Ascension’s Unwavering Commitment to Maternal and Infant Care

Providing quality care to moms and babies is central to Ascension's identity and Mission. The report issued by National Nurses United, an activist labor group, is an inaccurate and misleading representation of the clinical decisions Ascension has made over the last several years, the critical work Ascension care teams provide to our communities, and our longstanding commitment to serve all people with compassionate care.

One out of every 50 babies born in the United States over the past five years have taken their first breath in an Ascension hospital.

We are committed to ensuring our patients have access to top quality care. Ascension birthing centers across the country deliver a combined total of 72,000 - 78,000 babies each year.

Several of Ascension's comprehensive birthing centers deliver several thousand babies yearly. This high volume of deliveries provides meaningful data that we continually analyze to help us appropriately tailor our care delivery for the varying needs of the diverse patient populations we serve. For our lower-volume birthing centers, we continually work to ensure we have appropriate volume to maintain the capabilities and skill sets needed to deliver high quality care, especially for mothers with high-risk pregnancies.

Ultimately, our obligation is to provide the best care for every patient who entrusts us with their care.

It is a general truth in medicine that the more patient cases you care for as a provider or facility, the more skilled you are at providing that care. This is especially true when it comes to complex cases. Obstetric doctors and nurses want to practice medicine where they have sufficient labor and delivery volume to keep their skills sharp.

Generally, if a facility treats a high volume of complex cases, that facility is most likely going to offer a higher quality of care that should be reflected in better outcomes for its patients. As such, we continually adjust to the shift in obstetrics (OB) where more women are qualifying as patients with complex, high risk pregnancies.

Our approach is a matter of making sure we provide patients with the right care, at the right place, at the right time. If we shift services from one facility to another, or if we help identify a nearby alternative, our goal is to make sure that every woman has access to a place where she can receive the high quality care she needs.

Every decision we make is centered around delivering quality care to our patients.

We assess several factors and considerations when considering the best place to provide labor and delivery services. These considerations include:

• Complexity of deliveries, including the levels of neonatal intensive care units (NICUs)
• Volume trends
• Distance to alternative Ascension (or in some cases, non-Ascension) facilities with higher capabilities of care along with transportation options to the nearest facility
• Availability of advanced services (such as high risk OB, NICU) and advanced providers (maternal-fetal medicine specialists/MFMs) at a nearby facility

Before any decision is made to potentially close or transition a labor and delivery unit, an extensive discernment process takes place involving our Mission Integration, Clinical, Human Resources, and Operations departments. The key determining factor is how best we can ensure pregnant women who entrust their care to us become healthy mothers with healthy babies with the best outcomes.

We also make every effort to provide employment opportunities for our labor and delivery clinicians and support associates at our alternate sites of care.

We maintain that, in instances where we've shifted services or closed units, these transitions did not lead to lower access to care. They actually led to access to better care.

Data shows birth rates at Ascension hospitals have remained steady over the last 5 years despite declining births across the U.S., with a focus on vulnerable populations.

Across the country, births have been steadily declining for many years. Data suggests the U.S. saw 600,000 fewer births between the years 2007 and 2019, indicating a 13% reduction.

For the past five years, Ascension's birthing centers delivered between 72,000 and 78,000 babies annually, representing approximately 2 percent (1 in 50) of the 3.6 million babies born in the U.S. each of those years, according to the CDC.

In 2023, there were 3,745,361 births in the U.S. Of that number, 75,753 babies (2.02%) were delivered at Ascension hospitals.

• Of the babies born at Ascension hospitals in 2023, approximately 41.53% of the patients (nearly 2 of every 5) had Medicaid coverage and 1.65% of patients were self-pay.
• So far, in 2024, of the babies delivered at Ascension hospitals, approximately 43.30% of the patients had Medicaid coverage (a 4.26% increase from the previous year) and 1.51% of patients were self-pay.

Ascension is fully dedicated to supporting moms and babies in our communities, a commitment that is backed up by empirical data.

While we all still have work to do to address long standing health disparities impacting patients and communities across the country, we are proud of our clinical outcomes and programs which, according to outcomes data, are some of the nation's best.

Ascension strongly outperforms national averages for all maternal and infant clinical measures, including neonatal mortality. Our outcomes for Black and African American patients are better than the national average. In fact, we are up to 50 percent below the national average for maternal mortality between 2019 and 2021, and we continue to improve these outcomes year over year.

Through Ascension Medical Group, more than 90% of our patients across all demographics receive a minimum of eight prenatal care visits, a nationally recognized benchmark of performance and a key driver to help support improved outcomes for patients.

