Written by Mary Marschner
Spoon Feed
Hospitals with low volumes of operative vaginal deliveries (vaginal delivery with forceps or vacuum devices) were associated with more adverse perinatal outcomes compared to hospitals with medium to high volumes of operative vaginal deliveries.
When it comes to skills and procedures, less isn’t more
Pregnancy and delivery are a high-risk time for female patients, with rates of operative vaginal deliveries estimated to be around 3% of deliveries. We need to consider that where and how we refer these patients for their pregnancy care can make a difference in outcomes and complications. For instance, hospitals that have high rates of operative vaginal deliveries often have lower rates of c-sections and vice versa.
This retrospective cohort study examined the association between hospital operative vaginal delivery (OVD) volume and obstetric outcomes. High-OVD-volume hospitals had lower rates of severe perineal lacerations (8.2% vs. 12.5%; adjusted odds ratio, aOR 0.72, 95%CI 0.65–0.79) and neonatal trauma (3.1% vs. 4.6%; aOR 0.78, 95%CI 0.69–0.87) compared to low-volume hospitals. Findings suggest that delivery at high-OVD-volume hospitals may improve maternal and neonatal outcomes, emphasizing the importance of procedural experience. One limitation of this study is that it was conducted in a single state that showed statistically significant differences between OVD tertiles in patient characteristics including birthing parent’s age, insurance status, ethnicity, rural location, hospitalization at a teaching hospital, birthweight, and gestational age.
How does this change my practice?
This article reinforces the limits of interpreting retrospective analysis. While it caused me to reevaluate my referral network to guide patients to hospitals and practices that have higher volumes for their medical needs, it does make me pause as well and ask, are the outcomes because of the hospitals or because of birth parent care prior to delivery?
Source
Obstetric Outcomes by Hospital Volume of Operative Vaginal Delivery. JAMA Netw Open. 2025 Jan 2;8(1):e2453292. doi: 10.1001/jamanetworkopen.2024.53292. PMID: 39761043
