Transforming Maternity Care: Action Steps Toward a High-Quality, High-Value Maternity Care System

Abstract

In the eight years since publication of the Institute of Medicine’s Crossing the Quality Chasm: A New Health System for the 21st Century (2001), the United States has taken big leaps forward in understanding and addressing broad consequential deficits in health care quality. Until recently, these efforts have largely bypassed a major segment of the health care system, namely, the maternity care delivered to women, newborns, and families who experience over 4.3 million births annually. This oversight is an inadvertent result of current trends, such as a focus on Medicare beneficiaries and a focus on chronic disease. Maternity care holds a major position in the health care system. In 2007, it was the leading reason for hospitalization in the nation, with childbearing women and newborns accounting for 25% of all discharges. Six of the ten most common hospital procedures were maternity related, and cesarean section was the most common operating room procedure (Levit, Wier, Stranges, Ryan, & Elixhauser, 2009). Maternal and newborn hospital charges exceeded $86 billion in 2006, with employers and private insurers paying for 50% of all births and taxpayers/Medicaid paying for 42% (Russo, Wier, & Steiner, 2009). Although most childbearing women and their babies are healthy and at low risk, the current style of maternity care is procedure-intensive and costly. Deficiencies include overuse of many interventions and practices associated with harm and waste; underuse of beneficial practices that would improve outcomes; broad unwarranted geographic, facility, and caregiver practice