Delivery Complications and Postpartum Hospital Use in California

Published:September 24, 2021DOI:



      Research on maternal birth outcomes rarely includes postpartum complications with longitudinally linked patient data. We analyze characteristics associated with delivery complications and postpartum hospital use.


      This population-based cohort study is based on administrative data from California. International Classification of Diseases, 10th Revision, codes were used to categorize the incidence of severe maternal morbidity and other route-specific delivery complications as well as preexisting and pregnancy-related conditions and principal diagnoses for postpartum hospital visits. Postpartum hospital use is a composite outcome defined as emergency department visit or hospital readmission within 90 days of birth admission discharge. Multivariable modified Poisson regression analyses were used to estimate the association of patient-level and hospital-level characteristics with the likelihood of postpartum hospital use.


      In 2017, 457,498 birth admissions occurred in California-licensed hospitals, of which 348,828 index births with linked data were analyzed. Among linked births, 34,825 (10.0%) had an inpatient admission (4,206 [1.2%]) or an emergency department visit (30,371 [9.2%]) within 90 days of birth admission discharge. Birth complications included a 1.7% severe maternal morbidity rate, 7.9% rate of vaginal birth complications, 10.0% rate of cesarean birth complications, and 2.9% frequency of long lengths of stay, all of which were significantly associated with postpartum hospital use. Other significant risk factors for postpartum hospital use were preexisting and pregnancy-related conditions, undergoing cesarean birth, being younger than 18 years old, being non-Hispanic Black, living in a high poverty ZIP code, and having Medicaid.


      One in 10 birthing persons had a hospital visit within 90 days postpartum. Improving postpartum care is an urgent public health priority.
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      Chen Y. Wang, MD, MPH, is a Public Health and General Preventive Medicine Resident at Cook County Health and received a Master of Public Health at Northwestern University Feinberg School of Medicine. She is board-certified in Family Medicine.


      Lynn M. Yee, MD, MPH, is an Assistant Professor in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. Her work addresses obstetrics-focused patient-centered outcomes research and implementation science.


      Joseph M. Feinglass, PhD, is a Research Professor of Medicine in the Division of General Internal Medicine and Geriatrics with experience in health policy, quality improvement, health disparities, medical informatics, patient safety, women's health, and social epidemiology research.