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Midwifery by the Numbers

by Kimla McDonald, CNM, Guest Blogger

According to Amnesty International’s “Deadly Delivery: The Maternal Health Care Crisis in the USA,” published in March 2010, maternal mortality increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 in 2006. While improved data collection accounts for a portion of this increase, and even though the United States spends more than any other country on health care (about $98 billion for the 4 million births that occur each year), women here have a greater lifetime risk of dying of pregnancy-related complications than women in 40 other countries.

The US cesarean birth rate has increased each year since 1996, and is now more than double the WHO recommended range of 10% to 15%.*

I’m sure most, if not all, of these numbers are familiar to working midwives. And for those who tune in to CNN or occasionally read a newspaper, here’s another number that’s in the headlines: $2.4 trillion—the increase to the debt limit officials think is needed to get the government through November 2012.

Can midwives and obstetricians do anything to contribute to solving this debt crisis? Perhaps, since a part of our debt can be traced to the high cost of health care. Sometimes a small but fundamental change can make a big difference. I’m proud that the hospital where I practice recently established a formal policy requiring elective inductions to be scheduled no earlier than 39 weeks.

Cost reductions associated with the policy have not yet been calculated for our hospital, but in Utah, according to a June 2011 Reuters article, Intermountain Healthcare did the same thing in 2008 for the 18 maternity wards in its system. Intermountain figures that the 500 newborns who avoided breathing problems by being born after 39 weeks saved at least $1 million that year in unnecessary medical costs for families and insurers. With fewer early inductions, the cesarean delivery rate also fell, which reduced risk and saved about $46 million.

It’s amazing what promoting vaginal deliveries at an appropriate gestation can do—sounds a lot like how midwives practice!

*World Health Organization. Appropriate technology for birth.The Lancet 1985; 2:436-7.

Posted 8/2/2011 8:52:28 AM



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