliminating racial disparities in maternal and infant health outcomes. HAP fielded a member survey in December of 2023 to assess current areas of focus, capacity, and future interests in programming and support.
High-quality Maternal Care
Pennsylvania hospitals are involved in the delivery of approximately 97 percent of the more than 131,000 births occurring annually throughout the commonwealth. In 2021, Pennsylvania hospitals assisted in 127,304 births, of which 40,573 involved a cesarean delivery.1
Patient safety has always been the top priority for clinicians and hospitals. During 2023, The Commonwealth Fund ranked Pennsylvania 16th in its new scorecard composite measure of reproductive care and women’s health2, and America’s Health Rankings places Pennsylvania in the middle of all states (23rd) in its 2023 Health of Women and Childrens Report.
But there is still room for improvement.
The proportion of vaginal births to cesarean deliveries during the past 20 years has remained consistent over time.3
The Pennsylvania General Assembly established the Pennsylvania Maternal Mortality Review Committee during 2018 to review maternal mortality cases. That committee released its 2021 Report, which was the first, statewide, in-depth analysis. The report contains an overview, findings, and recommendations for improving care. The Philadelphia Department of Public Health also performed a review of maternal mortality cases in Philadelphia.
Recently, the Pennsylvania Health Care Cost Containment Council (PHC4) released a Severe Maternal Morbidity in Pennsylvania report highlighting a 40 percent increase in the rate of severe maternal morbidity from 2016 to 2022. And the Centers for Disease Control and Prevention (CDC) have identified a rise in infant mortality rates for the first time in 20 years.
To assist with improving care delivery, Pennsylvania has a Perinatal Quality Collaborative which provides programing and support for a variety of maternal health initiatives. HAP is one of the many multistakeholder groups involved in this collaborative.
Birthing Friendly Hospital Designation
During November 2023, The Centers for Medicare & Medicaid Services (CMS) created a Birthing-Friendly hospital designation. This new designation recognizes hospitals for:
- Participating in a statewide or national perinatal quality collaborative program.
- Implementing evidence-based quality interventions in hospital settings to improve maternal health.
This new designation is available on Hospital Compare. Pennsylvania has 71 hospitals recognized for achieving this designation.4
The birthing-friendly designation is part of the interventions outlined in the White House Blueprint for Addressing the Maternal Health Crisis.
Statewide and national data show concerning racial disparities is maternal and infant health outcomes.
PHC4’s report found that severe maternal morbidity rate per 10,000 deliveries in 2022 was 191.5 for Black mothers and 118.1 for Hispanic mothers, compared to 82.4 for white mothers. Nationally, Black mothers are three times more likely to die from a pregnancy-related cause than white mothers, according to the CDC.
In addition to efforts specific to maternal health, HAP is convening hospitals to collaboratively confront racial inequities in care through its Racial Health Equity Learning Action Network. This initiative brings hospitals together to share ideas and take a data-focused approach to advancing health equity.
In the fall of 2023, March of Dimes5 identified portions of Pennsylvania with low to no obstetrical services. More than 12 percent of women had no birthing hospital within 30 minutes, and more than 47 percent of women in rural counties live more than 30 minutes from a birthing hospital. Those maternity deserts are identified below.
Trained emergency medical services teams have delivered over 180 babies on average during the past four years while enroute to our birthing facilities.6
Reductions in the number of birthing service locations in recent years has been felt across the commonwealth. The most up-to-date map showing birthing locations with licensed beds is available here.
For additional information regarding maternal health care, please contact Robert Shipp, III, PhD, BSN, RN, NEA-BC, vice president, population health and clinical affairs. Media inquiries should be directed to Chris Daley, vice president, strategic communications.
1. Pennsylvania Department of Health (PA DOH) Birth Statistics. Live Births by Hospital and Method of Delivery. https://www.health.pa.gov/topics/HealthStatistics/VitalStatistics/BirthStatistics/Documents/Birth_HospMethod_Cnty_2021.pdf
2. 2023 Scorecard on state health system performance. The Commonwealth Fund. https://www.commonwealthfund.org/publications/scorecard/2023/jun/2023-scorecard-state-health-system-performance
3. PA DOH Birth Statistics. Live Births by Hospital and Method of Delivery 2001–2021
4. CMS Birth-Friendly Hospitals and Health Systems. Data.cms.gov. https://data.cms.gov/provider-data/birthing-friendly-hospitals-and-health-systems
5. Fontenot, J, Lucas, R, Stoneburner, A, Brigance, C, Hubbard, K, Jones, E, Mishkin, K. Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity in Pennsylvania. March of Dimes. 2023
6. PA DOH EMS Data Report(s). https://www.health.pa.gov/topics/EMS/Pages/Resources.aspx