At long last, The Birth Survey has given the public access to consumer ratings of maternity care providers and birth facilities. This is a major step toward increased transparency in maternity care.

I've been involved with The Birth Survey for a couple of years and am a vocal proponent of transparency in maternity care. I've studied the research on practice variation and concluded that we urgently need to publicize the rates of procedures and outcomes so that women can make informed choices and improve their likelihood of a safe and healthy birth. The Birth Survey team is on top of this and is working hard to obtain and publicize intervention rates for all birth facilities nationwide.

But what is the evidence that consumer feedback can drive quality improvement? Many analysts have questioned the value of "doctor rating" sites, and some doctors are even vigorously opposing and censoring these sites, a move that is ludicrous and unethical. What makes us think that The Birth Survey will be more effective than some of the consumer rating sites that have apparently failed to drive meaningful change in health care?

First, The Birth Survey is firmly rooted in scientific evidence on what comprises safe and effective maternity care. The questions were formulated from The Mother-Friendly Childbirth Initiative, a model of maternity care that is supported by a large body of medical literature and promotes the rights of childbearing women. Each of Lamaze's evidence-based Healthy Birth Practices is also represented in the survey questions. Finally, questions about the provider's interpersonal communication skills were developed and validated by the Agency for Healthcare Research and Quality, the leading federal agency on evidence-based health care.

In addition, women who have given birth may be more motivated to share their experiences than people who have had other types of health care encounters. Many women are eager to share their birth stories, and repositories of birth stories abound on the internet, presumably more so than testimonials about a people's pneumonia treatments or diabetes management, for example. So we cannot assume that the same limitations of other health care rating sites will apply to women who have given birth.

Finally, women's satisfaction and the care providers' interpersonal skills are potent quality indicators in maternity care. Unlike most other health care encounters, women presenting to prenatal appointments or to their birth settings in labor are usually not sick. The "treatment" should therefore be to support and facilitate the normal, healthy processes of labor and birth, and to intervene judiciously with the woman's fully informed consent only when problems arise. Research on birth physiology strongly suggests that the attitude of the care provider and the qualities of the birth setting can make labor either easier or harder, and can either promote optimal health or trigger complications and overreliance on risky procedures to correct these problems.

As a research enthusiast, I'm very eager to study the effectiveness of The Birth Survey and other transparency initiatives. But whether or not The Birth Survey drives meaningful change in maternity care depends on how many women use it, so spread the word!

Published: April 28, 2009

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