Evidence-Based Maternity Care

Earlier this month, The Reforming States Group, Milbank Memorial Fund, and Childbirth Connection released a report on the state of health care in the U.S. for expectant moms and their babies.

From the report summary
Milbank Report: Evidence-Based Maternity Care

Poor quality care and unacceptable health outcomes affect a very large population — there are over 4.3 million births in the United States every year. And they impact babies during their most sensitive and important period of development and younger, primarily healthy women.

Further, private insurers (covering 51% of all births) and Medicaid programs (covering 42%) are getting poor value for their considerable investment in maternity care. This translates to wasted resources for taxpayers, employers and families themselves. Maternity care plays a major role in the health care system. Hospital charges for mothers and babies far exceed charges for any other condition, and cesarean section is the most common operating room procedure in the country.

From Consumer Reports
Back to basics for safer childbirth

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies ... the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday "business hours," rather than at night, on weekends, or on holidays.

From USA Today
Study: High-tech interventions deliver huge childbirth bill

The University of Wisconsin's Douglas Laube, a former president of the American College of Obstetricians and Gynecologists, blames "very significant external forces" for the overuse of expensive technologies in maternity care.

"I don't like to admit it, but there are economic incentives" for doctors and hospitals to use the procedures, says Laube, who reviewed the new report before its release.

For example, some doctors might get bonuses for performing more labor inductions, which adds costs and increases the risk of C-sections, which, in turn, increase hospital profits because they require longer stays.

In addition, some doctors order unnecessary tests and procedures to protect against malpractice suits, Laube says.

Bonnie Jellen, head of the American Hospital Association's maternal and child health section, hadn't seen the report. She says women's preferences and doctor's malpractice concerns have helped raise the C-section rate.

Says Corry [co-author of the report]: "A lot of people think pregnant women are accidents waiting to happen. It's just crazy."

The full text of the report is available online in both HTML and PDF formats.