Women who deliver at Martin County’s only birthing hospital experience potentially life-threatening complications at a rate more than double the norm, according to hospital data analyzed by USA TODAY.

USA TODAY calculated the rates of severe complications at each birthing hospital in 13 states, including the five birthing hospitals on the Treasure Coast, using a methodology developed by the Centers for Disease Control and Prevention.

Some of the life-threatening complications include injuries such as stroke, dangerously high blood pressure and severe bleeding requiring blood transfusions.

More:The entire Deadly Deliveries project by USA TODAY

Many of these complications might have been prevented by following the practices set forth by the American College of Obstetricians and Gynecologists.

TCPalm does not know to what extent local hospitals follow these practices because spokespersons would not answer many of our questions.

What we found

The median severe maternal complication rate is 1.5 percent in Florida and 1.4 percent across more than 1,000 hospitals in 13 states USA TODAY was able to study.

More: Hospitals blame moms when childbirth goes wrong.

Four Treasure Coast birthing hospitals have higher rates and one has a lower rate:

Martin Medical Center (Stuart): 2.9 percent, about twice the state and national medians

Tradition Medical Center (Port St. Lucie): 2.4 percent, nearly twice the state and national medians

Indian River Medical Center (Vero Beach): 2 percent, higher than state and national medians

Lawnwood Regional Medical Center (Fort Pierce): 1.5 percent, nearly the same as state and national medians

St. Lucie Medical Center (Port St. Lucie): 1.1 percent, slightly below the state and national medians

Martin Medical Center is now called Cleveland Clinic Martin North Hospital since the Ohio-based health system acquired Martin Health System in January. Tradition Medical Center is now called Cleveland Clinic Tradition Hospital. Indian River Medical Center is now called Cleveland Clinic Indian River Hospital.

USA TODAY's investigation found hospitals sometimes blame their complication rates on poverty and economic demographics, saying mothers come to them in poor health.

Treasure Coast hospitals did not blame poverty, and the USA TODAY data analysis shows high complication rates can’t be explained by demographics alone. That’s even more evident in this area.

​​​​​​​More: The secret number hospitals don't want you to know.

For example, Lawnwood and St. Lucie Medical Center have lower rates of severe complications despite having the Treasure Coast's highest rates of poor mothers who deliver. More than three-quarters of mothers who deliver at those two hospitals are on Medicaid.

Fewer than half of mothers who deliver at Martin and Tradition are on Medicaid. At Indian River, it's just over half, in line with the state average.

In Florida, mothers on Medicaid account for half of hospital deliveries in more than 60 percent of birthing hospitals across the state.

Martin Health System

Martin Health System, the parent health system for both Martin and Tradition hospitals, would not directly answer several questions out of more than a dozen TCPalm sent by email about specific hospital safety practices in place at the hospitals.

Martin and Tradition hospitals have carts stocked with supplies to treat hemorrhages in delivery wards in accordance with guidelines from the American College of Obstetrics and Gynecology for the past five years, said Martin Health System spokesman Scott Samples. He would not answer follow-up questions seeking to clarify what specific supplies were stocked.

​​​​​​​More:How to report childbirth harms

Maternal-child staff at both hospitals conduct annual drills to respond to hypertensive and other obstetrical emergencies, Samples said. He would not answer questions seeking to clarify if those drills include OB/GYNs with admitting privileges who are not directly employed by Martin Health System.

Martin Health System does not employ OB/GYNs directly; rather, the organization provides admitting privileges to obstetricians who work in their own independent practices and perform deliveries at Martin and Tradition Medical Center.

Martin Health “saw opportunities for improvement, particularly in the number of blood transfusions we perform on post-delivery mothers,” Samples said, and is focused on reducing those transfusions.

As part of that process, Martin Health would review options for adopting a quantitative measure of blood loss during childbirth, such as weighing blood-soaked pads or using calibrated bed drapes to collect fluid, so doctors can more accurately identify when a mother is bleeding too much.

More:How to choose a doctor, midwife or hospital

Because Samples would not answer follow-up questions, TCPalm does not know:

Whether Martin Health uses a quantitative measure of blood loss during childbirth

The degree to which the number of blood transfusions performed on post-delivery mothers contributes to Martin's overall rate of severe maternal complications

What procedures Martin Health has in place to respond to bleeding emergencies during childbirth

What procedures Martin Health has in place to respond to blood pressure emergencies during childbirth

Indian River Medical Center

In 2015, the Indian River Medical Center participated in an initiative aimed at reducing obstetric hemorrhage emergencies in collaboration with the Florida Perinatal Quality Collaborative, a statewide organization that seeks to improve maternal and infant health outcomes throughout Florida, said spokeswoman Angela Dickens.

Obstetric emergency drills are performed quarterly with all maternal-child staff to respond to hypertension and other obstetrical emergencies, Dickens said.

​​​​​​​More:Hospitals know how to protect mothers. They just aren’t doing it.

Labor and postpartum units have hemorrhage carts stocked per guidance from the American College of Obstetrics and Gynecology, and hemorrhage response protocols include quantifiably measuring blood loss as opposed to using a visual estimation, Dickens said.

These protocols also include risk assessments performed before labor, upon admission to the hospital for delivery, immediately prior to birth and after delivery, Dickens said. Dickens did not provide specifics on what details are sought in this risk assessment.

As in Martin, Indian River “saw opportunities for improvement” in the number of blood transfusions performed on post-delivery mothers, Dickens said, but did not explain to what degree reducing the number of transfusions would affect complication rates.

Dickens also did not provide details about Indian River’s specific protocols and procedures for responding to obstetrical emergencies.

What we asked

TCPalm requested interviews with physician and/or nurse leaders at each of the five birthing hospitals on the Treasure Coast, and made multiple inquiries over two months.

None of the hospitals allowed TCPalm to speak with a practitioner or expert, and an HCA spokesperson would not answer any questions about Lawnwood and St. Lucie Medical Center.

More: How hospitals are failing new moms, in graphics

TCPalm sent more than a dozen questions to each hospital seeking an explanation for their rate of maternal complications — regardless of whether that rate was higher or lower than state and national medians — as well as clarification on the hospital’s use of specific safety practices recommended by experts.

We asked each hospital:

How it equips labor and delivery units to respond to bleeding emergencies, including its use of hemorrhage carts with medical supplies and its supply of blood for emergency transfusions

What emergency protocols and safety plans it has in place to respond to bleeding and blood pressure emergencies

How it trains and prepares its staff for obstetric emergencies

How its monitors outcomes and measures data on maternal complications to find opportunities to improve care.

Looking forward

Officials at Martin Health System and Indian River Medical Center said they would review the Alliance for Innovation on Maternal Health's recommendations for specific practices they can incorporate into their care for mothers during and after delivery.

Cleveland Clinic Florida CEO Dr. Wael Barsoum will convene a group of experts and practitioners to validate and confirm USA TODAY's data for the three Treasure Coast birthing hospitals the company acquired in January, spokeswoman Eileen Sheil said.

More: How to choose a doula and other patient advocates

Cleveland Clinic will address any issues found by the group, led by the executive director for quality and risk management in Florida, Sheil said.

The three hospitals are the only ones in Cleveland Clinic’s Florida network which provide obstetric care.

If you or someone you know suffered severe complications while giving birth at a Treasure Coast hospital, TCPalm wants to hear your story. Please contact investigative reporter Miranda Moore at (772)223-4747 or Miranda.Moore@tcpalm.com.