The good news coming out of a recent report on the state of maternity care in the US is that it’s easy to find areas where we can do better.
The report, Evidence Based Maternity Care, was produced by the Milbank Memorial Fund, Childbirth Connection and the Reforming States Group. Its underlying theme is that we rely too heavily on procedures and technology for what is essentially a natural process.
For example, we overutilize procedures like epidural anesthesia and cesarean section. We then deploy co-interventions to monitor, prevent and treat side effects caused by these procedures. And throughout, we overuse little-ticket items such as prenatal testing and continuous fetal monitoring.
As a consequence, per capita spending on childbirth in the US is the highest in the world.
Ironically, we tend to underutilize many low-tech, cost-reducing strategies. During pregnancy for example, we underprescribe prenatal vitamins and smoking cessation programs. We rarely use simple maneuvers to flip fetuses into a head-first position before delivery which can cut down unnecessary cesarean sections. At or near delivery, we underutilize continuous labor support and other measures that increase comfort and facilitate labor.
As a result we are no better than average among developed nations on key outcome statistics such as perinatal, neonatal and maternal mortality.
The report says we’ll have to overcome a familiar list of hurdles in order to implement more cost-effective maternity care. For example, we have no generally accepted quality measurement systems for childbirth. Our payment and tort systems create perverse incentives for providers. We rely excessively on specialists for low-risk populations, and so forth.
Depressing as this sounds, the report could have been written 25 years ago. Nothing has changed.