less is more when it comes to maternity care

I recently found this article from the L.A. Times.  The author of the article, Jennifer Block, previously wrote an amazing book entitled Pushed: The Painful Truth about Childbirth and Modern Maternity Care.  Like the movie The Business of Being Born (which I reviewed here), it takes a hard look at the maternity care system in the United States today and shows that it spends too much money and does not provide good care for mothers and babies.

The United States ranks at the bottom (41st place) of the world’s industrialized nations in regards to both infant and mother mortality rates.  This means a mother and her baby are more likely to die in (or soon after) childbirth here in American than in practically ANY other industrialized nation in the world!  How can this be?  We’re so MODERN here!  We have fancy machines at birth, we’re surrounded by doctors and nurses, our care is the best, right?

Wrong.

Study after study after study proves that when LESS machines are used in birth, when doctors are LESS involved, when LESS medications are given to mothers, and when LESS time constraints are put on labor – the result is MORE healthy babies, MORE healthy mothers, and MORE instances of successful starts to breastfeeding.  Less is more in childbirth, yet Americans in general don’t seem to believe that, and certainly not when it comes to childbirth.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife-led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

This topic becomes even more interesting when you consider the implementation of nationalized health care.  In most contries of the world with nationalized health care systems run by the federal government, midwives handle the majority of the births.  The high-risk births (about 20%) are attended by obstetricians, who are best able to handle the problems that go with these births.  But the majority of births are low risk, and those births are handled by midwives.  These countries spend far less on maternity care, yet they have far better outcomes for mother and baby.

There was much talk about “health care reform” in the last election.  Maternity care is a prime example of an area of health care that is badly in need of reform.  The good news is that reforming maternity care would dramatically lower costs!  Consider this quote from Block’s article:

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

If nationalized health care does indeed become part of the United States under the Obama administration, will midwifery become the new standard of care for Americans?  Will birth centers become more prevalent?  Most birth centers today have a hard time keeping their doors open.  Because they support hand-on, low technology births, they don’t bring much money in, and they have a difficult time staying open.  Furthermore, many insurance companies won’t cover births that occur outside of a hospital setting.  (Nor will insurance companies cover doulas, as I have unfortunately discovered during my last two births.  Grr.)  Will the evidence-based best practices be implemented on a national level, not only for their cost-saving measures but also for their greater health benefits?

I’m not an Obama supporter, but I would be very pleased to see him instigate such practices.  And if anyone can get people on board to make change happen in this area, he can.

—–

An interesting side note: Last month I had my yearly OB-GYN checkup.  After the requisite poking and prodding, I got dressed and met my doctor in his office.  I offered him my copy of The Business of Being Born, explaining what the movie was about.  He was glad to receive it, and said he would happily watch it with his wife (who is also an OB).  We talked about the waste that happens in obstetrics today, and he mentioned something interesting.  Apparently all pregnant mothers are now recommended to be screened for cystic fibrosis early in their pregnancy.  It’s a blood test, like the others, but it’s another test that has to be run, and another test for which insurance now has to pay.  My OB thought that this test wasn’t worth it, as he’s seen only a handful of CF babies in his 20+ years of obstetrics.  He said, “It’s another test that costs insurance companies money, it’s another test for the mother to worry about, and it’s really not necessary.”  He then added, “If Obama made me the OB czar, I would get rid of all the prenatal testing, save for the 16 week blood test and the Level 2 ultrasound halfway through the pregnancy.  Pretty much anything that’s significantly wrong with the baby can be discovered one of those two ways.  That would save a lot of money while still giving doctors and mothers adaquate information about the baby.”

Ah, yes, Americans’ obsession with medical tests!  Another way that waste could be cut out of the health care system!  (Don’t get me wrong – I know people with CF, and I’m not saying your disease isn’t important enough to test for.  But, from a practical and monetary perspective, it’s just not that common enough of a disease for the entire general populace to be tested for it.)

