BUYER'S GUIDE DISCUSSES COSTS OF HOSPITAL OBSTETRICAL SERVICES

Women preparing to have a baby may want to check a new buyer's guide to obstetrical services in Southeast Missouri.

The Missouri Department of Health released the guide, aimed at helping women make decisions about where to receive obstetrical services based on the costs of care and the services available. It also discusses quality and outcomes at different hospitals. The report includes satisfaction ratings provided by women who were patients at the hospitals.

Buyer's guides were prepared for each region of the state. The Southeast region includes 12 hospitals from Ste. Genevieve to the Bootheel.

Overall, the health department found that hospitals in Southeast Missouri have some of the lowest charges in the state for delivering babies.

It also found that vaginal delivery charges vary by nearly $3,000 and caesarean section charges differ by nearly $4,000 among hospitals. Most hospitals in Southeast Missouri have a high percentage of ultrasound imaging, which may indicate over-utilization. And women report being least satisfied with billing practices and most satisfied with nursing care following the birth of a baby.

Southeast Missouri Hospital in Cape Girardeau is one of three hospitals in the region with high patient satisfaction. Patients said they would return or recommend Southeast to friends.

That's good news to Karen Hendrickson, assistant administrator, and Joie Henley, nurse manager for obstetrics, at Southeast.

Southeast tops hospitals in the region for the number of babies delivered. In 1992, Southeast had 1,646 live births. The number for 1993 also topped 1,600.

The second busiest obstetrics department was at Lucy Lee Hospital in Poplar Bluff with 922 births in 1992.

The charge at Southeast Missouri Hospital for a vaginal delivery and two-day stay for mothers is $2,516. For a caesarean section and four-day stay for mothers, the charge is $4,381. The charge for a normal newborn who stays in the hospital two days after birth is $701.

The average length of stay for a vaginal delivery at Southeast is two days. For a caesarean, the average length of stay is 3.4 days. Normal newborns stay an average of 2.2 days.

The guide also lists six services women might want to consider when choosing a hospital -- labor-delivery-recovery rooms, a car-seat program, follow-up services, a formal transfer agreement to another hospital for high-risk pregnancies, a nurse educator to assist with breast feeding, and availability of tubal ligation.

The report shows Southeast offers three of the six, but Hendrickson said Southeast actually offers all six. Hendrickson said the survey questions were very specific, but results were reported in very general terms.

For example, the survey asked if they have a nurse educator dedicated to assist women with breast-feeding. The hospital answered no because all the nurses working in the obstetrics units are trained to assist mothers with breast-feeding. "And our nurse educators are available 24-hours a day even after discharge," she said.

The hospital doesn't sponsor its own car-seat program because it works with the local Easter Seals car-seat program.

The report shows Southeast has an "excessively high 1992 ultrasound rate."

Hendrickson said that may not really reflect over-utilization. "It may also indicate sophisticated practice and accessibility," she said.

Southeast shows a caesarean section rate between 16 and 29 percent. A national public health goal is to reduce the rate to no more than 15 per 100 births by the year 2000. However, vaginal births after caesarean sections occur at Southeast at a "significantly lower rate than the state average."

Regionally, the study also found:

-- Hospitals with higher percentages of caesarean sections and ultrasound imaging do not have fewer than expected newborn deaths.

-- Hospitals that treat high-risk women have low to moderate percentages of caesarean sections.

-- Hospitals with high percentages of caesarean sections tend to treat more highly educated women.

-- Hospitals with more newborn deaths than expected do not transfer high-risk infants to tertiary-care hospitals as frequently as other hospitals.

-- At every hospital, women reported dissatisfaction with billing practices.

The publication is the second in a series of consumer reports the department will release on various aspects of the health care system.

A copy of the guide can be ordered from the Department of Health, Division of Health Resources, P.O. Box 570, Jefferson City, Mo. 65102 for $3 per copy or by calling 314-751-6279.