December 24th, 2014
(written by lawrence krubner, however indented passages are often quotes). You can contact lawrence at: firstname.lastname@example.org
The ultimate paradox of how our species currently reproduces itself is that we have managed to make human birth an inhuman medical experience. Think how strange it is that policy-makers even need this advice:
Policy makers who wish to achieve clinically important improvements in maternity care, particularly around normalising and humanising birth and preventing preterm birth should consider midwife-led continuity models of care and consider how financing of midwife-led services can be reviewed to support this.
The USA has stumbled into a situation where it suffers with a fragmented system:
Fragmentation fosters frustrating and dangerous patient experiences, especially for patients obtaining care from multiple providers in a variety of settings. It also leads to waste and duplication, hindering providers’ ability to deliver high-quality, efficient care.
Amy Romano writes:
We see this kind of fragmentation in maternity care. For example, most electronic medical record systems are poorly integrated between ob-gyn offices and hospitals, so the standard way to get information to the hospital is to fax or email a copy of the prenatal record in the third trimester. This means women who present in preterm labor may not have any record available at all, while those who present at term may lack the last few weeks of data. As for provider continuity, a 2012 national survey found that one-third of new mothers reported having never met or only met briefly the provider who cared for them at birth. If no one taking care of you knows you, and your health record is missing, how are you going to get appropriate – or even safe – care?
But fragmentation is not just about disorganized and duplicative services. It is also about services that are missing altogether, like prenatal education, which has been squeezed out of the prenatal visit in favor of tests and procedures, or labor support, squeezed out by the machines and documentation that draw nurses’ attention away from the woman.
It is also about fragmenting health from family and community. We see this in how childbirth is managed as an “acute episode” requiring hospitalization. Once an intimate part of a family’s home life, childbirth has been plucked out of history’s long-honed human experience and put inside the four walls of a delivery room – or an operating theater. Although we gained access to some life-saving treatments, it is hard not to imagine that we gave something up in the process.