Obstetric care for Philadelphia and non-Philadelphia residents: A Comparative Analysis of Risk Factors, Birth Outcomes, and Impact on Obstetric Capacity, 2003-2007

In less than ten years, nine delivery hospitals closed in Philadelphia. Prior research on Philadelphia resident births found the obstetrical system is at or near capacity. This study examines the differences between Philadelphia residents and non-residents delivering in city hospitals, including factors affecting obstetrical system capacity. Data from 100,000 birth records for resident and non-resident births from 2003 through 2007 were analyzed for location of delivery (city or suburban). Chi-Square analysis was completed to study differences in both risk factors and poor birth outcomes. The analysis yielded significant differences between the populations. Non-residents were more likely than residents to have vaginal bleeding, infertility treatment, premature rupture of the membranes, multiple births, advanced maternal age, and previous poor birth outcomes. The prevalence of low birthweight and premature births was greater in the non-resident population. Non-residents were also more likely to have NICU admissions, C-Sections, and private insurance. Philadelphia residents delivering in suburban hospitals were less likely than residents delivering in city hospitals to have a low birthweight or premature births, NICU admissions, vaginal bleeding, premature rupture, or previous preterm births. However, they had more multiple births, C-section births, and were more likely to be older and privately insured. Non-resident women giving birth in Philadelphia city hospitals tend to have a greater prevalence of risk factors and poor birth outcomes which can lead to longer and more complicated hospital stays in a system already at/near capacity.