October 12th, 2008 by Judith Lothian
The Milbank Report, Evidence-Based Maternity Care: What It Is and What It Can Achieve, was released on October 8. This report should shake the world of maternity care to its very core!
The authors of Evidence-Based Maternity Care, Carol Sakala and Maureen Corry, have a long involvement with evidence-based maternity care including planning and leading Childbirth Connection’s national program to promote such care over the past decade.
Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund collaborated in planning, developing and issuing the report, including formulating policy recommendations.
The Millbank Memorial Fund is a foundation that works to improve health by helping decision makers in the public and private sectors acquire and use best available evidence to inform health policy. The Reforming States Group, organized in 1992, is a voluntary association of leaders in health policy from all 50 states, Canada, England, Scotland and Australia. Childbirth Connection (formerly the Maternity Center Association), founded in 1918, is a national not for profit organization that works to improve the quality of maternity care through research, education, advocacy and policy.
Many national policy, quality and maternity care leaders provided detailed feedback on report drafts and further strengthened the report.
In a nutshell, the report finds that despite the good intentions of health care providers and huge expenditures (by Medicaid, private insurers and women themselves) the quality of US maternity care is poor. Evidence-based care practices are underused and poor quality practices, like procedures, tests, and medications that are not needed, are overused. The report highlights best evidence that, if widely implemented, would have a positive impact on many mothers and babies and would improve value for payers.
USA Today quotes University of Wisconsin’s Douglas Laube, a former president of the American College of Obstetricians and Gynecologists, who blames “very significant external forces” for the overuse of expensive technologies in maternity care.
“I don’t like to admit it, but there are economic incentives” for doctors and hospitals to use the procedures, says Laube, who reviewed the new report before its release. Dr. Laube goes on to say that some doctors might get bonuses for performing more labor inductions, which adds costs and increases the risk of C-sections, which, in turn, increase hospital profits because they require longer stays. Some doctors order unnecessary tests because of fear of litigation.
Consumer Reports had this to say: “When it’s time to bring a new baby into the world, there’s a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new study.” We couldn’t agree more!
The full report plus ongoing press coverage can be found at Childbirth Connection. Every women in America needs to read this report. Every insurance provider needs to read this report. Every health care provider and hospital needs to read this report. Making the changes necessary to improve outcomes and make birth safer for mothers and babies is a collaborative responsibility. Evidence-Based Maternity Care is a call to action, for all of us.
