Spotlight on Safety in Maternity Care -- by Suzanne Delbanco, Ph.D.
Childbirth is the number one reason for hospitalizations in the U.S. and is also the runaway leader in hospital charges. Studies show that we over-use costly and risky interventions in maternity care, and underuse beneficial methods like continuous labor support that are generally safer and cheaper. There are 4.3 million births in the U.S. each year, and evidence is mounting that the quality of maternity care is deteriorating in some areas, as indicated by recent increases in maternal death among some populations. There are also incentives built into the delivery system to provide technology-intensive care to a primarily young and healthy childbearing population who may not need it. The quality and safety of maternity care warrants the nation's attention.
The Millbank Memorial Fund recently published a report called Evidence-Based Maternity Care: What it Is and What It Can Achieve, authored by the leaders of Childbirth Connection, a national, non-profit organization. The report contains a systematic review of maternity care practice and highlights that much of the care pregnant women receive has no basis in the evidence. In fact, some of it can be harmful. The Los Angeles Times op-ed about the report claimed, “The Obama administration could save the country billions by overhauling the American way of birth.”
I have been volunteering to support two efforts to focus attention on this topic that are likely of interest to others working to improve the safety and quality of health care.
First, Childbirth Connection will be hosting what could be one of the most important discussions of 2009. Transforming Maternity Care: A High Value Proposition, will be held on April 3 in Washington, DC. Over 200 multi-stakeholder participants will be recommending ways to improve maternity care and to align payment with quality as part of producing a “Blueprint for Action.”
Second, the California Maternal Quality Care Collaborative (CMQCC) aims to eliminate preventable maternal death and injury and promote equitable maternity care in California. The group works to bring resources, tools, measures, and quality improvement techniques to providers, administrators, and public health leaders. CMQCC has produced many of the measures of maternity care now included in standards and goals produced by the National Quality Forum, the Joint Commission, and other groups.
Improving maternity care will require more informed health care professionals and patients alike. Since expectant parents have months to conduct careful research on providers and facilities, maternity care presents the ultimate opportunity for increasing consumer engagement in health care. Careful measurement and tracking of maternity care outcomes, along with public reporting, could provide a solid start to reversing some of the negative trends toward excessive clinical intervention of recent years. That would be a high value proposition for all involved.
Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.