Here in the U.S., we spend the most on maternity care in the world (an average of $9,000 to $15,000 per birth), yet we're the only developed nation in which our maternal mortality rates continue to rise. The birth industry in the U.S. is clearly fraught with challenges that need to be addressed. Dealing with insurance issues and a health care system that isn't always patient-centric can leave pregnant women frustrated and potentially upset over the handling of their labor and delivery. But what other options are there? Perhaps we can take a page from the U.K.'s handbook.
NICE's guidelines, which state it is safer for most women to have their births outside a hospital setting, start by recognizing that pregnancy is not a pathology and shouldn't be treated as such:
Giving birth is a life‑changing event. The care that a woman receives during labour has the potential to affect her – both physically and emotionally, in the short and longer term – and the health of her baby. Good communication, support and compassion from staff, and having her wishes respected, can help her feel in control of what is happening and contribute to making birth a positive experience for the woman and her birth companion(s).
If only this model of care was seen more frequently here in the U.S. Unfortunately we live in a country where patient care is simply not the focus when it comes to labor and delivery. To understand further, I spoke with Deborah Wage, a certified nurse midwife currently with Vanderbilt Department of OB-GYN (and who also happens to be my partner on a new book looking at the concept of the perfect birth). "Obstetrics in the United States is organized around a model where every pregnancy is viewed as a potential medical complication," she said. "Costs rise due to the technology and interventions required to support this model. Incorporating midwifery into obstetrics in the U.S., as has been done in the U.K. and many other countries, is essential if we wish to improve outcomes."
The U.K. understands the benefits of midwifery and has stringent education and licensing requirements for midwives. Unlike the U.S., where home birth midwifery is still illegal in some states and there is no regulation over home birth midwives, U.K. midwives are allowed the freedom to practice in hospitals, birth centers and homes, offering a wide option of settings for patients. This allows women to choose the best setting for their pregnancies while still maintaining a set standard of care, safety and skill. The NICE guidelines note that the risk of serious complications or death for infants is the same in all three settings, with the one exception of first-time mothers, where the risk increased slightly from 9 in 1,000 home births experiencing serious complications compared to 5 in 1,000 for babies born in a hospital. Overall, the guidelines state that women who have given birth under midwife-led care have had fewer chances of undergoing medical interventions like episiotomies, C-sections and use of instruments like forceps.
In the U.K., it's not about birth wars, with home births being pitted against hospital ones. It's about patient-centric care, as it should be. Deborah explained that the current U.S. system of birth needs a drastic change if we want to see positive results like in the U.K. "It is the siloed system in the U.S. that continues to marginalize midwifery and sadly marginalizes choice for women as well. We need a humanized, seamless, integrated model of care in the U.S. that offers and supports choice."
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