Methodology: Best Hospitals for Maternity Care

The Leapfrog Group is a nonprofit organization that aims to help consumers make informed decisions about their health and access safe, high-value care. For over two decades, it has collected and published data on patient safety and quality of care from voluntary surveys and other sources. More than 2,200 hospitals completed its flagship Leapfrog Hospital Survey in 2022.

To compile its new list of the best hospitals in the country for maternity care in partnership with Money, the Leapfrog Group used maternity care data submitted via the 2022 Leapfrog Hospital Survey, which participants were required to submit by August 31, 2022.

To qualify for the list, eligible hospitals were required to carry an A or B letter grade on the Leapfrog Hospital Safety Grade assessment for spring 2022. Hospitals were also required to meet criteria specific to providing maternity care, which is outlined below.

The 259 hospitals that made the cut are a combination of hospitals that provide care for uncomplicated pregnancies, as well as hospitals that provide care for high-risk deliveries, such as offering neonatal intensive care units, etc.

For more information on Leapfrog’s standards, visit Leapfrog’s hospital survey measure page.

For the Best Hospitals for Maternity Care list, the following criteria were applied :

I. Early Elective Deliveries: A hospital must achieve Leapfrog’s standard for Early Elective Deliveries.

Early elective deliveries are scheduled cesarean sections or medical inductions performed prior to 39 completed weeks of gestation without a medical reason. This is full-term as defined by the American College of Obstetrics and Gynecology (ACOG) and the Society for Maternal-Fetal Medicine, and deliveries before this period carry risks to both babies and mothers, like admissions to neonatal ICUs (NICUs), longer hospital stays, and higher costs to both patients and payers. Studies also suggest an early delivery can have long-term developmental risks for infants. Hospitals report on their rate of scheduled cesarean sections or medical inductions prior to 39 weeks gestation without a medical reason. The measure used by Leapfrog is endorsed by the National Quality Forum (NQF #0469) and also used by The Joint Commission (TJC). For more information, see: https://ratings.leapfroggroup.org/measure/hospital/2022/early-elective-deliveries.

Leapfrog’s standard for Early Elective Deliveries requires a rate of 5% or less.

In addition to improved health outcomes for both mother and baby, nearly $1 billion dollars could be saved annually in the U.S. if the rate of early term delivery was reduced to 1.7% due to a reduction in the number of NICU days.

II. Cesarean Birth: A hospital must achieve Leapfrog’s standard for Cesarean Birth.

Babies born by scheduled cesarean delivery have significantly higher rates of respiratory complications, infections, and prolonged length of stay in NICUs compared to babies delivered vaginally. There are also health risks to women undergoing a cesarean delivery including increased rates of infection, hemorrhage, and hospital readmission. The Leapfrog Hospital Survey uses a nationally endorsed measure (NQF#XXX) known as the Nulliparous, Term, Singleton, Vertex (NTSV) Cesarean Birth rate, which includes cesarean sections for mothers with first-time pregnancies (nulliparous) that have reached at least 37 weeks of gestation (term) and have a single baby (singleton) in the head-down position (vertex). This measure exclusively examines the population of women least likely to need a cesarean section, offering a standardized way to compare hospital performance. For more information, click here.

To meet Leapfrog’s standard, hospitals must achieve the Healthy People 2030 NTSV cesarean birth rate target of 23.6% or less.

A reduction in the NTSV C-section rate is associated with concrete quality improvement activities that can be performed to address the differences in cesarean delivery rates among hospitals, including reducing admissions in early labor and eliminating elective labor induction before 41 weeks in first births.

III. Episiotomy: A hospital must achieve Leapfrog’s standard for Episiotomy.

An episiotomy is an incision made in the perineum to make the vaginal opening larger during childbirth. Once a routine practice in childbirth, medical guidelines today urge against the routine use of episiotomy, due to the risk for perineal tears, loss of bladder or bowel control, and pelvic floor defects. Other significant issues include infections and other complications, slow recovery, and the potential for lifelong discomfort. Due to these concerns, ACOG recommends the use of episiotomy only in highly restricted circumstances. Hospitals report on their episiotomy rate among vaginal deliveries. For more information, click here.

Hospitals that achieve Leapfrog’s standard have an episiotomy rate of 5% or less.

Leapfrog is the only organization to track and publicly report rates of episiotomy by hospital.

IV. DVT Prophylaxis: A hospital must achieve Leapfrog’s standard for DVT Prophylaxis.

Women who have a cesarean section should be given medication or have compression devices placed on their legs prior to the surgery to prevent deep vein thrombosis (DVT), a serious condition that occurs when a blood clot forms in a vein located deep inside the body. This condition is a leading cause of death in women undergoing cesarean delivery. Hospitals report on their rate of implementing DVT prevention protocols. For more information, click here.

Hospitals that achieve Leapfrog’s standard are 90% or more compliant with providing DVT prophylaxis among women undergoing cesarean delivery.

Appropriate prevention protocols has been shown to reduce the incidence of post-cesarean deaths from thromboembolism by approximately two-thirds.⁴

V. Bilirubin Screening: A hospital must achieve Leapfrog’s standard for Bilirubin Screening.

If not detected and treated, hyperbilirubinemia (high bilirubin levels) in a newborn can cause irreversible brain damage resulting in permanent visual, muscular, or other disabilities and even death. Unfortunately, visual inspection of the baby for jaundice frequently fails to identify the presence of the condition, particularly if the infant is discharged after a short inpatient stay. Simple serum or transcutaneous screenings conducted before discharge significantly improve the detection and treatment of hyperbilirubinemia. Hospitals report on their rate of serum or transcutaneous bilirubin screening prior to discharge among all infants delivered. For more information, click here.

Hospitals that achieve Leapfrog’s standard are 90% or more compliant with screening for bilirubin among all infants.

VI. High-Risk Deliveries: A hospital must achieve or make considerable progress towards achieving Leapfrog’s standard for High Risk Deliveries.

Note: This criterion only applies to hospitals electively admitting high-risk deliveries.

Babies with low birth weight (<1500 grams) are more likely to survive if they are delivered and treated at a hospital with an experienced neonatal intensive care unit (NICU), defined by caring for 50 or more very-low birth weight babies a year, or at a hospital that has demonstrated “better than expected” performance on the Vermont Oxford Network’s (VON) measure of death or morbidity. Hospitals report on their annual volume of very low birth weight babies or their performance on the VON measure. For more information, click here.

To achieve Leapfrog’s standard, hospitals electively admitting high-risk deliveries need to care for at least 50 or more very-low birth weight babies per year (defined as less than 1500 grams) or have “better than expected” performance on VON’s measure of death or morbidity.

VII. Hospitals eligible for a Leapfrog Hospital Safety Grade must receive an A or B on the letter grades publicly reported at the time of the Best Hospitals for Maternity Care public announcement.

Note: This criterion does not apply to hospitals that are not eligible for a Safety Grade, such as military treatment facilities, specialty facilities, critical access hospitals, etc.

The Leapfrog Hospital Safety Grade assesses how safe hospitals are for patients. Each A, B, C, D or F score comes from expert analysis of publicly available data consumers can use to protect their families from harm or death during a hospital stay. Some hospitals are exempted from receiving a Safety Grade, including specialty hospitals like children’s or surgical, and Critical Access Hospitals. Hospitals that are eligible for a grade, which includes general acute-care hospitals, must receive an A or B on the current Leapfrog Hospital Safety Grade (spring 2022) in order to qualify for the list of Best Hospitals for Maternity Care.