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?
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? 😉