The childbirth care paradox affects everyone

<p>How do you make health care decisions? Do you consider the comparative costs of your treatment options? Do you defer to your physician, believing she knows best? In deferring to your doctor, you are most likely assuming that her recommendations are based on evidence well supported by medical research.</p><p>In most aspects of medicine in the United States, doctors base their practice decisions on best evidence from scientific data. But maternity care appears to be an exception. Recently, routine practices in childbirth were subjected to a systematic review; the findings of this analysis are surprising.</p><p>Childbirth affects everyone, not just those planning families. Every time you pay insurance premiums or taxes, you help pay for someone else’s maternity care. Over four million births each year in the United States make childbirth the leading reason for hospitalizations, outnumbering admissions for pneumonia, cancer, heart failure, bone fractures and strokes. Hospital charges for birthing women with their newborns exceeded $79 billion in 2005, far more than any other health condition, and these charges increase with every added procedure or intervention that is used.</p><p>Are these interventions improving the quality of care? According to the Milbank Report, “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” maternity care in the United States is doing more but accomplishing less. The report, issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers) and the Milbank Memorial Fund, was released last fall. This comprehensive review of the literature concludes that many doctors and hospitals are unnecessarily overusing high-tech procedures during childbirth, and these procedures are not providing best outcomes.</p><p><NO1><NO><NO1><NO>Despite the good intentions of many dedicated physicians and a large expenditure of resources in the U.S., the World Health Organization has identified 29 nations with lower maternal mortality rates and 35 nations with lower early neonatal mortality rates than ours.</p><p>Our culture has come to expect certain procedures as part of normal childbirth, but these practices have not been shown to improve outcomes. They do increase the cost of care. The average charge for an uncomplicated vaginal birth in the hospital is just over $6,000, but a simple Caesarean section, without complications, costs more than twice as much.</p><p>Pregnant women are generally healthy, but most women in the U.S. receive prenatal care from specialists who are experts in surgery and pathology. While specialists are needed for high-risk or complicated deliveries, 85 percent of women do not require expensive high-tech care for childbirth.</p><p>Important indicators such as low birthweight and preterm labors have been worsening in the U.S. for decades. The Milbank Report found that common interventions during childbirth are responsible for some of these trends. Interventions such as labor inductions, routine epidurals, repeat Caesarean sections and continuous electronic fetal monitoring increase the rate of complications while driving up the cost of health care.</p><p>The report also found that many underutilized, less expensive practices are safe and effective. These practices include maternity care provided by family physicians or midwives, the presence of a doula (labor companion), drug-free pain management, and access to vaginal births after Caesareans.</p><p>The financial toll of maternity care on employers and taxpayers is especially large, playing a considerable role in escalating total health care costs. In times of economic hardship, and with a health care system needing reform, it is imperative that we become smart consumers. This involves taking a careful look at how we are spending our resources and asking: Are we currently getting value for our health care dollars?</p><p>We would be wise to look at health care practices for childbearing women and consider the evidence about safe, effective maternity care. Cost and scientific evidence should be considered when making medical decisions. Being an informed health care consumer is a big responsibility, but we owe it to ourselves and our families to make smart choices when it comes to our health care.</p><p>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.</p>