I've given a talk called, "Transparency in Maternity Care: Bringing Birth Out of the Dark to Improve Quality" a number of times at conferences and as a webinar. (I will give it again as a webinar in September for Lamaze, so make sure you're signed up to get e-News updates if you're interested.) The case for transparency in maternity care is compelling. Maternity care is unique among health care specialties because women have a long interval of time (9 months!) to decide where to go for their labor and birth care, so it's reasonable to assume that publicly available quality information might help women make informed choices and drive quality improvement. (Compare that with the decision making process for someone having acute chest pain - just call 911 and go to the closest hospital!) Also, most consumers of maternity care are healthy, so unlike surgical or chronic care specialties, good outcomes are not measured in survival or duration of hospital admission (although these are of course very important), but rather how well the system protects, promotes, and optimizes the health of its beneficiaries - women and babies.

Unfortunately, we have very few studies that actually measure the effectiveness of transparency programs in maternity care. So for my talk I built my case using the evidence that supports six points that, taken together, demonstrate an urgent need for better transparency.

• Intervention rates and outcomes vary widely across providers and facilities
• Most of this variation has to do with factors unrelated to the woman's health status
• Excess use of interventions leads to excess injury and cost
• Public awareness of quality indicators results in improved quality
• Intervention rates can be lowered without compromising safety
• Mother-friendliness is a measure of quality

Not long ago, Nasima Pfaffl from The Birth Survey asked me to post the bibliography from my talk on The Grassroots Grapevine, a site where maternity care advocates can connect and work together on maternity care improvement initiatives, including transparency. I'm posting that list again here, along with a brief note on the key findings of each article. Click on the extended post to see the bibliography.

The Birth Survey just reached a major milestone. Consumer survey results rating health care providers and birth facilities are now available at TheBirthSurvey.com. Watch this space for more about transparency and The Birth Survey in the weeks to come.

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