Make Maternity Better: Focus on and Measure What Really Matters

Physically and psychologically healthy mothers and babies are what really matter - the process of how that happens should be secondary. So why do we measure and focus on the process and almost entirely ignore the desired outcome? Further, do the things we measure, really tell us what we need to know, to make maternity care in North America better?

The first goal of maternity care, should be to minimize the number of women and children who die as a result of the childbirth process, particularly those who die preventable deaths. Currently, statistics in Canada and the US are kept on infant and maternal mortality, however, statistics on preventable deaths are generally absent. We should measure what matters: what is the rate of preventable infant and maternal mortality in Canada and the US? Measuring this would be a first step in identifying the circumstances under which a preventable death is more likely and would enable action to minimize the risk of preventable deaths of mothers and their infants.

The second goal of maternity care should be to minimize the rate of serious physical injury to either mothers or babies and in particular the rate of preventable serious physical injuries. We generally measure serious maternal and infant morbidity, but tend not to measure the degree to which such morbidity would be preventable.

The third goal of maternity care should be to minimize the incidence of psychological harm to mothers as a result of the birth process. Currently, this is very poorly measured (if at all). There's a real opportunity to make maternity better by better understanding and measuring maternal psychological morbidity. Birth is a physical process, but its also a psychological process and its time that, that was better recognized.

We need to move away from the goal of maximizing 'normal birth', as normal birth in and of itself is not what really matters (physically and psychologically healthy moms and babies matter - regardless of whether or not they came into the world vaginally or surgically). We need to move away from the goal of maximizing breastfeeding, as breastfeeding in and of itself is not what really matters (physically and psychologically healthy moms and babies matter, regardless if they are breastfed or formula fed). It is entirely possible that by focussing on what really matters, rates of normal birth and breastfeeding might increase - but if they happend to decrease and rates of what really mattered improved, would that be such a bad thing?

It's time to radically change the business and religion of being born in North America, by shifting the focus to measuring what really matters.

Measuring Access Delayed and Denied

I have anecdotal evidence that timely access to medical care during labour and delivery is sometimes delayed and sometimes denied in BC. I have news articles about these cases and I have the conversations that I have had with other moms. I have some evidence that access to some services is significantly lower in BC than in other parts of the country (for example, the use of epidurals in BC is 30 percent compared to 60 percent in the rest of the country).

I know a problem exists, what I have no real way of knowing is how big of a problem exists. Statistics on how long a person waits for a requested service are not kept. Statistics on requests for services that ultimately didn't happen are not kept. Statistics on services that are bumped by more urgent cases are not kept. As such, I don't know how many other moms in BC are like me - I know that I'm not alone in my experience, but I don't know exactly how not alone I am.

I fear that I am less alone than I should be - I fear that cases like mine, that should be a very rare exception, actually aren't. I fear that quality care is missing for many women. If access delayed and denied was measured, it might be a first step to recognizing that a problem exists, the magnitude of it and moving towards changing it so that patients have a better experience of care.