Consumer Reports report of Maternity Care

NishaG · 10-10-2008, 01:49 PM

Back to basics for safer childbirth
Too many doctors and hospitals are overusing high-tech procedures

To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.
Noninvasive measures can mean better outcomes for baby and Mom.

When it's time to bring a new baby into the world, there's a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment.
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.
without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our
To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.
to test your knowledge.) "Evidence-Based Maternity Care: What It Is and What It Can Achieve," co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.

Overuse of high-tech measures
The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent
Electronic fetal monitoring, unnecessarily adding to delivery costs
Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday "business hours," rather than at night, on weekends, or on holidays.

Underuse of high-touch, noninvasive measures
Many practices that have been proven effective and do little to no harm are underused in today's maternity care for healthy low-risk women. They include:

Prenatal vitamins
Use of midwife or family physician
Continuous presence of a companion for the mother during labor
Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one's back
Vaginal birth (VBAC) for most women who have had a previous Caesarean section
Early mother-baby skin-to-skin contact

The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers' performance, and a medical tradition that doesn't prioritize the measurement of adverse effects, or take them into account.

To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts.

supermouse · 10-10-2008, 02:01 PM

Interesting, thanks for posting.

I agree that many doctors in the US follow the "cover your butt" theory of medicine and end up doing or folllowing unnecessary procedures. However, Im still glad that we have access to such measures when they are needed. Ultimately, the safety and health of the baby and mother should be considered first, but if all is well, then why put them through expensive and unnecessary procedures?

This is one reason I love my OB. Im carrying monochorionic twins, which will likely result in a c-section birth. If one or both are not turned right, or if the shared placenta poses a risk to one or both, that would clearly be the best way to proceed. But my OB has not decided that a csection is definitely in order yet---she's waiting until later to see how things stand, so she can make the best, most educated decision about that as possible. I believe some doctors would have already scheduled a csection for me, without any further thought.

CAMMAM · 10-10-2008, 11:41 PM

Thanks for posting this! I agree with the article and this is why I have chosen to have a home birth. I feel like having the baby at home with a midwife and my husband is the safest thing for me and baby. going to the hospital scares the crap out of me, I know that in a hospital setting there is no way I will get the birth that I want.

Tummy · 10-11-2008, 02:45 PM

Very interesting article -- thanks for posting! Like Supermouse, I chose a fantastic OB. He is totally open to doing as non-interventional a delivery as possible and encourages me to have a doula (labor support partner) to help me meet that goal. Also, like Supermouse, he is skilled in doing all of these procedures when necessary, but only if there is a risk to baby or mom if they are not done. I think the key is being informed about all of the procedures and WHEN they are and aren't necessary, so you are not blindly going into delivery taking what is given to you without knowing the benefits/risks to each one. And of course choosing an OB you trust and who supports your choices.

On the other hand, it is also interesting to note that MOMS are choosing interventions these days, too, not just the docs. A lot of moms want to be induced early b/c they're uncomfortable, or want a C-section so they won't get "stretched out," etc. So some docs get pressure not only from a legal standpoint but from the moms themselves.