Since the publication of “Our Bodies, Ourselves: Pregnancy and Birth,” OBOS has become increasingly involved in the movement to reform childbirth practices. We have become vocal in criticizing the highly medicalized births that have become the norm for most women and advocating for changes, including increased access to midwifery care and birth centers and the reversal of hospital bans on vaginal births after cesarean (VBAC).
Now a new report has been released that highlights the many shortcomings of the U.S. maternity care system. “Evidence-Based Maternity Care,” a report by Childbirth Connection in conjunction with the Milbank Memorial Fund and the Reforming States Group, focuses on the reality that many common maternity care practices are not based on the most reliable evidence of what is safe and effective.
The report addresses a range of maternity cares issues in the United States, including costs, geographic and institutional variation in practices, and current barriers to improving care. It also addresses specific interventions and concludes with a series of policy recommendations.
The report raises the following important points:
- Financial and other external forces have a large impact on the maternity care that is provided in the United States. This means that the kinds of care mothers and babies receive are often not based solely on what is best for them.
- Becoming informed and being actively involved in making maternity care decisions can dramatically influence the health outcomes and experiences of mothers and babies.
- For women without established problems, having skilled, dedicated support for their innate capacities to give birth (“physiologic childbirth”) will generally be the path to effective care with the least harm. Relying routinely on external procedures, drugs and other interventions during labor and birth can expose women and babies to avoidable harm.
Rather than focusing solely on the idea of overused interventions such as labor induction, epidurals, and cesareans, the report also suggests a list of interventions that may be underused. The authors list midwifery care, smoking cessation interventions, ginger for nausea and vomiting, upright positioning during labor, and interventions related to postpartum depression among several other examples. In other words, the report does not simply argue what not to do, but suggests things to do to potentially improve maternity care, and does not limit these to traditional medical services (such as prescription drugs for morning sickness).
Among the barriers to improving maternity care, the authors discuss the current payment system, malpractice concerns, the use of specialty care, reliance on expert opinion in the absence of solid evidence, lack of provider skill for aspects of labor such as coping support and vaginal breech birth, the slowness with which new evidence is adopted by providers, industry pressure (such as distribution of formula samples), and other challenges. The review of each of these issues provides an interesting overview of the U.S. maternity system and the challenges a woman may face when interacting with that system.
Finally, the review provides four policy recommendations, focused on increasing knowledge and use of evidence-based maternity care, supporting research, reforming the reimbursement system, and requiring performance measurement, reporting, and improvement.
The report has the potential to be an important tool for childbirth advocates and allies as we work to improve legislation and other policies that impact maternity care. As Childbirth Connection Director Maureen Corry states, it is the hope of the authors that “clinicians, health systems, payers, policymakers, consumers and the media” each take a role in implementing the recommendations in order “to ensure that all mothers and babies receive safe, effective and satisfying maternity care.”
The Childbirth Connection website has an overview of the report as well as the full 113-page report (PDF). USA Today also has coverage of the report that focuses on the high economic costs of the failure to incorporate evidence-based practices.