Posts Tagged ‘Maternity Care’

You, The Consumer.

You are a mother. You are also a patient, or a client, depending on your care provider’s terminology. But, primarily, you are a consumer.

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Most of us don’t think of maternity care in this way- deciding to pay a specific birthplace and provider, rather than just going to the place that’s cheapest or where your friends went. But primarily, you are purchasing a service, not merely sitting under nonnegotiable care.

I am not writing this to undermine trust in your provider, or to encourage being a “bad” patient who is never satisfied. However, I think that there is enough variance in opinions, management styles, and routines among qualified providers to say that it’s fair to search for one who jives the most with your ideals. Let’s look at some examples.

Hospitals & Birthing Centers- First, look at the time limitations of  your hospital or birthing center. For example, our local hospital is the only one in about a 30-45 minute radius that provides maternity care, and only has 16 OB/GYNS who practice there, delivering around 3000 babies a year (at a 36.9% c-section rate). This means that this place is, in the words of several women I know who have birthed there, “a baby factory.” There is nothing wrong with choosing to have a baby there, but the implications of doing so must be considered. When there are literally not enough beds in the mother/baby unit and new moms are being made to share rooms with elderly men in the general sick patient area, you know that the hospital might be too busy. You know you won’t be receiving care from newborn nurses. You know there’s a possibility of  exposing your newborn to strange germs. You know you will lack privacy. You know you will lack sufficient one-on-one care. Yes, this hospital has a good NICU, round-the-clock anesthesiologist and cesarean availability, and a history of generally good outcomes (by American hospital standards), but does the high number of healthy babies at the end justify the means of care in helping them arrive?

Let it be known that not all hospitals are like this. I attended one about 2 hours from me that was much less busy, had only a 21.6% c-section rate, was quiet and calm, and had enough staff that the nurses could pop in whenever mom wanted them. Which of these two hospitals would I rather pay for their services? Certainly the latter.

One must also consider monetary influences on practices. (Before I write this, you must know that I don’t think all doctors/hospitals only want more money! I really do believe that they DO care about their patient’s well being!) It is worth noting that c-section rates are notably higher at for-profit hospitals than at non-profit institutions. Check out this news story for one example of this disturbing trend.

Home Birth Midwives

Time and money are also considerations for your midwife, though not as frequently as a big organization. How much does she charge? Does this correspond to her training and experience? How many clients does she take on a month? What is her back-up plan if she has two women in labor at once? You must know the answers to these questions before you hire her for your birth.

When hiring a home birth midwife, I think the most important consideration is finding out if you are paying for a qualified provider. As much as I support home birth midwifery,you  must remember that there are different breeds of midwife (CNM, CPM, and DEM), and there is currently no standard of certification for direct entry midwives. I’m not saying you shouldn’t hire one (my own midwife was direct entry), but you should make darn well sure that she is qualified to attend your birth before doing so. Find out her training and experience. Where and with whom did she complete her apprenticeship? Does she have references? Does she have a back-up doc?What is her hospital transfer rate, and what percentage is emergencies? What is her relationship to local hospitals? What are her maternal/infant/perinatal mortality rates, and for what reasons? How would she handle a hemorrhage? What equipment does she bring to a birth? Does she practice with legal integrity? I am not trying to scare anyone out of a home birth, but the safety of a home birth has been shown to depend upon the presence of a qualified attendant. Make sure that yours is.

Birth Philosophies– Remember, you are consuming services. Would you pay for a protestant pastoral education at a local college where the professors are Buddhist? Would you go to McDonald’s to purchase an organic beef hamburger? Would you go to the chiropractor’s office for heavy painkillers? No! Of course these are silly propositions.

Yet we do this over and over again when purchasing birth services. You might want a VBAC, but your provider’s successful VBAC rate is only 15%. “Too bad,” you say. “This is where our insurance takes us. I guess we’ll just work with it.” You have to think through how important your birth preferences are to you, and then choose (and sometimes actually pay for) a provider with a similar birth philosophy as you. You, the consumer, are responsible for picking a provider and birth place that support your desires. If you do not, then it shouldn’t be a surprise when things go differently than you’d hoped. Of course there are always aspects beyond your control, but you can make every effort within your power to ensure that you have purchased like-minded maternity care.

It has been said before that most people put more research into choosing a car or a stereo system than they do in choosing a care provider or birth place. Don’t let this statement be true of you. Make every effort to be an informed consumer.

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Saturday Morning Quote: Join the Minority

“Examine your own views toward the medical caregivers you have dealt with in your life- not just OBs. Korte and Scaer [authors of A Good Birth, A Safe Birth] classify medical consumers by the amount of control they hand over to their caregivers.

  • On one end of the spectrum are patients who totally relinquish responsibility for decisions about their bodies to the medical authority. A group of consumers closely related to the relinquishers are those who want to know what’s going on but still don’t want to make the decisions. Most consumers of medical care in North America lean towards these two views.
  • On the opposite end of the spectrum, a very few consumers opt out of the current sytem altogether, using self-perscribed regimens for healing, without ever consulting a mainstream medical practitioner.
  • A small minority of consumers are somewhere in the middle. They enter into a partnership with their caregiver or view the relationship as one of professional and client, as opposed to patient. These people want to have an active voice in their health care, They view their physician as an advisor who has expertise they can integrate into a plan for health. Join this minority.”

Natural Childbirth After Cesarean, Karis Crawford, PhD, & Johanne C. Walters, BSN, RN.

The Birth Survey

I’ve seen The Birth Survey referenced many times across the web, but I didn’t take it until last night. This survey has potential to be a fantastic tool for use in improving maternity services across the US. The makers of the survey wish to bring “Transparency in Maternity Care,” so that all women have access to information and feedback on various providers, hospitals, and birth centers in their area.

The objectives of the Transparency in Maternity Care Project read as follows:

Objective 1
Annually obtain maternity care intervention rates on an institutional level for all fifty states.

Objective 2
Collect feedback about women’s birth experiences using an online, ongoing survey, The Birth Survey.

Objective 3
Present official hospital intervention rates, results of The Birth Survey, and information about the MFCI (Mother Friendly Childbirth Initiative) in an on-line format.

Objective 4
Increase public awareness of differences among maternity care providers and facilities and increase recognition of the MFCI as the gold standard for maternity care.

The Birth Survey included questions about my prenatal, labor, delivery, and postpartum care by any and all providers that saw me during these times. Its questions tracked quality of care, intervention rates, availability of comfort measures, breastfeeding support, circumcision rates, and my satisfaction with my providers. 

I discovered after taking the survey that I could search for any provider in my area to view feedback provided on him or her by other women. Additionally, I found resources for searching birth statistics such as method of delivery, VBACs, birth weights, intervention rates, etc. in each state and each hospital or birth center. I found that 1,011 out of 2,727 total deliveries at our local hospital were c-sections in 2009 (that’s a 37% c-section rate!). About 34% of those cesareans were repeat, and only 21 VBACs were reported for the year. Wow!

This information should be widely available to women choosing maternity care providers and birthplaces. Please take The Birth Survey to share your birth experience, and have all of your friends do it too! It only takes a few minutes, and might help make big steps towards improving maternity care.