Milbank Report: Evidence-Based Maternity Care

What are the key findings of Evidence-Based Maternity Care?

Evidence-Based Maternity Care Report
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Despite good intentions of many dedicated health professionals and very large expenditure of resources, the U.S. maternity care system has many shortcomings. Many women and babies receive poor quality maternity care, including many procedures, drugs and tests that are not needed — "overuse" — and failure to get many beneficial forms of care — "underuse". Thus, overall national performance on many quality indicators is poor when compared to the benchmarks of high performers in the United States and achievements of many other affluent and less affluent nations. In fact, important indicators such as low birthweight and preterm birth rates have been worsening for decades.

Poor quality care and unacceptable health outcomes affect a very large population — there are over 4.3 million births in the United States every year. And they impact babies during their most sensitive and important period of development and younger, primarily healthy women.

Further, private insurers (covering 51% of all births) and Medicaid programs (covering 42%) are getting poor value for their considerable investment in maternity care. This translates to wasted resources for taxpayers, employers and families themselves. Maternity care plays a major role in the health care system. Hospital charges for mothers and babies far exceed charges for any other condition, and cesarean section is the most common operating room procedure in the country.

However, there is good news: a large body of rigorous systematic reviews is available now to point the way toward improved care, health and use of resources. The Evidence-Based Maternity Care report (PDF) highlights best evidence that, if widely implemented, would have a positive impact on many mothers and babies and would improve value for payers. The report also identifies barriers to providing evidence-based maternity care, and presents policy recommendations to address the barriers.

What are top implications for policy makers, childbearing women and maternity professionals?

Policymakers can play an important role in improving quality, health outcomes and resource use by addressing barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.

Childbearing women
need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices — for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task — and can have very big pay-offs.

Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.

How was the new report developed?

The authors of Evidence-Based Maternity Care (PDF), Carol Sakala and Maureen Corry, are senior staff at Childbirth Connection. Their long involvement with evidence-based maternity care includes planning and leading Childbirth Connection's national program to promote such care over the past decade.

Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund collaborated in planning, developing and issuing the report, including formulating policy recommendations.
  • The Reforming States Group, organized in 1992, is a voluntary association of leaders in health policy from all fifty states, Canada, England, Scotland and Australia.
  • Milbank Memorial Fund is a foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform health policy. The Fund has worked on significant health policy issues since 1905.
  • Childbirth Connection, founded in 1918, is a national not-for-profit organization that works to improve the quality of maternity care through research, education, advocacy and policy.

Many national policy, quality and maternity care leaders provided detailed feedback on report drafts and further strengthened the final report (PDF).

Most recent page update: 4/4/2011

© 2016 National Partnership for Women & Families. All rights reserved.

Founded in 1918, Childbirth Connection has joined forces with and become a core program of the National Partnership for Women & Families. Together, these two women's health powerhouses are transforming maternity care in the United States.
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