{"id":244403,"date":"2010-01-29T07:00:00","date_gmt":"2010-01-29T12:00:00","guid":{"rendered":"http:\/\/www.rhrealitycheck.org\/blog\/2010\/01\/29\/the-cure-an-ailing-maternity-care-system"},"modified":"2010-02-01T11:35:45","modified_gmt":"2010-02-01T16:35:45","slug":"the-cure-for-an-ailing-maternity-care-system","status":"publish","type":"post","link":"https:\/\/mereja.media\/index\/244403","title":{"rendered":"The Cure for An Ailing Maternity Care System"},"content":{"rendered":"

Maternity care is big business in the United States. We\u2019re
\ntalking $86 billion big.\u00a0 With that kind of investment, you\u2019d think women and their newborn babes in this
\ncountry would be entering the postpartum recovery period universally healthy
\nand happy after being well cared for throughout pregnancy and birth. Unfortunately, the return on investment for maternity care
\nis poor. The U.S. spends more on health care than most \u2013 a staggering
\namount<\/a> per person in fact – yet lags far behind when it comes to maternal
\nand newborn health and mortality indicators. The United States ranks 41st
\nout of 171 countries when it comes to our maternal mortality rates.\u00a0 <\/span>So it makes sense that stakeholders
\nfrom health care advocates and providers to hospital and insurance company
\nexecutives, but most importantly women themselves, would want to ensure a much
\nbetter return-on-investment for maternity care in this country, right?<\/p>\n

\n \n<\/p>\n

\nUnfortunately, what has constituted success in terms of a
\ngreater ROI among these various stakeholders has not always been
\nuniform.\u00a0 <\/span>Where women are growing
\nweary of the increase in unnecessary medical interventions during childbirth
\nthat only increase costs and the chance of poorer health outcomes, doctors have
\ntaken to routinely encouraging and performing unnecessary c-sections at an
\nexponential rate to keep malpractice claims lower but also because our health
\ncare system\u2019s \u201cglobal
\nfee\u201d<\/a> method of payment for in-hospital birth promotes a one-size-fits-all
\ntype of care which does not lend itself well to vaginal birth but does increase
\na hospital\u2019s profit; where insurance companies and Medicaid do not provide
\nhomebirth coverage across the country, which would bring overall maternity care
\ncosts down (for insurance companies, states, those insured and tax-payers
\nacross the board), Medicaid funds almost half of all hospital births.\n<\/p>\n

\nIt is precisely because of these issues and more that a team of over 100 national leaders in maternity care, led by maternity care advocacy
\norganization Childbirth Connection, convened two and a half years ago to come
\nup with a shared vision and an action plan for change.\n<\/p>\n

\n\u201cIt was time to act and we called upon key leaders across
\nthe health care system to develop a long-term vision for the future of
\nmaternity care in the United States,\u201d said Maureen Corry, Childbirth
\nConnection\u2019s Executive Director. The results of this multi-year
\nmeeting-of-the-minds, the Transforming
\nMaternity Care Project<\/a>, are two key reports released today, \u201c2020 Vision For A
\nHigh-Quality High-Value Maternity Care System\u201d<\/a> and \u201cBlueprint For Action.\u201d<\/a>\n<\/p>\n

\nAs we move forward, towards reform of our overall health
\ncare system, the problems and solutions identified in these two reports are key
\nto fixing our broken maternity care system and may help birth an entirely new
\nsystem.\n<\/p>\n

\nThe \u201c2020 Vision\u201d report underscores 11 key focus areas or
\nproblems that include: payment reform, disparities in access and outcomes of
\nmaternity care, coordination of maternity care, clinical controversies (such as
\nhome birth, VBAC (vaginal birth after cesarean) and elective induction), and
\ndecision-making and consumer choice. The \u201cBlueprint for Action\u201d report
\nidentifies concrete actions to address all of these problems in order to move
\ncloser to this shared vision of a high-quality, high-value system.\u00a0 <\/span>How do we get the most value \u2013 in every
\npossible way that word can be defined \u2013 for our money?\n<\/p>\n

\nRima Jolivet, Transforming Maternity Care Project Director
\nwith Childbirth Connection is optimistic: \u201cThe good news is that every
\nchallenge is an opportunity for improvement that can benefit millions of
\nmothers and babies annually.\u201d In other words, maternity care is a problem with
\na solution. And the solution lies in the answers to the questions posed to the
\nwork groups involved with these reports:\n<\/p>\n

\n

\n\t\u201cWho needs to do what, to, with, and for whom over the next
\n\tfive years to improve the quality care?\u201d\n\t<\/p>\n<\/blockquote>\n

\nIn truth, the answers to these questions are not earth
\nshattering. They seem to echo what women\u2019s health advocate have said for years.
\nWe need a system that is woman-centered, evidence-based, safe, timely,
\nefficient and equitable. But how exactly do these concepts translate into in practical approaches to care?\n<\/p>\n

\nWoman-centered care, according to the \u201c2020 Vision\u201d report
\nis care that \u201cthat respects the values, culture, choices and preferences of the
\nwoman, and her family, as relevant, within the context of promoting optimal
\nhealth outcomes. It means that all childbearing women are treated with\u2026respect,
\ndignity and cultural sensitivity throughout their maternity care experiences.\u201d\n<\/p>\n

