Catalyst for Payment Reform

Throwback Thursday: Maternity care stagnation

Throwback Thursday: Maternity care stagnation

In CPR’s column in Health Affairs last September, Suzanne and experts, Malini Nijagal and Jeff Levin-Scherz, highlighted how efforts to improve the rate of cesarean sections in the U.S have stagnated.   We haven’t made any further progress since then.  Given that pregnancy comprises a substantial portion of many employers’ health care spending, we think this is a topic worth revisiting!

Elective cesarean births are worse for both mothers and their children than vaginal deliveries.  In 1985, the World Health Organization (WHO) declared that there was no scientific justification for cesarean births in more than 10-15 percent of pregnancies.  But in 2016, the Center for Disease Control reported that 32.2 percent of U.S. births were delivered by cesarean section.

Why does the rate of cesarean deliveries remain persistently high?

There are multiple systemic factors contributing to this issue.  Doctors are paid more for cesarean deliveries than vaginal births—typically 50% more. They are also more convenient—the birth can be performed in a shorter amount of time and on a specific date. Some doctors and women also believe, erroneously, that cesarean deliveries come with fewer risks than spontaneous vaginal birth.  However, cesarean deliveries mean more potential health complications for both mothers and babies, from surgical site infections in the mother to respiratory problems in the newborn.

What can be done to change this?

Cesarean sections will always be more convenient for the provider—so there is little that can be done there. But, some organizations have mounted campaigns to educate expectant mothers and their doctors on the benefits of vaginal births and the risks of cesarean sections. However, given that the rate of cesarean sections is still high, these efforts don’t seem to have led to significant changes in clinical practice.

What can I do?

As a health care purchaser, there are several steps you can take to ensure your health plan’s maternity care strategy reduces the rate of cesarean sections to align better with the WHO’s suggestion, including:

  • Encouraging health plans to pay facilities the same for vaginal or cesarean deliveries.
  • Contracting directly with nurse midwives, who are shown to perform fewer cesarean sections.
  • Contracting with accredited free-standing birth centers.
  • Steering women to centers of excellence that have shown they can lower the number of cesarean deliveries.
  • And more!

You have a role to play in this effort. Take the first step to higher-value maternity care! Read more about what you can do by revisiting our Health Affairs blog.

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