Millbank Report on Evidence-Based Maternity Care

Two articles just came out in USA Today about the rising costs of maternity care and about evidence-based solutions to the high levels of unnecessary interventions and procedures performed during labor and birth.

Study: High-tech interventions deliver huge childbirth bill
Maternity-care failings can be remedied with cost-saving fixes

The findings come from a report, Evidenced-Based Maternity Care, issued jointly by the Milbank Memorial Fund, The Reforming States Group, and The Childbirth Connection. You can download a PDF of the report or request a free printed copy.

From a summary of the report's findings:

What are the key findings of Evidence-Based Maternity Care?
Despite good intentions of many dedicated health professionals and very large expenditure of resources, the U.S. maternity care system has many shortcomings. Many women and babies receive poor quality maternity care, including many procedures, drugs and tests that are not needed -- "overuse" -- and failure to get many beneficial forms of care -- "underuse". Thus, overall national performance on many quality indicators is poor when compared to the benchmarks of high performers in the United States and achievements of many other affluent and less affluent nations. In fact, important indicators such as low birthweight and preterm birth rates have been worsening for decades.

Poor quality care and unacceptable health outcomes affect a very large population -- there are over 4.3 million births in the United States every year. And they impact babies during their most sensitive and important period of development and younger, primarily healthy women.

Further, private insurers (covering 51% of all births) and Medicaid programs (covering 42%) are getting poor value for their considerable investment in maternity care. This translates to wasted resources for taxpayers, employers and families themselves. Maternity care plays a major role in the health care system. Hospital charges for mothers and babies far exceed charges for any other condition, and cesarean section is the most common operating room procedure in the country.

However, there is good news: a large body of rigorous systematic reviews is available now to point the way toward improved care, health and use of resources. The Evidence-Based Maternity Care report (PDF) highlights best evidence that would have a positive impact on many mothers and babies and would improve value for payers. The report also identifies barriers to providing evidence-based maternity care, and presents policy recommendations to address the barriers.

What are top implications for policy makers, childbearing women and maternity professionals?
Policymakers can play an important role in improving quality, health outcomes and resource use by addressing by barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.

Childbearing women need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices -- for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task -- and can have very big pay-offs.

Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.