More than 50,000 babies are born each year in military hospitals, and while most are delivered without major complications, the recent Pentagon military health system review found that for half the measures used by the National Perinatal Information Center to compare quality of care, the military is failing infants and mothers.
In good news for children born in the military's 56 major medical centers, the facilities have statistically lower rates of infant mortality and maternal trauma than the NPIC averages.
But for other measures — postpartum hemorrhage, neonatal trauma and readmission to the hospital after birth for both moms and babies — military hospitals are performing "statistically worse" than national averages.
For instance, for hemorrhage in childbirth, the national annual rate in 2013 according to NPIC was 3 percent, but the the overall rate for all military facilities was 5 percent.
Also in 2013, the rate of neonatal trauma at military treatment facilities was nearly twice the national average.
Military medical centers also performed statistically worse than average for deliveries involving shoulder dystocia — an emergency that occurs when a baby's shoulder gets stuck during vaginal delivery, requiring manual manipulation or intervention to save the child.
Pentagon officials undertaking the review noted that military physicians have access to simulators that teach ways to prevent or handle these conditions in childbirth but they concluded that the Defense Department's existing training capabilities "have not yielded the desired level of improvement."
According to the report, U.S. military hospitals perform fewer cesarean sections, percentage-wise, than NPIC national averages: 26 percent to 35 percent.
The reviewers noted that the system's higher-than-average rates of deliveries using forceps likely are attributable to military obstetricians following American Congress of Obstetricians and Gynecologists guidance that supports forceps and vacuum use when safe to reduce C-section deliveries.
Nationwide, labor and delivery departments in military hospitals still perform better in composite measures used by the Joint Commission to review DoD facilities, according to the report.
But there's vast room for improvement, the reviewers added. They recommend that military hospitals be required to adhere to proper documentation procedures, that the Defense Health Agency investigate the issue of hospital readmissions for mothers and infants and that the assistant secretary of defense for health affairs standardize annual and interval training to ensure quality of care.