The past few weeks have been big ones for 95 year old, New York based Childbirth Connection. Since I started working in the birth world, I have always appreciated the information and publications from Childbirth Connection, not only to advance my own professional knowledge, but as a reliable, evidence based resource for my clients and students as well as the doula and CBE trainees that I work with. Today on Science & Sensibility, I would like to share the three new Childbirth Connection reports that you may find useful.

1. Vaginal or Cesarean Birth: What Is at Stake for Women and Babies?

Maternity care stakeholders (consumers, health care professionals, insurers, state Medicaid agencies and others) are increasingly concerned about the immediate, short-term and long-term impact that the country's high cesarean delivery rate is having on mothers and children. A Maternity Action Team was convened by a collaboration of national organizations. The purpose of this team was to address unsafe or inappropriate maternity care. The team's overall goal of reducing the cesarean rate in low-risk women to 15% or less.

The report created by Childbirth Connection focuses on the adverse consequences of cesarean birth on both women and children. Included in the report is also information on potential adverse outcomes of labor and vaginal delivery. The following questions are answered:

• What physical effects may occur in women more frequently with
• cesarean delivery?
• What physical effects may occur in babies more frequently with cesarean delivery?
• What role may cesarean delivery play in the development of childhood chronic disease?
• What complications are unique to cesarean delivery?
• What complications are unique to vaginal birth?
• What are potential psychosocial consequences of cesareans?
• What are potential effects of cesareans on women in future
• pregnancies and births?
• What are potential effects of a scarred uterus on future babies?
• Does cesarean delivery protect against sexual, bowel, urinary, or
• pelvic floor dysfunction?
• Does cesarean delivery protect against injuries to babies?

The results of the evidence reviewed allowed the following conclusion to be reached the authors:

The findings of this report overwhelmingly support striving for vaginal birth in general and spontaneous vaginal birth in particular in the absence of a compelling reason to do otherwise. To improve both the quality and value of maternity care in the United States and promote the optimal health of women and infants, clinicians, policy makers, and other stakeholders should prioritize identifying and promulgating practices that promote safe, spontaneous vaginal birth and reduce the use of cesarean delivery.

2. The Cost of Having a Baby in the United States

Childbirth Connection in collaboration with Catalyst for Payment Reform and the Center for Healthcare Quality and Payment Reform recently released a report on the financial impact our current maternity care system has on both private payers and government funded care. Maureen Corry, Childbirth Connection Executive Director shared that if the US were able to reduce the cesarean rate down to 15%, (from the current 33%), national spending on maternity care would go down by $5 billion dollars.

For the commercially insured, the average cost of a birth by c-section in 2010 was $27,866, compared to $18,329 for a vaginal birth. Medicaid programs paid nearly $4,000 more for c-sections than vaginal births. (The Cost of Having a Baby in the United States)

http://flic.kr/p/4vgkDo

There are facilities and providers who are effective at providing quality care and excellent outcomes while also demonstrating fiscal responsibility. Yet other teams have costs that are drastically higher with outcomes that leave a lot of room for improvement. What is the difference? The report also noted that there were large variations in costs based on different geographic regions in the US. Does the opportunity for practicing evidence based maternity medicine (resulting in a lower cesarean rate) provide the path for a reduction in maternity costs? We learn in this report that 'high-quality, high-value care' is an attainable goal and one that will benefit mothers and babies everywhere in our country.

3. Maternity Care and Liability: Pressing Problems, Substantive Solutions

If everyone is in agreement that the cesarean rate in the United States is too high, and that health care costs, including maternity care costs are skyrocketing, without an improvement in outcomes, then the next stop has to be examining the risks that health care providers and facilities assume and are held liable for when a less than optimum outcome occurs for mother or baby. In the newest Childbirth Connection report released this week, Childbirth Connection takes a look at 25 different possible liability reforms and runs each scenario through the same filter, to find out which ones;

• promote safe, high-quality maternity care that is consistent with best evidence and minimizes avoidable harm
• minimize maternity professionals' liability-associated fear and unhappiness
• avoid incentives for defensive maternity practice
• foster access to high-value liability insurance policies for all maternity caregivers without restriction or surcharge for care supported by best evidence
• implement effective measures to address immediate concerns when women and newborns sustain injury, and provide rapid, fair, efficient compensation
• assist families with responsibility for costly care of infants or women with long-term disabilities in a timely manner and with minimal legal expense
• minimize the costs associated with the liability system

Which proposal will stand the test, and prove to be the solution that has the possibility of improving the situation for all involved, consumers, providers and insurers. Are we headed down the right track with the changes that have been already implemented? It appears that we may be doing more harm then good in some cases. Liability concerns may very well drive every decision a health care provider makes, and the proper system has to offer protection to both the consumer and the provider. This report identifies the factors that the appropriate reform needs that will allow for everyone involved to benefit.

Additionally, along with this fascinating report, is a set of 10 printable fact sheets that can be shared with health care administrators, consumers and health care providers to facilitate understanding and discussion on the topic of liability reform.

Childbirth Connection Executive Director Recognized

Finally, I would like to share that Maureen P. Corry, MPH, the executive director of Childbirth Connection was recently named by Forbes Magazine as one of the '13 To Watch in 2013: The Unsung Heroes Changing Health Care Forever.' Maureen is recognized as 'a strong policy advocate, but also a thoughtful and purposeful researcher who brings all sides together in very constructive ways, which is why many of the issues she has raised over the years are now on the top of the policy agenda in Washington.'

The reports that Childbirth Connection has recently released clearly show that this organization, under the leadership of Maureen, is making significant and timely contributions to improving pregnancy and birth outcomes for mother and babies. I am grateful for this organization, and would like to congratulate Maureen on behalf of myself, this blog and Lamaze International for a job well done!

Next week, Amy Romano, former Science & Sensibility community manager, and current Associate Director of Programs for Childbirth Connection will share how educators and advocates can use these reports in their classroom and with their clients and patients. Have you taken the time to read any of the reports listed here today? Are you already using them? Please share your thoughts in our comments section.

Published: January 10, 2013

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