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Report Reveals Serious Problems in Maternity Care Quality and Value

Written by Pathways Magazine   
Monday, 01 December 2008 00:00
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Report Reveals Serious Problems in Maternity Care Quality and Value
Underused Maternity Practices
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Overuse of Cesarean Section and Other Interventions Puts Women and Babies at Risk, Increases Costs

New York NY – More than 31% of U.S. births are now by cesarean section although a 5% to 10% rate is best for mothers and babies. The extra cost is in excess of $2.5 billion per year. These cesareans do not result in reductions in maternal and newborn deaths, but they cause unneeded exposure to the dozens of adverse effects more common with c-sections. This is just the most striking example of how health care provided to mothers giving birth exposes them to avoidable harm and expense. These conclusions are found in Evidence- Based Maternity Care: What It Is and What It Can Achieve, a report released recently by Childbirth Connection, The Reforming States Group, and the Milbank Memorial Foundation. The report cites an extensive body of evidence to make the case that, despite paying top dollar, American women do not receive the best maternity care. It is the most comprehensive review to date of how maternity care is delivered, financed, and experienced by mothers, families, and health care payers. It concludes that maternity care can be significantly improved using evidencebased care.


Main Recommendations for Improvement

To speed adoption of evidence-based maternity care, the report recommends:

  • Develop a standardized evidencebased set of maternity care performance measures to address overuse and underuse.

  • Incorporate these measures into Medicaid quality improvement activities, and encourage private insurers and other entities to adopt them.

  • Reform the reimbursement system —with such strategies as reducing payment for overused services, increasing payment for underused services, and rewarding highperforming providers and facilities.

  • Support more research into evidence-based maternity care, including long-term effects of common maternity practices.

  • Increase the use of evidence-based maternity care by educating a wide range of stakeholders.

“If implemented, these recommendations can help close the evidence-practice gap in maternity care,” said Maureen Corry, co-author and Executive Director, Childbirth Connection.

“There’s a role for everyone—clinicians, health systems, payers, policymakers, consumers and the media. It’s time to seize the opportunities to ensure that all mothers and babies receive safe, effective and satisfying maternity care.”

“The report shows maternity care is one more example of what’s wrong with American health care. We’re paying too much and getting the worst results in the developed world because of unneeded care,” said Reforming States Group Vice Chair, State Senator Charles Scott of Wyoming. “The main causes are that providers earn more from unneeded care while fear of malpractice litigation encourages the same unneeded care. In my state, nearly half the births are paid for by the taxpayers through the Medicaid program. If we can implement the recommendations of this report, we can both reduce costs and improve the care our mothers and babies get.”


Overused Maternity Practices

Cesarean section is one notable example of frequently overused maternity care interventions documented in the report. C-sections are now the most common operating room procedure in the United States. Although clearly beneficial and lifesaving in selected circumstances, the absolute indications for c-section apply to only a small proportion of births. Yet, rates have steadily risen from 20.7% in 1996 to a record high of 31.1% in 2006, a 50% increase. Wide variation in medical practice exists – for example, differences in rates of performing cesarean section vary across physicians, hospitals, or geographic areas. Just a fraction of these differences are due to differences in the health needs of mothers and babies. Rather, this variation reflects differences in professional styles of practice and other factors such as the number of providers and hospitals offering the surgery, concerns about being sued, and financial incentives that favor surgery. The evidence showed that areas with higher rates of cesareans had more inappropriate care and more surgery in healthier women. The report clarifies that many other common maternity interventions, e.g. labor induction and epidural, are also overused. It can be accessed at www. childbirthconnection.org/ebmc/