My latest obsession...

     Lately I have been compiling a lot of research regarding the maternal/child health crisis in the United States.  The disparities in the current model of care versus evidenced based practice are alarming. I am appalled that we have access to amazing studies that support the midwifery model of care and yet, current obstetric protocols are based off of long standing opinions. 
  The first report that I would like to highlight is the Milbank Report. The Milbank Memorial Fund puts together reports to improve health by supporting evidence-based practice in all fields of health care. "The Fund has engaged in nonpartisan analysis, study, research, and communication on significant issues in health policy since its inception in 1905."

   The specific Milbank report I have been blown away by is Evidence-Based Maternity Care: What it is and What it Can Achieve. It discusses the paradoxical system we have set up in the US. We (the current medical system.... not midwives!) do more interventions that are known to cause harm and do less of the interventions that we know are beneficial. If we know theses things then why do we continue to do them????? 
     Money is why. "The present system of payment for maternity care provides strong incentives for inappropriate care of healthy childbearing women." This includes overusing technology to achieve provider goals.... get the women in and out with the least amount of time(money). Also, since providers are often paid for all OB care in a total package fee, those who take the time to allow a woman's body to do it's thing naturally (which we all know can take a long time), are not reimbursed for their time or effort.
     So if you want to talk about health reform, this is where it should start. Pregnancy/childbirth/newborn care is the number one reason for hospitalization in the US. Six of the top 15 hospital procedures are related to childbirth. “Mother’s pregnancy and delivery” is the most costly hospital condition for both Medicaid and private insurers, followed by “newborn infants.” These conditions are associated with 27 percent of hospital charges to Medicaid and 15 percent of hospital charges to private insurers." If you do not have children and think this this does not apply to you, you are wrong, as long as you pay taxes in this country it involves your money paying for these poor outcomes. 


    Not only do we spend twice as much on maternal child health, than any other country in the world, we have terrible outcomes. "World Health Statistics 2010 identified 33 countries with lower maternity mortality ratios than the United States, while 37 countries had lower neonatal mortality rates, 40 had lower infant mortality rates, 65 had lower low birthweight rates, and 32 had higher rates of exclusive breastfeeding to at least six months". See this Maternity Care Fact Sheet produced by the Childbirth Connection for many more shocking statistics.
     If you are not a research junkie, like me, and do not plan on reading the entire report I would like to highlight the interventions that are overused and have associated risks: induction, epidural analgesia, cesarean section, continuous elelectronic fetal monitoring, rupturing membranes, and episiotomy. I would like to make note that these interventions are needed in specific situations, however not to a majority of women. The over-use of these interventions exposes women and babies to risks with little to no benefit.  


Please note the differences in intervention rates: 

   
     The things that we know have benefits with little or no risks are: USING MIDWIVES or Family Physicians. "A systematic review comparing provision of prenatal care led by midwives and/or general practitioners and by obstetricians found that the differences in outcome favored midwives and general practitioners, who were associated with reduced likelihood of pregnancy-induced hypertension and preeclampsia, greater satisfaction, and lower costs (Khan-Neelofur, Gülmezoglu, and Villar 1998)." Other under-used interventions that midwives often promote are: prenatal vitamins, smoking cessation,  ginger for nausea or vomiting,  preventing pre-term birth, external version for breech babies, practices to increase women's satisfaction with care, continuous labor support, measures to relieve pain, bring comfort, and/or promote progress during labor, delayed and spontaneous pushing, non-supine positions for giving birth (not on their back),  delayed cord clamping, early skin-to-skin contact, breastfeeding initiation support, interventions to reduce newborn pain, and interventions to reduce post-partum depression.  
    

    Another report to check out is Deadly Delivery released in 2011 by Amnesty International. It puts more of a human rights spin to the heath care crisis.

     All I can say is if you are pregnant or planning to become pregnant, you should not go into the health care system blindly expecting to receive the highest quality care.  Educate yourself and take responsibility for choosing a health care provider that has your interests in mind, and of course, I would say that is a midwife!

Somehow, I have done it again.... Filled my life so full of craziness, that I cannot seem to find time to blog. The original idea behind starting this blog was that it would force me to sit down and reflect on life. Oh well, maybe I will begin to find the time. Until then, here's some tomatoes:) Yes, homegrown.