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Childbirth Connection Report Reveals Serious Problems in Maternity Care Quality and Value
Overuse of Cesarean Section and Other Interventions Puts Women and Babies at Risk, Increases Costs
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NEW YORK, NY -- (Marketwire) -- 10/08/08 -- Over 31% of US births are now by cesareansection, although a 5% to 10% rate is best for mothers and babies. Theextra cost is well over $2.5 billion per year. The excess cesareans buy noreduction in maternal and newborn deaths. But they cause unneeded exposureto the dozens of adverse effects more common with c-sections. This is justthe most striking example of how health care provided to mothers givingbirth exposes them to avoidable harm and expense. These conclusions arefound in "Evidence-Based Maternity Care: What It Is and What It CanAchieve," a report released today by Childbirth Connection, The ReformingStates Group, and the Milbank Memorial Foundation.
The report cites an extensive body of evidence to make the case that,despite paying top dollar, American women do not receive the best maternitycare. It is the most comprehensive review to date of how maternity care isdelivered, financed, and experienced by mothers, families, and health carepayers. It concludes that maternity care can be significantly improvedusing evidence-based care.
Main Recommendations for Improvement
To speed adoption of evidence-based maternity care, the report recommends:
-- Develop a standardized evidence-based set of maternity care performance measures to address overuse and underuse.-- Incorporate these measures into Medicaid quality improvement activities, and encourage private insurers and other entities to adopt them.-- Reform the reimbursement system -- with such strategies as reducing payment for overused services, increasing payment for underused services, and rewarding high-performing providers and facilities.-- Support more research into evidence-based maternity care, including long-term effects of common maternity practices.-- Increase the use of evidence-based maternity care by educating a wide range of stakeholders.
"If implemented, these recommendations can help close the evidence-practicegap in maternity care," said Maureen Corry, co-author and ExecutiveDirector, Childbirth Connection. "There's a role for everyone --clinicians, health systems, payers, policymakers, consumers and the media.It's time to seize the opportunities to ensure that all mothers and babiesreceive safe, effective and satisfying maternity care."
"The report shows maternity care is one more example of what's wrong withAmerican health care. We're paying too much and getting the worst resultsin the developed world because of unneeded care," said Reforming StatesGroup Vice Chair, State Senator Charles Scott of Wyoming. "The main causesare that providers earn more from unneeded care while fear of malpracticelitigation encourages the same unneeded care. In my state, nearly half thebirths are paid for by the taxpayers through the Medicaid program. If wecan implement the recommendations of this report, we can both reduce costsand improve the care our mothers and babies get."
Overused Maternity Practices
Cesarean section is one notable example of frequently overused maternitycare interventions documented in the report. C-sections are now the mostcommon operating room procedure in the US. Although clearly beneficial andlifesaving in selected circumstances, the absolute indications for cesareansection apply to only a small proportion of births. Yet rates have steadilyrisen from 20.7% in 1996 to a record high of 31.1% in 2006, a 50% increase.
Wide variation in medical practice exists -- for example, differences inrates of performing cesarean section vary across physicians, hospitals, orgeographic areas. Just a fraction of these differences are due todifferences in the health needs of mothers and babies. Rather, thisvariation reflects differences in professional styles of practice and otherfactors such as the number of providers and hospitals offering the surgery,concerns about being sued, and financial incentives that favor surgery. Theevidence showed that areas with higher rates of cesareans had moreinappropriate care and more surgery in healthier women. The reportclarifies that many other common maternity interventions, e.g. laborinduction and epidural, are also overused. It can be accessed atwww.childbirthconnection.org/ebmc/
Underused Maternity Practices
The analysis also found underuse of many effective practices with few or noknown adverse effects. These practices include continuous supportthroughout labor (such as that provided by a doula), numerous measures thatincrease comfort and facilitate labor progress, upright and side-lyingpositions for giving birth, delayed cord clamping, and early skin-to-skincontact between mother and baby. More frequent use of these beneficialforms of care would lead to improved outcomes for many mothers and babies.Best available evidence also supports providing access to vaginal birthafter cesarean (VBAC) for most women with a previous cesarean, but suchaccess has fallen off sharply in recent years, despite demand from women,and more than nine out of ten women with previous cesareans now have repeatcesareans.
