Monday, May 12, 2014

Asking the Hard Questions about Complacency and Spending in US Maternity Care

After reading the article "Why are Cesarean Sections so common when most agree they shouldn't be" from Public Radio International, it got me to thinking.

If, as the article said,  Cesareans relieved the labor and delivery units from mayhem and unpredictability, introduced order and efficiency, contributed clear profits to the hospital, and provided an alternative method of delivery for doctors worried about medical malpractice suits associated with complicated vaginal births then is the same true for other non-evidence based interventions such as clear liquids only during labor, routine IVs, routine fetal monitoring, routine episiotomy, and more?

Is complacency the real reason why women experience routines or traditions in care?  

Is the reason why this complacency was not revealed is that in the 1980's, childbirth education moved from being community-based to becoming hospital based, where the same hospital mentioned above had control over what was being taught?  

So if you don't let women know they have options and a voice, they won't ask for the type of care that interferes with order and efficiency and profits?

Even with joint resolutions between organizations and the massive dissemination of evidence-based research to the general childbearing public as well as professionals, there is still a lag time between the publication of evidence and putting it in practice.

"I could tell you that hospital committees hold up the progress toward evidence-based care", said one nurse, who asked to remain anonymous for fear of losing her job.  "I could also tell you that policies are only there on paper and they are no good unless the care providers want to change practice.  Therein lies a huge barrier to change."  According to the WHO Report, the United States had the third highest number of unnecessary Cesarean sections in the year 2008, costing the country an estimated $687 million. "So where did those millions of dollars go?" asked the same nurse.

Healthcare in the US and in many other parts of the world is in a frenzy.  Health care costs are rising yet the maternal/infant morbidity and mortality rates are not improving. In terms of the use of cesarean section worldwide, low and some middle income countries should improve accessibility to this intervention which could reduce adverse maternal and perinatal outcomes. At the other extreme, in high and in some middle income countries, excessive use of this surgical procedure could result in added morbidity and no discernable benefits.

Therefore, we have seen and heard that women in the US (and other countries) are victims (if you will) of complacency and money.  It is not about them giving birth, one of if not the most important day of their lives.  It is not about ensuring the long term safety of the society.  It is not about "first do no harm".  

Perhaps it is time for a substantial portion of childbirth education to return to being community-based.

Perhaps it is time to bring the evidence about physiologic birth to more professionals.

Perhaps it is time to be the change we want to see happen?

WHO Health Systems Financials

Why are Cesarean Sections so common when most agree they shouldn't be" from Public Radio International

1 comment:

Tory Starr said...

Thanks so much for this post. I'd love for you to join our Ninth Month Facebook community and post this there. Let me know if you have any questions!