Frankly, if all of this waste WERE cut out (and I’m sure there’s similar instances of waste in other medical fields), perhaps health insurance would become more affordable and there wouldn’t be this great health insurance debate going on right now!  We wouldn’t need to even consider getting the federal government involved, because costs would be under control.

Oh, well.  One can always dream, right? 😉

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5 thoughts on “less is more when it comes to maternity care

  1. Oh, we definitely need to talk (I love this topic)!

    As Joel and I have talked of adding baby number 4, and subsequent babies, we’ve often had the conversation turn to prenatal and delivery care. There is so many diagnostics and fear-inducing rituals in today’s medical world, especially in this department.

    Our current plan for the next few babes is to avoid pre-natal care until week 16. After all, I’ve had completely healthy pregnancies the with the last three and my midwife declared that she felt I took great care of myself while pregnant. They don’t request that you make an appointment until at least 10 weeks anyway. Would 6 weeks matter that greatly? As you said, the OB thought the week 16 blood test would catch most problems.

    We’re also thinking that the next delivery will be at home. My labors are short and relatively easy, without complications. Also, with Logan, he was born at 7:32 am and I was up, showered, dressed, and ready to go home by 8:15 am. Unfortunately, the hospital requires (can they actually do that?) you to stay for 48 hours for observation. I have a feeling that the only thing they’ll discover if I stay for that long again is that I dislike the uncomfortable setting of hospitals and get squirrelly really fast!

    The final decision we’ve made for future children is no vaccinations until age two. Even at that point, the type and number of vaccinations we’ll be giving will be minimal.

    If you’re up for it, I’d love to have an ongoing conversation about this… you sound much more knowledgeable about the subject!

    ~Kirsten

  2. An ongoing discussion about childbirth?? That’s like offering me a giant box of chocolate-covered peanuts and maid service for a year! You bet! 🙂 Childbirth and theology – I could talk for a long time on both subjects. 😉

    Hospitals want new mothers to stay for 48 hours, but I believe that your OB/midwife can discharge you earlier if you request it (and s/he agrees to it).

    I certainly give you (and anyone else who does it) kudos for doing a home birth. After the scare that Curious J’s birth gave us, I don’t think I would be able to do one, but I totally support people who can do it. Thankfully, I have a good OB who doesn’t mind me going natural. I think if I wasn’t working with him and didn’t have such a good relationship with him, I’d be singing a different tune.

    Have you ever seen the documentary movie “The Business of Being Born”? You probably would find it very interesting.

    ~ Emily

    PS. I’m with you on the vaccines, too. I wish I hadn’t given Lyd all her shots in her first two years. I’m kicking myself now, but I can’t change it, so, oh well. Thankfully, so far she seems to be okay.

  3. We actually asked that Lauren (our 7 year-old) not receive the varicella and another vaccine and they gave them to her anyway. I was furious. It happened again at Logan’s 12 month checkup with a completely different clinic (in a different state!). I asked that he only receive the MM of the MMR, but was told it would be costly and we’d have to travel to another clinic. I agreed to the MMR, but asked for no polio, hep, varicella, and uh… some other one (sorry, can’t remember the name). They STILL gave them to him! Worse yet, the gave them to him in a cluster shot! Sooooo sneaky! I’m certainly going to be more vigilant and protective with any future babies, starting from the very beginning with the “eye goop” at birth.

    Our local natural living group is going to have an upcoming discussion on vaccinations. Is there anything insightful you can share, either comments or documentation, that I can take to the group?

  4. If you haven’t yet read the book “The Vaccine Book” by Robert Sears, it is VERY worth it. It’s not either pro-vaccine or anti-vaccine, but it is extremely respectful of both positions. It also has an alternative vaccine schedule as well as a selective vaccine schedule, both of which I think are worth discussing. I wrote a review of it on my blog last summer. Here’s a link to my review:

    https://notfinishedyet.wordpress.com/2008/08/18/the-vaccine-book-by-robert-w-sears/

    For me, as far as vaccines go, there are some thoughts that come to mind:

    1) Vaccines have done a lot of good for generations past, but our children are not growing up in the same world that we did, nor in the same world that our parents did. We can’t think that doing the same things that worked 20 or 40 years ago will be similarly effective today. For example, I don’t think the polio vaccine is necessary anymore. I told this to my mother, and she was not in agreement, to say the least. But the world she grew up in was different – kids actually GOT polio and ended up in Iron Lungs or were paralyzed. But that doesn’t happen anymore. No one gets polio in the U.S. anymore! If people still did get polio, you can bet that I’d get my kids vaccinated. But, the world has changed.

