Maternity-care failings can be remedied with cost-saving fixes

by Rita Rubin, USA Today

It’s a problem seen throughout health care, but it might be of particular concern when the patient is a healthy pregnant woman: the overuse of tests and potentially risky procedures that, at best, might benefit only a limited number of patients, and the underuse of proven techniques with few or no known drawbacks.

A new report, “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” lays out the good and the bad. It will be posted at 10 a.m. today at www.childbirthconnection.org/ebmc.

“I don’t believe there’s a lot of consumer awareness about the serious quality problems in maternity care,” says co-author Maureen Corry, executive director of Childbirth Connection, a New York-based research, education and policy organization.

If the quality of maternity care were improved, the U.S. health care system could be saved billions, according to the report.

As family-practice doctor Valerie King of the Oregon Health & Sciences University in Portland puts it: “Fortunately, maternity care is a place where good care and good economics come together.”

King and others in maternity care reviewed the report before its release and discussed some of the interventions, which, when used appropriately, could improve the health of mothers and babies, as well as trim costs:

• C-sections. In 2006, more than 31% of U.S. births were by Cesarean section, an all-time high that’s expected to climb, according to preliminary data from the National Center for Health Statistics. Though the optimal rate is a subject of debate, “Healthy People 2010,” a set of goals set by the U.S. government, aims for a 15% rate among women without a previous pregnancy, nearly 10% below the 2005 rate for those moms.

On the other hand, the United Kingdom, with its National Health Service, is in the midst of a nationwide campaign to lower its C-section rate from about 24% overall, says nurse-midwife Holly Kennedy, an associate nursing professor at the University of California-San Francisco, who recently returned from a year as a Fulbright scholar in England. In the U.K., Kennedy says, two-thirds of births are attended by midwives, who aren’t trained to do C-sections.

• Informed consent. Studies have raised questions about whether pregnant women are adequately informed about the risks and benefits of high-tech procedures such as C-sections and episiotomies, according to the new report.

For example, women “have been sold a bill of goods about how their bottoms are going to fall apart when they get older” if they deliver vaginally, says Douglas Laube, chair of obstetrics and gynecology, University of Wisconsin-Madison.

New York Gov. David Paterson recently signed a bill to create “an education and outreach program” for consumers and doctors and others who care for pregnant women about the risks and benefits of labor and delivery options. It is to be designed by the state health department.

“I realized that there was a need for general education so that women could make the right choices for themselves,” says legislation sponsor Assemblywoman Amy Paulin.

• Doulas. Many women have never heard of doulas, whose name comes from a Greek word meaning “women who serve.” According to DONA (Doulas of North America) International, which calls itself the world’s oldest and largest doula organization, “the doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth.”

For millennia, mothers, sisters and friends filled that role, and sometimes they still do. But today, many women live far from their families, so specially trained labor doulas step in. Research has shown that doulas lead to shorter, less-complicated labors; a lower likelihood of labor induction, pain medication or epidurals; and more favorable memories of childbirth.

“Labor is an intensely psychosocial process. It’s not just a physical thing that happens in your body,” King says. “I think what a doula primarily does is put a social safety net around labor.”

Some doctors and patients don’t see the need for such low-tech care, she says. “If a doula could be put in an IV drip, everyone would get it.”

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