"Hundreds of rigorous systematic reviews of best evidence assess the safetyand effectiveness of maternity practices," said Carol Sakala, lead reportauthor and Director of Programs, Childbirth Connection. "Yet, all too oftenthe evidence is ignored."
Maternity Care is Major Segment of Hospital Market
Most maternity care provided to women who give birth in US hospitals -- alarge and primarily healthy population -- is resource and technologyintensive. Six of the fifteen most commonly performed hospital proceduresin the entire population are associated with childbirth. Hospital chargesfor maternal and newborn care are greater than charges for any othercondition: $79 billion in 2005, jumping to $86 billion in 2006.
Maternal and newborn care are the most costly hospital conditions for bothMedicaid (which pays for 42% of all births in the country) and privateinsurers (shouldering 51%). And, the proportion of Medicaid-covered birthsis growing, making the quality and cost of maternity care a significantpublic policy issue. The report finds that lower intensity care, like thatprovided by midwives, is safe and effective, avoids many procedures withestablished risks, and is cheaper. Yet, just a fraction of women who givebirth in hospitals today receive low intensity care.
And while the US spends much more on health care, its performance lags farbehind other developed nations on quality indicators including lowbirthweight, perinatal and maternal mortality, and cesarean rates. Thereport spotlights the market influences and other factors contributing towhat has been called the "Perinatal Paradox: doing more and accomplishingless" (Rosenblatt 1989).
About Milbank Memorial Fund
Milbank Memorial Fund is an endowed operating foundation that works toimprove health by helping decision makers in the public and private sectorsacquire and use the best available evidence to inform policy for healthcare and population health. The Fund has engaged in nonpartisan analysis,study, research and communication on significant issues in health policysince its inception in 1905.
About Reforming States Group
The Reforming States Group (RSG), organized in 1992, is a voluntaryassociation of leaders in health policy in the legislative and executivebranches of government from all fifty states, Canada, England, Scotland andAustralia.
Childbirth Connection
Founded in 1918, Childbirth Connection is a not-for-profit organizationworking to improve the quality of maternity care through research,education, advocacy and policy. As a voice for the needs and interests ofchildbearing families, Childbirth Connection uses best research evidenceand the results of its periodic national Listening to Mothers surveys toinform policy, practice, education and research.
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Contact:Kat Song212-777-5000 ext. 8Email Contact
Main Recommendations for Improvement
To speed adoption of evidence-based maternity care, the report recommends:
-- Develop a standardized evidence-based set of maternity care performance measures to address overuse and underuse.-- Incorporate these measures into Medicaid quality improvement activities, and encourage private insurers and other entities to adopt them.-- Reform the reimbursement system -- with such strategies as reducing payment for overused services, increasing payment for underused services, and rewarding high-performing providers and facilities.-- Support more research into evidence-based maternity care, including long-term effects of common maternity practices.-- Increase the use of evidence-based maternity care by educating a wide range of stakeholders.
"If implemented, these recommendations can help close the evidence-practicegap in maternity care," said Maureen Corry, co-author and ExecutiveDirector, Childbirth Connection. "There's a role for everyone --clinicians, health systems, payers, policymakers, consumers and the media.It's time to seize the opportunities to ensure that all mothers and babiesreceive safe, effective and satisfying maternity care."
"The report shows maternity care is one more example of what's wrong withAmerican health care. We're paying too much and getting the worst resultsin the developed world because of unneeded care," said Reforming StatesGroup Vice Chair, State Senator Charles Scott of Wyoming. "The main causesare that providers earn more from unneeded care while fear of malpracticelitigation encourages the same unneeded care. In my state, nearly half thebirths are paid for by the taxpayers through the Medicaid program. If wecan implement the recommendations of this report, we can both reduce costsand improve the care our mothers and babies get."
