Childbirth in the United States is, on average, more expensive and less safe than in many other developed countries. Our cost for a vaginal delivery is much higher than that in the next-most-expensive country, Switzerland. And we're not getting great value for the extra money: Cesarean deliveries are more common and maternal and infant mortality rates are higher than in many other countries. Meanwhile, many women say they would prefer to receive fewer medical interventions in childbirth.
In a viewpoint published this week in JAMA, three physicians from Stanford's Clinical Excellence Research Center propose a new approach that would address all of these problems simultaneously. Hospital-affiliated outpatient birth centers could be opened to care for many women who are expected to have low-risk births, say Victoria Woo, MD, Arnold Milstein, MD and Terry Platchek, MD. "As a society with increasing health care costs, it makes little sense to pay for inpatient care for women who neither need nor want it," they write. Other countries such as the United Kingdom have already developed successful methods for identifying women with low-risk pregnancies who may not need to plan to deliver in hospitals, they add. Although the U.S. already has some birth centers, they aren't widely used or well-integrated into the health care system, the authors argue.
One potential drawback to birth centers is that in some circumstances, low-risk deliveries suddenly turn into emergencies for the mother, the baby, or both. In those cases, good hospital care can make a big difference. But birth centers could be set up adjacent to hospitals and operate in a way that provide access to expert care when needed:
An outpatient birth center and associated hospital would be staffed at all times by an integrated health care delivery team including a certified nurse-midwife in the birth center and an obstetrician and anesthesiologist in the associated hospital. In an emergency, the woman would be transported to the ... hospital and, if necessary, directly to the operating room.
A dedicated pediatrics physician or nurse practitioner could work shifts in the hospital and birth center settings and with broader experience and regular practice in resuscitation skills, be better able to manage neonatal emergencies.
The team concludes that with the right planning and execution, outpatient birth centers could make births safer, let women giving birth avoid medical interventions they don't need, and save money, too.
Previously: Reducing cesarean delivery rates, without jeopardizing safety, Avoiding first-time cesareans: Stanford-based center releases new guidelines and Experts brainstom ways to safely reduce health-care costs
Photo by Joshua Rappeneker