\nIn effect, we\u2019re talking about personalized care and the understanding that
\neach woman brings a unique vision, perspective, belief system, and cultural
\nidentity to their pregnancy and birth experience. Let\u2019s not only respect that but
\nalso work with these ideals to promote positive experiences.\n<\/p>\n

\nThe idea that maternity care should be evidence-based,
\nsafe, and efficient seems like a no-brainer but one key goal to note is how
\nthese imperatives lay the groundwork to minimize \u201coveruse, underuse, and misuse
\nof care practices and services.\u201d We need to make sure we\u2019re providing optimal
\ncare to all<\/em> women by guaranteeing
\nwomen are able to access the services they need if they need them. However
\n(this is a big one), let\u2019s also start from a place of understanding that
\npregnancy is a healthy<\/em> state of being
\n\u2013 not an inherently sick state \u2013 and so let\u2019s also minimize the amount of
\nunnecessary interventions that now drive up costs and place women and newborns
\nat risk for poorer health outcomes.\n<\/p>\n

\nAs the \u201c2020 Vision\u201d puts it:\n<\/p>\n

\n

\n\t\u201cThe majority of childbearing women are healthy and have
\n\tgood reason to expect an uncomplicated pregnancy and birth and a healthy
\n\tnewborn. Thus, practice variation for low-risk women is minimized under the
\n\tprinciple that any intervention in the physiologic processes of pregnancy and
\n\tchildbirth must be shown to do more good than harm\u2026\u201d\n\t<\/p>\n<\/blockquote>\n

\nThe goal of ensuring greater equitability in
\naccess to care is critical in this report. Racial and ethnic disparities run
\nrampant in maternity care. Shockingly, African-American women in the U.S. are
\nfour times as likely to die during childbirth as white women. We know, too,
\nthat the idea that women can \u201cchoose\u201d where to birth and with whom is
\nnon-existent for low-income women who cannot afford to pay out of pocket for a
\nhomebirth or midwife at a birthing center. The \u201cBlueprint for Action\u201d notes
\nthat:\n<\/p>\n

\n

\n\t\u201cNon-Hispanic black, Hispanic, and American Indian-Alaskan Natives were
\n\tmore than twice as likely as non-Hispanic white women to receive late or no
\n\tprenatal care in 2006; as of 2008, nearly 40 percent of low-income women ages 18-44
\n\twere uninsured.\u201d\n\t<\/p>\n<\/blockquote>\n

\nThe solutions lie in a host of actions including (what else?)
\nnational health care reform legislation, encouraging states to exercise
\nMedicaid\u2019s eligibility option for pregnant women under CHIP and other programs,
\nand expanding public support for maternity care programs, providers and
\ninstitutions as well.\n<\/p>\n

\nAnother key problem notes the \u201c2020\u201d report is improving the
\nfunctionality of payment systems. It sounds dry but the truth is that payment
\nreform is key to aligning financial goals with optimal health outcomes. As the
\n\u201cBlueprint for Action\u201d report puts it:\n<\/p>\n

\n

\n\t\u201cVolume-driven reimbursement increases
\n\tcost without improving health outcomes. Providing more services than are needed
\n\tdoes not improve health and increases the risk of harm, while driving up
\n\tspending.\u201d\n\t<\/p>\n<\/blockquote>\n

\nNot the best use of anyone\u2019s time or money, really.\n<\/p>\n

\nOf special interest, also, is the section in the \u201cBlueprint
\nfor Action\u201d on what are termed \u201cclinical controversies\u201d such as Home birth and
\nVBAC (vaginal birth after cesarean section). The Blueprint acknowledges and
\nreinforces key solutions that grassroots advocates have been working towards
\nfor years:\n<\/p>\n

\n

\n\t\u201c\u2026developing national clinical guidelines for VBAC, labor induction,
\n\tvaginal breech and out-of-hospital birth using transparent processes; improving
\n\tthe capacity of hospitals and health systems to meet the needs of women who
\n\tface these controversial scenarios; improving the capacity of community health
\n\tsystems to meet the needs of women who make an informed choice of planned home
\n\tbirth and, finally, improving cooperation between hospital systems and home
\n\tbirth providers.\u201d\n\t<\/p>\n<\/blockquote>\n

\nIf these reports can be used as actual blue prints for
\naction within health care reform, I can see our maternity care system getting
\nhealthier already.\n<\/p>\n

\n

\n\tFor more on these reports, please check out Amy Romano’s post<\/a> at Lamaze, International’s blog Science & Sensibility and Melissa Garvey’s post<\/a> at Midwife Connection, ACNM’s blog!\n\t<\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

Maternity care is big business in the United States. We\u2019re talking $86 billion big.\u00a0 With that kind of investment, you\u2019d think women and their newborn babes in this country would be entering the postpartum recovery period universally healthy and happy after being well cared for throughout pregnancy and birth. Unfortunately, the return on investment for […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"class_list":["post-244403","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/244403","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/comments?post=244403"}],"version-history":[{"count":0,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/posts\/244403\/revisions"}],"wp:attachment":[{"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/media?parent=244403"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/categories?post=244403"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mereja.media\/index\/wp-json\/wp\/v2\/tags?post=244403"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}