    2) Along those same lines, children today are recommended to get FAR more vaccines at a MUCH younger age than we did 25 years ago. That’s a whole different ballgame in my opinion.

    3) I don’t know how to succintly say this, so I’ll have to use a lot of words to make my point. I don’t like how vaccines are being created to keep people from having to live healthily. Case in point – the flu vaccine. NONE of us had even heard of a flu vaccine ten years ago! People were told to get rest, wash their hands, and eat healthily. Now, everyone’s supposed to get the flu vaccine. I think it’s a way to take the responsibility for health off of people’s shoulders (as well as provide income for Big Pharma.) Another case in point – the HPV vaccine. Girls (and boys) can avoid getting HPV by not having sex. However, rather than encourage abstinence, society encourages a vaccine (that only covers a few kinds of HPV anyway) to keep people from getting HPV. Once again, the burden of staying healthy is taken out of the individual’s hands and put in the hands of a vaccine.

    4) This is not specifically against vaccines, although vaccines are a part of it, but I dislike how the medical establishment today seems to view death, ANY death, as a failure. The fact is: people die. People are always going to die. No one will live forever. So, pardon me for sounding crass and/or cruel (I don’t mean to be), but why should all of us get the flu vaccine to help keep some sick elderly person from dying? That is one of the main reasons suggested for getting the flu vaccine – to help the elderly population! Now, if I have the flu, I’m certainly not going to visit my local nursing home and cough on all the residents, but life happens. People get old, people get sick, people die. We can’t keep everyone alive forever.

    Those are my thoughts. Take ’em for what they’re worth. 😉 Thanks for asking!

    ~ Emily

  5. I haven’t read “The Vaccine Book” yet, but I plan to. My friend, who started the natural living group highly recommended it. I’d like to get a copy of it and read it before the next meeting. I’m still waiting for my “Inner Lives of Men” book from the library, so I’m not holding my breath that the vaccination book will be here in time either (agh!).

    My thinking for vaccines is quite similar to yours. We’re not in tune with what’s really affecting this generation; we’re overdoing everything in an attempt to avoid true health; and we’ve gotten so fearful about day to day safety and minor illnesses that we are willing to risk the long term outcome of our lives through injesting some more drugs/chemicals.

    Joel and I were actually just discussing the polio vaccine this afternoon. The last active, naturally occuring case of polio in this country was in 1979. In developing countries, there is still outbreaks, but in most medical information I’ve found (Mayo, etc.) a person only needs the vaccine if they’ll be travelling overseas. Furthermore, there is really sketchy information out there on the disease and the vaccine. Should we really be forcing something on our future generations that we truly don’t know the ramifications of?

    As for the fact that we vaccinate our children so rapidly, I’m not surprised. It seems Americans (many anyway) tend to be easily swayed into doing something because of our parental fears (most often brought on by the medical community). In Japan, the minimum age for vaccination was raised to two years old. After, their infant mortality rate became the best in the world. (I believe the age requirement may have changed now).

    The HPV vaccine absolutely frightens me! Are people crazy? This is what I found online. It’s in agreement with what you said… “Up to 70 percent of cervical cancer cases are caused by HPV-16 and HPV-18. These are two of the types that the HPV vaccine (sold under the brand name Gardasil®) protects against. The sexually transmitted varieties of high-risk HPV include: HPV-16, HPV-18…..” As you said, why not promote abstinence? It seems pretty obvious to me!

    Thanks for sharing your thoughts. I appreciate it (and look forward to reading that book so we can chat more!).

    ~K

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