December 1, 2008
Nation Targets “Unwarranted Cesareans” to Improve Health of Americans
On November 17th, The National Priorities Partnership identified six goals to improve the health of all Americans. Two of the goals are directly related to maternity care.
- To engage patients and their families in managing health and making decisions about care.
- To eliminate waste while ensuring the delivery of appropriate care. In the full report, the National Priorities Partnership targets unwarranted maternity care interventions, specifically cesarean sections.
Instead of encouraging only “Informed Consent,” the new trend in health care is now promoting “Informed Decision-Making.” Patients or consumers should be presented with the full array of treatment options for their illness or condition. Contrary to the opinion of some physicians, research indicates that when presented all possible treatment options, consumers most often choose the least invasive option for themselves. It will not be enough for health care providers to discuss only the risks and benefits of epidural analgesia when presenting pain relief options to pregnant women. To promote informed decision-making, providers should discuss all possible effective pain relief measures including nonpharmacological strategies such as continuous support, warm baths, massage, and movement. Health care providers may be surprised at how many laboring women will try these options if they are offered before asking for drugs which may have unintended effects on both mother and baby.
The sixth goal is to “To eliminate waste while ensuring the delivery of appropriate care.” Under this goal, “targeting unwarranted cesarean section” is specifically highlighted. Because of the increased risks to both the baby and the mother with cesarean delivery and increased costs of 2.5 billion dollars a year, health care professionals and consumers are charged with reducing unnecessary cesareans in the U.S. The World Health Organization (WHO) recommends a maximum cesarean rate of 15%.
Childbirth educators can be instrumental in reducing cesarean rates by promoting effective strategies for low-risk women such as:
- allowing labor to begin on its own,
- planning for continuous labor support,
- staying at home in early labor, and
- avoiding unnecessary interventions such as continuous electronic fetal monitoring.
The National Priorities Partnership is composed of the nations' most respected health organizations including The National Institutes of Health, the Institute of Medicine, The National Institutes of Health, the Institute of Medicine, The Joint Commission on Accreditation of Healthcare Organizations, the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality, and many others.