High Interventions deliver huge childbirth bill

Study: High-tech interventions deliver huge childbirth bill
By Rita Rubin, USA TODAY

Childbirth is the leading reason for hospitalization in the USA and
one of the top reasons for outpatient visits, yet much maternity
care consists of high-tech procedures that lack scientific evidence
of benefit for most women, a report says today.

U.S. hospital charges for maternal and newborn care jumped from $79
billion in 2005 to $86 billion in 2006, the authors write. More
than $2.5 billion a year is spent on unnecessary C-sections, which
now represent nearly a third of all deliveries.

Reducing expensive techniques such as C-sections and increasing
low-cost approaches such as childbirth assistants called doulas
would improve mothers' and babies' health while cutting costs, the
authors say.

The report was produced by the Milbank Memorial Fund, the Reforming
States Group of government health policy leaders; and Childbirth
Connection, a research and advocacy group.

"Everybody recognizes that our health care system's in trouble,"
says Childbirth Connection's Maureen Corry, co-author with colleague
Carol Sakala. "But when it comes to maternity care, no one talks
about it."

Yet, she says, with 4.3 million babies born annually, nearly one
in four people discharged from U.S. hospitals are new mothers or
newborns. On the outpatient side, only checkups, follow-ups and
coughs rack up more visits than maternity care.

In 2005, the average hospital charge for an uncomplicated vaginal
birth was $7,000, compared with $16,000 for a complicated C-section,
Corry reports. "I think a lot of people have no idea about the
cost," she says.

The University of Wisconsin's Douglas Laube, a former president of
the American College of Obstetricians and Gynecologists, blames
"very significant external forces" for the overuse of expensive
technologies in maternity care.

"I don't like to admit it, but there are economic incentives" for
doctors and hospitals to use the procedures, says Laube, who reviewed
the new report before its release.

For example, some doctors might get bonuses for performing more
labor inductions, which adds costs and increases the risk of
C-sections, which, in turn, increase hospital profits because they
require longer stays.

In addition, some doctors order unnecessary tests and procedures
to protect against malpractice suits, Laube says.

Bonnie Jellen, head of the American Hospital Association's maternal
and child health section, hadn't seen the report. She says women's
preferences and doctor's malpractice concerns have helped raise the
C-section rate.

Says Corry: "A lot of people think pregnant women are accidents
waiting to happen. It's just crazy."

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