Thursday, July 11, 2013

Penny Wisdom and Pound Foolishness in Maternity Care

It is fashionable to bemoan the high cost of health care - it does not matter if you live in Canada or the United States - and that extends to the costs associated with maternity care. Never mind that comparing the costs of maternity care between countries is fraught with difficulties - different countries have wholly different population health statuses, wholly different litigation systems, wholly different health care systems - all of which might contribute to differences in the price paid for maternity care. Unfortunately, what gets forgotten is what is bought with the money spent on health care during pregnancy and childbirth - and the value of those things, in terms of improved outcomes and satisfaction with the care received. It is not unlike bemoaning the high-cost of pursuing a university education that is likely to lead to a much higher paying job AND completely ignoring the likely increase in income (and productivity) that will be realized after graduation. Unfortunately, the economics of pregnancy and birth, for whatever reason, seems to be done rather poorly - with a focus on very broad measures of outcomes (mortality) and very limited timeframes (sometimes only counting costs that accrue within 30 days of birth).

It is often forgotten that countries that have realized a lower cost of care for pregnancy and birth, may have done so by cutting corners on the quality of care available to women and their children - limiting reasonable access to options and sacrificing the lives and well-being of some women and children. Examples of the sort of tragedies that can result fill the pages of the Action to Improve Maternity (AIM) website a New Zealand based organization that has tried to bring some accountability and improvements to the midwife led system that is focussed on promoting normal birth. It is also not uncommon to hear tales of epidurals being denied or delayed in the UK or parts of Canada - again both countries where integrating midwifery into the system of care and promoting "normal birth" is the norm. A birth that does not involve an epidural is cheaper than one that does, but that does not mean that quality care was provided - particularly if the woman wanted an epidural and endured a painful and traumatic delivery as a result. A birth that results in a vaginal delivery is not necessarily quality care either - particularly if it leaves the woman traumatized, or herself or her child disabled.

I would not be surprised if well done economic studies on birth and intervention in birth would show that an ideologically driven system focussed on promoting and facilitating normal birth actually comes at a tremendous cost.

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