Friday, October 10, 2008

USA Today Article on High-tech Interventions

High-tech Interventions Deliver Huge Childbirth Bill

I am so pleased to see this article in a mainstream newspaper! I do wonder about the title though... I would love to have seen something about how the costs don't produce healthier mothers and babies - that piece, to me, is the real story.

Here are two excerpts:
"Childbirth is the leading reason for hospitalization in the USA and one of the top reasons for outpatient visits, yet much maternity care consists of high-tech procedures that lack scientific evidence of benefit for most women, a report says today.

U.S. hospital charges for maternal and newborn care jumped from $79 billion in 2005 to $86 billion in 2006, the authors write. More than $2.5 billion a year is spent on unnecessary C-sections, which now represent nearly a third of all deliveries.
[The language in this sentence is unclear to me: it makes it sound like ALL of the Cesareans are unnecessary; clearly there are times when a Cesarean birth is appropriate use of technology. Maybe the "which now represent" refers to C-sections in general, not unnecessary ones in particular? Anyway...]

Reducing expensive techniques such as C-sections and increasing low-cost approaches such as childbirth assistants called doulas would improve mothers' and babies' health while cutting costs, the authors say.

. . .

"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."
It's important to remember that these higher prices DO NOT equal better care. The United States is not the standard-bearer for safety for mothers and babies. Using 2008 statistics, the United States (6.3/1000) currently ranks BEHIND the following countries for infant mortality rates: South Korea (5.94/1000), Cuba, Isle of Man, Italy, Taiwan, San Marino, Greece, Monaco, Ireland, Canada, Jersey, New Zealand, United Kingdom, Gibraltar, Portugal, Netherlands, Luxembourg, Guernsey, Liechtenstein, Australia, Belgium, Austria, Denmark, Slovenia, Macau, Isreal, Spain, Switzerland, Andorra, Germany, Czech Republic, Malta, Norway, Anguilla, Finland, France, Iceland, Hong Kong, Japan, Sweden, and Singapore (2.3/1000).

If you are interested in reading the report, it is available in pdf format, and a print copy can be obtained for free by emailing your contact information.

Milbank Report: Evidence-based Maternity Care
"What are top implications for policy makers, childbearing women and maternity professionals?"

Policymakers can play an important role in improving quality, health outcomes and resource use by addressing barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.

Childbearing women need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices — for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task — and can have very big pay-offs.

Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.

I am so excited to read this report and be able to include this information in my classes!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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