Editor’s note: This post was updated 1:12pm EST, July 28, 2010
An increasing push for a more focused and intense effort to address maternal and newborn health in this country has led to the introduction of the MOMS (Maximizing Optimal Maternity Services) for the 21st Century Act last week. Congresswoman Lucille Roybal-Allard introduced the bill into the House of Representatives in hopes of reversing some dangerous trends in maternity care, including rising c-section rates and increased use of interventions during labor that do not, overall, improve health outcomes for mothers or their babies.
The legislation has the potential to transform maternity care in the United States and it’s a system that badly needs transforming if we are to save women’s and newborns’ lives. Despite spending more than $86 billion per year on maternity costs (costs associated with pregnancy care and in-hospital birth), the United States still ranks high when it comes to maternal mortality rates among industrialized nations. In fact, according to Amnesty International,
“The United States is the wealthiest country in the world and spends more on health care than any other country. But we are failing to reverse the trend of preventable maternal deaths and complications. Amnesty International USA’s recent report “Deadly Delivery: The Maternal Health Care Crisis in the USA” found that women in the United States have a greater lifetime risk of dying of pregnancy-related causes than women in 40 other countries. For women of color, the risks are especially high. As a nation, we simply cannot allow one more woman to die needlessly or experience life-threatening complications. We must urgently move toward a health care system that respects, protects and fulfills the human right to health.”
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Rep. Roybal-Allard calls this a “national tragedy” saying,
“Tragically, in spite of all the money we spend, the United States continues to rank far behind nearly all developed countries in perinatal outcomes, with childbirth continuing to present significant risks for mothers and babies, particularly in communities of color…”
The intent of the bill is to make evidence-based maternity care a national priority while, at the same time, bring down maternity care costs and address important health disparities to allow for the best possible health outcomes for mothers and their babies. The legislation aims to do this in a variety of ways.
First, there is the inclusion of language that supports birth attended by Certified Professional Midwives (CPMs) and birthing in out-of-hospital settings like certified birth centers; both of which, as supported by evidence, reduce unnecessary medical interventions (which contribute to poor health outcomes) in healthy pregnancies.
This language, in part, is the result of a key partnership with the American Association of Birth Centers (AABC), The Big Push for Midwives and the American College of Nurse-Midwives (ACNM).
“Certified nurse‐midwives (CNMs) and certified midwives (CMs) are leading experts in evidence‐based maternity care practices associated with excellent maternal and infant outcomes,” said ACNM Executive Director Lorrie Kline Kaplan. “ACNM is working with federal policymakers to increase the number of skilled midwives and increase access to midwifery care in the U.S.”
The legislation notes that “although most women in the U.S. are healthy and at low-risk for complications,” Ob-Gyns are by far the most common care providers, rather than midwives and family practice physicians. Studies have shown that patient satisfaction is higher and costs are lower with out-of-hospital, midwife-attended birth while safety remains equivalent. The legislation doesn’t facilitate legalization of midwives in those states in which certified professional midwifery is still criminalized but it does make clear that our country’s over-reliance on medical interventions such as continuous fetal heart rate monitoring, episiotomies, and epidurals can lead to greater harm in mother and newborn when used “indiscriminately.”
The legislation also acknowledges extreme disparities along racial and ethnic lines, when it comes to maternal and infant health. African-American women (of every socio-economic strata) are four times as likely to die during childbirth as are White women – and this hasn’t changed in twenty years. Non-Hispanic Black infants, according to the bill, “continue to experience significantly higher rates of both pre-term birth and low birth weight, two of the leading causes of infant mortality in this country.”
Our system is in need of a major fix also in terms of the creation of a more culturally diverse and interdisciplinary maternity care workforce. The bill not only incentivizes entering the maternity care profession by providing a special loan repayment program for potential family physicians, OBs, Certified Nurse MIdwives and Certified Professional Midwives (CPMs) who have graduated from an accredited midwifery education program), according to Patrick Cooney, lobbyist for ACNM, but it also encourages various provider groups to “recruit, within their particular professions, a more racially and ethnically diverse community.”
In addition, a good portion of the bill, says Cooney, is focused on educating the consumer about evidence-based literature on maternity care options. Cooney told me, “In many ways, it boils down to what the woman decides is the care she wants.” By initiating a national public awareness campaign, which will include a web site to house an extensive database with information on childbirth, and provide information on caring for newborns; and also by ensuring funding for both radio and television ads about evidence-based maternity care options for women, the bill is focused on providing extensive publicly-available information to supplement information from care providers themselves.
The bill, then, intends to establish an additional focus area for the Office of Women’s Health while also creating an Inter-agency Coordinating Committee on the Promotion of Optimal Maternity Outcomes.
This legislation provides the blueprint for a badly needed overhaul to maternity care in the United States. It won’t happen while Congress finishes out the remainder of the session because there simply isn’t enough time. But with 25 sponsors signed on as the bill was introduced and at least six more signing on soon after, Cooney is confident that when it’s re-introduced in January 2011, with a new Congress, they’ll have at least 50-100 House sponsors ready. It’s a long time in the making.