Maternal and Neonatal Outcomes of Vaginal Deliveries Are Comparable Across Hospital Levels in Latvia

Vaginal deliveries account for approximately 70% of all births in Latvia and represent a clinically homogeneous population suitable for assessing the quality and safety of inpatient obstetric care. This population-based cross-sectional observational study evaluated quality indicators of vaginal delivery care across different hospital levels in Latvia using retrospectively collected data from seven hospitals’ performance in 2022. Medical records of 296 women with term singleton pregnancies ending in spontaneous vaginal delivery were involved. Coverage of key antenatal care indicators, including ultrasound screening, essential laboratory testing and newborn screenings, was high and largely comparable across hospital levels. Intrapartum and neonatal outcomes were generally comparable, with low complication rates and high coverage of Apgar scoring, newborn screening, and vaccination. Early breastfeeding within the first hour occurred in 94.9% of cases, and exclusive breastfeeding at discharge in 81.7%; however, breastfeeding practices differed significantly between hospital levels (p = 0.01). Anticoagulant use was uncommon overall (5.8%) but varied significantly across hospital levels (p = 0.01), reflecting the possibility of differences in clinical management and documentation practices. Overall, the results demonstrate that when vaginal delivery proceeds physiologically, hospitals of all levels in Latvia are able to provide safe and high-quality maternal and neonatal care, with largely comparable clinical outcomes. At the same time, observed variation in selected process indicators — particularly breastfeeding practices and anticoagulant use — suggests a need for improved harmonisation of clinical protocols and documentation standards. These findings support further refinement of quality criteria and justify extending similar quality assessments to more complex obstetric populations, including Caesarean deliveries.