Sunday, August 2, 2009

Worth Repeating- The Birth Survey

I have another blog that is becoming defunct, but this post from a month ago is worth repeating, especially since I have a mostly new audience:

I think we all know that the intervention rate in the US for hospital births is through the roof. My OB with my first pregnancy told me why. My translation of what he said: "First we are typically recommended to administer an IV bag of fluids- it is just hospital protocol. That dilutes the oxytocin in the body, which is controlling the contractions. The contractions slow, become ineffective, or cease completely. Then you are labeled 'failure to progress.' As active managers of labor, we as OBs are required to do something to actively manage and we administer pitocin. The pitocin makes the contractions unbearable, and an epidural is called for. The epidural numbs everything and can slow, stop, or make the contractions ineffective. You are again labeled 'failure to progress' and the pitocin is upped. The baby doesn't always handle the combo of the pitocin and epidural well, and an emergent c-section is performed. It's not a domino effect, it's a bundled effect. An IV and bag of fluid greatly increases the likelihood that you will have a c-section." I asked him what we could do to change this and he said that he didn't know.

We now know how to make these changes. It's called The Birth Survey. The Coalition for Improving Maternity Services has spent years developing a way to create transparency among facilities and providers of maternity care. As of now, in the state of SC, you can call any doctors office or hospital and ask for their c-section and intervention rates and you will be told that that information is a) something that they do not retain, b) something that they do not give out, or c) is too controversial and will not be released. As a consumer of goods and services I have the right to know what those providers' and facilities' intervention rates are because research shows that 'place of birth and provider are the most important variable in predicting patient outcome and morbidity.'

Yes, morbidity. Women are still dying in childbirth in the US. Our c-section rates are over 3 times higher that the World Health Organization's recommendations of 10%, yet our mothers and babies are dying. We have the worst infant mortality rate in the developed nations. One would assume that with greater technology and higher intervention rates, the ratio of death and negative outcomes should be inversely proportionate to the interventions used. So, if the interventions go up, the negative outcomes decline. But it's not. What we are seeing is that as the interventions increase, the negative outcomes either stay the same or increase.

And let's not forget about the physical and emotional effect that cesareans are having on these new mothers (and their babies!), especially when they anticipated vaginal deliveries. Midwifery Today had a compelling article about it not too long ago.

Transparency is an issue whose time has come. 25% of all hospital discharges are maternity related, so it is obvious that this transparency must include maternity care. And just like the Hawthorne Effect shows us in industrial engineering- people who are watched while doing their work do a much better job (you can see it everywhere- at your home, at work, as a laboring woman, as a doctor)- Transparency translates to better care.

The Birth Survey is a comprehensive questionnaire about your prenatal care and birth experience. It is a chance to sing the praises of your healthcare practioners and facilities, or share unpleasant experiences. Then, women who are searching for high quality care can look up each hospital and each individual doctor and practice and make an informed decision based on other women's experiences. I would personally not choose a doctor who had a 60% c-section rate, or a hospital that required an IV 100% of the time. And this is where YOU come in.

If you have had a baby in the last 3 years in the United States and have access to an internet connection, you can help make changes in the maternity care system. All you need is about 30 minutes to fill the survey out. Go to The Birth Survey and click on "Share"... We can change the way maternity care is done in the US, but it will be done one woman, one answer, one click at a time.

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