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Tag: Childbirth

A Tale of Two Births

I have two sons, both healthy happy boys, both brought into this world in very different ways.  I work in healthcare and like many readers of THCB, the business of healthcare is often viewed through the business lens.  When we become the healthcare consumer, and are knee deep in the conundrum that is our healthcare system, the perspective changes dramatically.

Ezra was born in a major medical center, under the supervison of state of the art OB/GYNs, with all of the greatest technology, and under the care of the best nurses.  My wife wanted a “natural birth”, so natural that I affectionately describe it as a “granola birth”.  We were active duty military at the time so our choices were limited.  She hired a birth doula, read Ina May’s “Guide to Childbirth”, chose to see a Women’s Health Nurse Practitioner for her wellness visits, and was adamant that she did not want an epidural.

As we approached 40 weeks the adventure began.  At 36 weeks she could no longer see the NP, she had to now see the OB/GYN.  The OB/GYN began to make reference to not allowing us to go past 40 weeks, it would “endanger the child”.  My wife began to feel very uncomfortable and that she was slowly losing control of the experience she wanted to have.  At the 40 week visit, the OB/GYN gave a very stern warning that an “induction was now necessary for the safety of the baby” regardless of there being no indication that Ezra’s wellbeing was compromised.  We resisted as much as possible (with the help of no beds in the maternity ward) but at 41 weeks and 2 days, doctors’ orders brought us into the hospital for an induction.

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Bending the Curve, Beginning with Birth

As I prepare for next week’s webinar on payment reform to align incentives with quality, I have been thinking a lot about how we pay for maternity care in this country, and the opportunities to rein in costs while improving the quality of care. I have concluded that we face both an unprecedented opportunity and an unprecedented responsibility to get serious about maternity care payment reform.

Pregnancy, childbirth, and newborn care are collectively the most common and expensive hospital conditions billed to both Medicaid and private insurers.  The national hospital bill for maternity care totaled $98 billion in 2008 – and no other condition came close to this figure. (See more facts about costs on Childbirth Connection’s updated Facts and Figures page),  With states across the country facing budget crises, strategies that responsibly reduce the Medicaid bill for births ought to be on the table, especially if we can do so while simultaneously improving quality.  (More on that in a minute.)

What are the arguments for payment reform?  They fall into a few categories:

  • We’re paying too much
  • Incentives and idiosyncrasies built into the current system virtually guarantee that we’ll continue to pay too much
  • The payment system offers no accountability whatsoever for providing high quality care. In fact, it incents poor quality care.

Although maternity care seems to have been off the radar of those debating strategies to bend the cost curve, that seems to be changing.  A flurry of recent articles and reports have demonstrated the points above:

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