Healthcare Reform

What Healthcare Reform Means for Mamas on Bedrest

March 25th, 2010

I have been somewhat glued to the television these past few days as I have watched the Health Care Reform bill voted on in the House of Representatives and then signed into law by President Obama. There is a lot of controversy surrounding the new law, but the bottom line is that there are some health care revisions on the horizon and Mamas on Bedrest stand to benefit.

When a woman receives a high risk diagnosis,  medical interventions are not far behind (or I should say More medical interventions). There are the endless ultrasounds, Non-Stress tests, blood tests and office visits-and that’s just before the birth. If a woman goes into preterm labor, she may have a cesarean section to “avoid potential complications”.  If she delivers a premature infant, the costs can skyrocket. If the baby spends a long time in the neonatal intensive care unit (NICU), even with the best of insurance policies, the family’s portion of the medical costs can reach well into the thousands and in some cases a million dollar. Who has that kind of money? The question that we all have to ask is, “Even if a woman has a “high risk pregnancy” how much of the current interventions and technologies are really necessary?”

Childbirth Connection, a national not-for-profit maternity advocacy organization, is dedicated to making evidence based improvements to maternity care. Their mission is to improve the quality of maternity care through research, education, advocacy and policy. Childbirth Connection promotes safe, effective and evidence-based maternity care and is a voice for the needs and interests of childbearing families. This description may seem pat but let’s take a look at what Childbirth Connection is doing for maternity practices in general, Mamas on Bedrest in particular, and see how they are advocating for all women in the Health care Reform Debate.

For the past 2 1/2 years, the leaders and advocates of Childbirth Connection have been studying maternity practices in the United States and what they found is nothing short of shocking. Citing statistics from Agency for Healthcare Research and Quality and the National Vital Statistics Reports (both reports are dated 2009),

“Childbirth and birth-related conditions are the most common reasons for hospital care, accounting for one-fourth of hospital discharges in 2007. In that year, cesarean delivery was the most common operative procedure in the country, comprising 31.8% of births. Meanwhile, the incidence of vaginal birth after cesarean (VBAC) has declined to 9.7% (from 35.3% in 1997)”

According to “The National Hospital Bill: The most expensive conditions by payer (2006)” the Agency for Healthcare Research and Quality states that in 2006, charges for “mother’s pregnancy and delivery” and “newborn infants” were $86 billion — far exceeding charges for any other hospital condition. At this rate who can afford to have one child let alone more than one? And keep in mind, these statistics are for the so called “normal” births. Heaven forbid there are complications and intensive care admissions as is often the case for Mamas on Bedrest. What then?

But hang on, the most alarming statistics (at least in my opinion) were presented by Childbirth Connection. In the course of their research, Childbirth Connection noted that rates of preterm birth have increased to 12.7%, and rates of low birth weight infants rose to 8.2% in the past two decades.

So let me get this straight. Americans pay more for health care than any other industrialized nation. We are the only industrialized nation that charges its citizens for health care. It’s true that we have some of the most advanced technologies available and some of the most cutting edge research is taking place in American research centers. But the sad truth is that all of the money spent and all of the technology has not translated into improved outcomes. In fact, The Unites States has some of the worst maternal and infant mortality rates not only in the industrialized world, but in the world as a whole. And, if a US citizen is uninsured or unable to pay for treatment, they have virtually no access to medical care. So what are we gaining with all of our technological advances?

Since 2008 Childbirth Connection has been researching and analyzing the health care delivery system as it pertains to maternal and infant care. In 2008, organizational leaders authored “Evidence-based Maternity Care: What It Is and What It Can Achieve,” a Milbank report that takes stock of the US maternity care system and identifies a wealth of opportunities for improving quality, outcomes, and value. It is truly a comprehensive assessment of what is wrong and what is right with maternal and infant health care delivery. As a result of this study, Childbirth Connection and health care policy experts and advocates have come together to form Transforming Maternity Care. This project has been in effect for the past 2 1/2 years and it is a candid assessment of what needs to happen in order to improve maternity services.

MedScape’s Katharine Hikel, MD caught up with Childbirth Connection’s Carol Sakala, Phd, MSPH, The Director of Programs for Childbirth Connection and a co-editor of the Transforming Maternity Care publication, to assess what The Blueprint for Transformation* has uncovered via its research and what strategies it proposes in an effort to redirect the current course of maternity care in the United States.

Discoveries and Inefficiencies

  • Maternity Care (which includes moms and newborns) accounts for 25% of all patients discharged from the hospital.
  • There exist considerable overuse of interventions that may pose risk and expense without benefit, underuse of beneficial practices and broad practice variation that largely cannot be explained by needs and preferences of childbearing women and their newborns.
  • Not enough Evidence-Based, reliable data exists to justify many of the current procedures and protocols.
  • Two major interventions that are overused are labor induction and cesarean section and many times have no clear indication for use.
  • Epidural anesthesia is widely overused and is known to slow labor and create need for other interventions
  • The Milbank Report also presents data on overuse of continuous electronic fetal monitoring, artificial rupture of membranes, and episiotomy.

Proposed Changes- Most of these underused techniques are proven effective by Evidence-Based research in relieving labor and delivery discomfort, promoting maternal and fetal wellness and curtailing hospital labor and delivery costs.

  • smoking cessation interventions for pregnant women;
  • External version to turn babies to a vertex position at term;
  • Continuous support during labor (such as from a doula);
  • Use of hydrotherapy to promote comfort and labor progress;
  • Non-supine positions for giving birth;
  • Early skin-to-skin mother-baby contact;
  • Interventions to increase initiation and duration of breastfeeding;
  • psychosocial and psychological interventions to relieve postpartum depression.

Sakala also addresses the fact that obstetricians and other health care providers involved in providing maternity care have recognized the vast variations in practice styles. Childbirth Connection has approached these various groups and has received widespread support of its initiatives. In order to clearly identify the shortfalls and a path towards repair, Childbirth Connection’s committees have developed two written reports:

The first report, “2020 Vision for a High-Quality, High-Value Maternity Care System,” from the project’s Vision Team, clarifies where we need to head.

“Blueprint for Action: Steps Toward a High-Quality, High-Value Maternity Care System,” from the project Steering Committee, summarizes priority recommendations for getting there. It is available for review and download as well as in bound, published form.

With so many initiatives ready to be implemented, it’s hard to imagine that there is still a lot of work left to be done. But as with any recommendation for change, the path to progress is often slow. Sakala is heartened because the Vision team and Steering committee at Childbirth Connection have identified clear cut areas of deficit and proposed clear cut pathways to change. Now it is time to work with all of the various providers, agencies and organizations to implement these changes and to truly deliver health care reform in Maternity Care.

Mamas on Bedrest, be a part of this change! Voice your opinions and concerns regarding childbirth and high risk pregnancy and childbirth in particular. Childbirth Connection is really working hard for all moms, but we can’t let the focus be only on “uncomplicated” pregnancies. We are the ones with much to lose and everything to gain. Submit your comments and I will submit them to those that I know at Childbirth Connection and to other influential advocates.

Sign up for the Mamas on Bedrest newsletter (Upper right hand corner of this page!!) so that you can keep up with the advocacy efforts and learn what progress has been made on your behalf. Whenever there is news on the high risk maternity front, you’ll be first to hear it! (after me of course) ~DTL

* If you are interested in having the full Transforming Maternity Care Vision and Blueprint, you can order the Women’s Health Issues Journal, Volume 20 Number 15,  January/February 2010  from Elsevier Publications.