The majority of U.S. childbearing women and their babies are healthy and at low risk. Among all healthcare sectors, the maternity care system leads the nation in annual hospital charges of more than $86 billion. Much of this money pays for costly and overused childbirth procedures performed on minimal- to low-risk women and newborns. Procedures proven to be safer and less expensive are underutilized. At the same time, women and babies in need of specialized care have insufficient access. In short, there is a gap between contemporary practice and evidence-based care. Most women become consumers of maternity services without knowledge of this gap.
National organizations and leaders across the healthcare system are beginning to grapple with the complex barriers between women and top-quality maternity care. Earlier this year, Childbirth Connection released a framework for revamping care: “2020 Vision for High Quality, High Value Maternity Care System.” The 2020 Vision is powerful for the diversity of participants coming together. Because the nation’s maternal and newborn health indicators are moving in the wrong direction, even as we spend more than any other country, reform is more important than ever before.
As a mother-baby advocate and childbirth educator in training, I look forward to examining and grappling with local barriers to top-quality maternity care in Lane County, Oregon. The good news is that Lane County is blessed with a wide variety of settings and providers for women and families.
That said, Lane County outcomes are not what they should be. Local cesarean rates are at or above national levels, which are more than twice the recommended rate. The Lane County fetal-infant mortality rate is higher than national and state averages. Fetal- infant mortality is a community-wide problem affecting all socio-economic, age and education level groups.
My role is twofold. First, I empower women, the consumers of maternity services, to identify and require mother- and baby-friendly care. Second, I encourage maternity service providers to provide individual-centered and evidence-based care supporting normal birth, bonding and breastfeeding.
Empowerment occurs when a woman sees clearly that her body and her baby belong to her. She is informed and knows she has the right to be in charge of what happens to her body and her babies. She can identify mother- and baby-friendly care, i.e. evidence-based care. This form of care occurs when practices and statements by providers reflect confidence in normal birth. It occurs in environments in which rare complications are not referenced as normal bridges to unnecessary medical intervention. And, finally, it occurs in settings where women’s desires and feelings are honored. Compliance and complacency are not part of mother- and baby-friendly settings.
Working with women and maternity service providers, I hope to play a positive role in reducing the gap between contemporary practice and what we know to be best for mothers and babies.