|
Page 2 of 2
Underused Maternity Practices
The analysis also found underuse of many effective practices with few or no known adverse effects. These practices include continuous support throughout labor (such as provided by a doula), numerous measures that increase comfort and facilitate labor progress, upright and side-lying positions for giving birth, delayed cord clamping, and early skin-to-skin contact between mother and baby. More frequent use of these beneficial forms of care would lead to improved outcomes for many mothers and babies. Best available evidence also supports providing access to vaginal birth after cesarean (VBAC) for most women with a previous cesarean, but such access has fallen off sharply in recent years, despite demand from women, and more than nine out of ten women with previous cesareans now have repeat cesareans. “Hundreds of rigorous systematic reviews of best evidence assess the safety and effectiveness of maternity practices,“ said Carol Sakala, lead report author and Director of Programs, Childbirth Connection. “Yet, all too often the evidence is ignored.”
Maternity Care is Major Segment of Hospital Market
Most maternity care provided to women who give birth in US hospitals — a large and primarily healthy population — is resource and technology intensive. Six of the fifteen most commonly performed hospital procedures in the entire population are associated with childbirth. Hospital charges for maternal and newborn care are greater than charges for any other condition: $79 billion in 2005, jumping to $86 billion in 2006. Maternal and newborn care are the most costly hospital conditions for both Medicaid (which pays for 42% of all births in the country) and private insurers (shouldering 51%). And, the proportion of Medicaidcovered births is growing, making the quality and cost of maternity care a significant public policy issue. The report finds that lower-intensity care, like that provided by midwives, is safe and effective, avoids many procedures with established risks, and costs less. Yet, just a fraction of women who give birth in hospitals today receive lowintensity care. And while the United States spends much more on health care, its performance lags far behind other developed nations on quality indicators including birthweight, perinatal and maternal mortality, and cesarean rates. The report spotlights the market influences and other factors contributing to what has been called the “Perinatal Paradox: doing more and accomplishing less“ (Rosenblatt 1989).
About Milbank Memorial Fund
Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research and communication on significant issues in health policy since its inception in 1905.
About Reforming States Group
The Reforming States Group (RSG), organized in 1992, is a voluntary association of leaders in health policy in the legislative and executive branches of government from all 50 states, Canada, England, Scotland, and Australia.
Childbirth Connection
Founded in 1918, Childbirth Connection is a not-for-profit organization working to improve the quality of maternity care through research, education, advocacy and policy. As a voice for the needs and interests of childbearing families, Childbirth Connection uses best research evidence and the results of its periodic national Listening to Mothers surveys to inform policy, practice, education, and research.
Visit Childbirth Connections here: www.childbirthconnection.org
 This article appeared in Pathways to Family Wellness magazine, Issue #20.
To purchase this issue, Order Here.
|
Wellness Articles 
