The solution

The good news is that there are many ways to reduce spending on maternal health care that actually benefit patients. Even small improvements can result in large savings.

The place to start is with the most common hospital procedure in America — the Cesarean section. A C-section is a surgical delivery of a baby, rather than a normal, vaginal delivery. Not only does a C-section typically cost twice as much as a vaginal delivery, it is more likely to result in infections, injuries and other complications for both mothers and babies. Yet today, nearly one-third of all babies in the country are delivered by C-section.

Fifteen years ago, C-section delivered only 20 percent of babies, and in the 1960s the C-section rate was less than 5 percent.

C-sections are particularly problematic when they are used to deliver babies too early. In non-emergency situations, a decision to surgically intervene has resulted in a growing number of cases in which doctors uses drugs or procedures to induce labor rather than let the pregnancy take its natural course.

About one-fourth of deliveries are now electively induced before the baby has reached full term (39 weeks). Yet research has shown that even babies born a few days too early are more likely to have problems such as developmental delays. Moreover, labor inductions before 39 weeks are more likely to result in expensive and risky C-sections, and the baby is more likely to spend time in an expensive neonatal intensive care unit.

Delivering better outcomes

by integrating midwives


Collaborative care gets better outcomes

Our collaborative care model of midwives and physicians at Bay Area Midwifery (with deliveries at El Camino Hospital Los Gatos) has achieved a primary cesarean section rate of 6% versus that hospital's average of 16.3%(the national average is 33%.)  While this practice has a low risk population of women, numerous studies have reported similar findings in women with selected risk factors.

Other practice data from our pilot project for the year 2012 shows no induction, no prematurity and a patient satisfaction rate of over 98%.

Facts about midwives

  • 75% European births are attended principally by midwives, while 5% of births are attended by Certified Nurse Midwives in the U.S.A.
  • Number of midwives needed in the U.S. to meet European levels: 120,000
  • 100% Medicaid reimbursement for CNM care is mandatory in all states.
  • 82% of CNM's have a masters degree.
  • More than 4 million babies are born each year in the United States. Nurse-midwives assist in slightly more than 7 percent of those births (CNM's account for 5%).
  • The Center for Healthcare Quality and Payment Reform has estimated that reducing the rate of US cesarean deliveries to the 15% recommended by the World Health Organization could save about $5 billion a year.

CNM's attend 5% of U.S. births