An overview of distribution of births in United States hospitals in 2008 with implications for small volume perinatal units in rural hospitals.

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.