Milbank report

This report from Childbirth Connections, called Evidence-Based Maternity Care is a whopping 128 pages long. Only half of it is the actual report; the other half is citation and appendices. But, if ever faced with a difference of opinion with a health care provider concerning any childbearing issue, you're sure to find helpful and well-cited information within its pages.

From what I can gather, though, it can be boiled down to these two ideas:

1. Today's U.S. maternity care costs a lot and performs poorly.
2. Both of those problems can be remedied with evidence-based practices.

The report spends most of its length describing in detail these preferred, safer, more effective evidence-based practices. They include: limiting labor induction, epidurals and cesarean sections; while more routinely utilizing midwives and family doctors, good nutrition and lifestyle choices, doulas (or other continuous labor support), spontaneous (rather than forced or too early) pushing, early skin-to-skin, breastfeeding support, minimizing newborn discomfort, and psychosocial postpartum support.

Well, let's get the great big "Duh!" out of the way, and move on to more constructive remarks.

I tried to find specific comments about the safety of different birth places, but the report focuses on practices, not birth place, although it is assumed that home is a viable choice. So, no points for or against homebirth from this report, except that you're likely to have fewer overused birth technologies at home, that's for sure!

The conclusions at the end are not written for the parents' (or consumers'), but for the birth community as a whole: parents, health care providers, insurers, administrators, etc. I like this statement best:

"Maternity care decision should be guided by the best available evidence and the principle of effective care with least harm, as well as the informed preferences of women and their families, rather than by unsupported beliefs about appropriate care, convenience, liability pressure, or other extrinsic factors. " (page 68, emphasis mine)

It's actually more readable than I thought it was going to be. I hope it's of interest to some of you.

~s~