Our high risk cases, both medical and socioeconomic, are among the highest of any large health system in America, with NICUs resuscitating as low as 22 weeks gestation. Despite this, we have maternal and infant outcomes that strongly outpace national averages for all measures.

Based on an independent study of PC-07^*, a nationally reported measure of Severe Obstetric Complications, our outcomes are as follows:

• PC-07 Maternal morbidity and mortality, all patient (independently validated by Yale/CMS/The Joint Commission)
  • 198/10,000 vs national average 249/10,000, p<0.00001
• PC-07 Maternal morbidity and mortality, Black/African American (independently validated by Yale/CMS/The Joint Commission)
  • 244/10,000 vs national average 362/10,000, p<0.00001
• Maternal mortality, all women and non-Hispanic Black women
  • 33%-50% below national average for 2019-2021 (more current national benchmarks are not available, but Ascension's 2022 rate was half of our 2021 rate)

Further, we are expanding our programs beyond birth to address the contribution of post-birth health concerns to maternal mortality (which is measured for one year post birth), including behavioral health, cardio-OB, pelvic floor rehabilitation and bariatric care.

Caring for our communities and ensuring we have healthy moms and babies is imperative to who we are.

Over the past several years, we have listened to communities and engaged in developing resources that aligned with the voiced needs of our community members by creating innovative models of care for our moms and babies.

To be successful in advancing maternal health equity, we must go above and beyond usual care, especially for those individuals who are experiencing care disparities. We must also activate and engage the persons we serve, designing care around each person's needs and circumstances and working together to create a seamless, holistic care experience across the continuum.

To this end, we have deployed resources and support within our communities from our Maternal Health Social System Initiative (MHSSI). This expansive initiative works to provide support for patients and communities within our catchment areas and beyond through our Ascension Foundation for Health Equity-ensuring equitable and high quality care reaches beyond our walls. We launched the Ascension Foundation for Health Equity to help address the maternal mortality crisis in the U.S. by providing support to postpartum mothers so both they and their babies can thrive. Our foundation also actively partners with community-based organizations that provide for both generations at once, while providing catalyst grants nationally.

We also embarked upon a framework to promote better maternal health outcomes across the continuum of maternal healthcare. Our MHSSI provides dedicated resources and a dynamic response. Within this framework, our maternal health navigators build relationships with patients and communities to help identify and mitigate social barriers to promote healthier birth outcomes. This approach helps to ensure we have a personalized and individualized response that is patient informed, community informed and data informed.

This process and approach yields improved quality of care for mother and baby, reduced avoidable maternal and infant morbidity/mortality, improved provider relationships and patient/provider satisfaction, all while contributing to the overall quality of life and health improvement for the community at-large.

Following in the footsteps of our Sponsor, Ascension remains committed to serving vulnerable populations, now and for generations to come.

Beyond direct care, Ascension goes well beyond Community Health Needs Assessment (CHNA) requirements to understand and respond to patient and community needs, even when they are not directly related to healthcare services. Many of the programs supported by Ascension's community benefit funding are purposely aimed at promoting health equity and addressing social determinants of health (SDOH).

Ascension's charity care deductions, as a percentage of total gross patient revenue, has traditionally averaged roughly 3.6%, which well exceeds the median across hospitals which were recently reported as 1.5% to 1.6% amongst other non profit systems.

Ascension's Medical Group (AMG) focused efforts on implementing our SDOH Survey, to provide robust system data to support the identification of group disparities. Since 2020, our providers have collected over 2 million SDOH surveys. This information helps us to better shape care that uniquely addresses the needs of the vulnerable population we serve.

Rooted in the loving ministry of Jesus as healer, our Mission guides us to provide holistic care that not only benefits individuals but uplifts entire communities. Ascension has a long legacy of being present in communities that others have turned their back on and responding to the needs of moms and infants has been part of our history for centuries. From home care in the mid-1800s through the expansion of hospital-based services during the Baby Boom era, and now in a blended format of hospital, clinic, and community-based care, we are called to respond to the changing needs of the communities we are privileged to serve.

^{* Severe Obstetrical Complications Electronic Quality Measure Report (PC-07): See Table 9 (page 54): Any severe obstetric complications - Observed outcome rate per 10,000 deliveries non-Hispanic Black/African American 362. See Table 10 (page 56): Any severe obstetric complications - Observed outcome rate per 10,000 deliveries Across All encounters - 249}

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