Overused Maternity Practices
Cesarean section is one notable example of frequently overused maternitycare interventions documented in the report. C-sections are now the mostcommon operating room procedure in the US. Although clearly beneficial andlifesaving in selected circumstances, the absolute indications for cesareansection apply to only a small proportion of births. Yet rates have steadilyrisen from 20.7% in 1996 to a record high of 31.1% in 2006, a 50% increase.
Wide variation in medical practice exists -- for example, differences inrates of performing cesarean section vary across physicians, hospitals, orgeographic areas. Just a fraction of these differences are due todifferences in the health needs of mothers and babies. Rather, thisvariation reflects differences in professional styles of practice and otherfactors such as the number of providers and hospitals offering the surgery,concerns about being sued, and financial incentives that favor surgery. Theevidence showed that areas with higher rates of cesareans had moreinappropriate care and more surgery in healthier women. The reportclarifies that many other common maternity interventions, e.g. laborinduction and epidural, are also overused. It can be accessed atwww.childbirthconnection.org/ebmc/
Underused Maternity Practices
The analysis also found underuse of many effective practices with few or noknown adverse effects. These practices include continuous supportthroughout labor (such as that provided by a doula), numerous measures thatincrease comfort and facilitate labor progress, upright and side-lyingpositions for giving birth, delayed cord clamping, and early skin-to-skincontact between mother and baby. More frequent use of these beneficialforms of care would lead to improved outcomes for many mothers and babies.Best available evidence also supports providing access to vaginal birthafter cesarean (VBAC) for most women with a previous cesarean, but suchaccess has fallen off sharply in recent years, despite demand from women,and more than nine out of ten women with previous cesareans now have repeatcesareans.
"Hundreds of rigorous systematic reviews of best evidence assess the safetyand effectiveness of maternity practices," said Carol Sakala, lead reportauthor and Director of Programs, Childbirth Connection. "Yet, all too oftenthe evidence is ignored."
Maternity Care is Major Segment of Hospital Market
Most maternity care provided to women who give birth in US hospitals -- alarge and primarily healthy population -- is resource and technologyintensive. Six of the fifteen most commonly performed hospital proceduresin the entire population are associated with childbirth. Hospital chargesfor maternal and newborn care are greater than charges for any othercondition: $79 billion in 2005, jumping to $86 billion in 2006.
Maternal and newborn care are the most costly hospital conditions for bothMedicaid (which pays for 42% of all births in the country) and privateinsurers (shouldering 51%). And, the proportion of Medicaid-covered birthsis growing, making the quality and cost of maternity care a significantpublic policy issue. The report finds that lower intensity care, like thatprovided by midwives, is safe and effective, avoids many procedures withestablished risks, and is cheaper. Yet, just a fraction of women who givebirth in hospitals today receive low intensity care.
And while the US spends much more on health care, its performance lags farbehind other developed nations on quality indicators including lowbirthweight, perinatal and maternal mortality, and cesarean rates. Thereport spotlights the market influences and other factors contributing towhat has been called the "Perinatal Paradox: doing more and accomplishingless" (Rosenblatt 1989).
About Milbank Memorial Fund
Milbank Memorial Fund is an endowed operating foundation that works toimprove health by helping decision makers in the public and private sectorsacquire and use the best available evidence to inform policy for healthcare and population health. The Fund has engaged in nonpartisan analysis,study, research and communication on significant issues in health policysince its inception in 1905.
About Reforming States Group
The Reforming States Group (RSG), organized in 1992, is a voluntaryassociation of leaders in health policy in the legislative and executivebranches of government from all fifty states, Canada, England, Scotland andAustralia.
Childbirth Connection
Founded in 1918, Childbirth Connection is a not-for-profit organizationworking to improve the quality of maternity care through research,education, advocacy and policy. As a voice for the needs and interests ofchildbearing families, Childbirth Connection uses best research evidenceand the results of its periodic national Listening to Mothers surveys toinform policy, practice, education and research.
Add to Digg Bookmark with del.icio.us Add to Newsvine
Contact:Kat Song212-777-5000 ext. 8Email Contact
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