Report on Evidence-based Maternity Care in the US – What are the lessons for India?

Posted on: October 31, 2008

Recently I had the opportunity to read most of the 128-page report published by Childbirth Connection (www.childbirthconnection.org) the non-profit maternity care research and advocacy group, Milbank Foundation, a non-partisan endowment working in the health care field, and the RSG, a voluntary association of legislative leaders and policy makers in the US. Here is the link to the report – http://www.childbirthconnection.org/pdfs/evidence-based-maternity-care.pdf

The report is an excellent one, and gives credence to what maternity and newborn advocates have been saying for many years – procedures and practices which have been repeatedly known to cause harm, and which has been recommended to be used only in limited circumstances are today widely in use, and are often routine in most hospitals. As I kept reading, I could not help wonder that if the US health care system, with its watchdogs and numerous checks and balances can receive such an indictment then what are the implications for India, where advocacy is almost non-existent, and many hospitals have almost 80% c-section rates?

The report mentions that US hospital charges for maternal and newborn care in 2006 were $86 billion, a nearly 9% jump from 2005 figures. Of these, unnecessary c-sections took up $2.5 billion, representing almost 33% of all US deliveries. Further, I was surprised to note that a 2008 study conducted by Agency for Healthcare Research & Quality (AHRQ), looked at 2005 data and concluded that childbirth in the US was the leading cause of hospitalization, surpassing heart-failure, cancer, and stroke. Maternity care (pre and post-partum visits) was the third-most frequent reason for all outpatient visits. Further, at $79 billion, cost of hospitalization with respect to maternity care (women and new born) was by far the largest component of health care costs in the US, according to the same study conducted by AHRQ.

Private insurance paid 51% of costs of hospital stays in the US, with government Medicaid picking up 42%. It was also surprising to note that going by 2005 data, 49% of all hospital procedures done on the 18 to 44 year-old population were related to childbirth. Six of the 15 most commonly used procedures done on the entire US population involved childbirth, according to AHRQ. Some of these include medical induction (2nd), c-section (7th), fetal monitoring (13) and artificial rupture of membrane (14th).

So what does this mean to us in the Indian health care context? I would love to read such a report prepared for India that captures some of the same facts in the above report. I encourage anyone interested in creating such a research finding to get in touch with us so that we can collaborate or point us to good, existing  research data. I know of two not-so recent research studies, one conducted in Delhi and one near Chennai.

I would also imagine insurance companies, both government and private payers, would be interested in knowing where their money is being spent and how. Evidence-based research has shown repeatedly that physiological approach to childbirth without routine intervention provides the best outcomes for a healthy mother, and for her baby AND is less expensive for insurance companies, specifically by avoiding costs involved as a result of technology-led interventions, and post-partum issues that occur because of c-sections. I invite responses from Indian insurance company stakeholders on what their company’s view is. It would be interesting to note their take on the issue.

We at Healthy Mother believe in the power of physiological approach to childbirth and in the natural ability of a woman’s body to give birth without external intervention in most cases. In our classes we reinforce this confidence in the minds of women and their families and follow evidence-based practices that facilitate a fulfilling and healthy childbirth. It is our belief that a system that promotes normal childbirth with continuous labor support in the form of midwives/trained labor support personnel, and one which relies on medical intervention only as a backup, is more beneficial to families, society, and to the entire nation as a whole.

As usual please send me your comments…

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