While working clinically as a Physician's Assistant, one of my favorite industry medical journals to read was always Clinician Reviews. Geared toward mid-level practitioners, this journal is typically sound in its presentation of medical literature as well as sensitive to the unique aspects of clinical practice for PAs and Nurse Practitioners.

Last week, I discovered what to me felt like a major faux pas in an article written by the journal's managing editor. The article entitled, Women's Health in the US: Have We Lost Our Way?, started out sounding pretty good until I discovered that, like many discussions on the state of healthcare in the United States - maternity care was left out completely.

In Dr. Tricia Pil's recent blog post about the institution of the HCAPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey, we learned that while patient experience surveys like this are becoming integrally useful in assessing the state of U.S. healthcare, maternity care-specific analysis is still lagging.

In fact, the Clinician Reviews(CR) article was also based on a healthcare system analysis tool, a 'Report Card' fueled by the National Women's Law Center (in partnership with the Oregon Health and Science University). Although the Report Card does address a few issues pertaining to maternity care (namely Women Without Health Insurance and access to First Trimester Prenatal Care) these indicators were not even mentioned in the CR article.

I have sent in the following response to the editorial staff at Clinician Reviews with the hopes they will print my remarks in their next issue:

It's great to see individual efforts underway whic raise awareness of U.S. maternity care system failings such as those by:
The Coalition for Improving Maternity Services
The Leapfrog Group
Childbirth Connection
California Maternal Quality Care Collaborative
United States Breastfeeding Committee
Members of Congress who are working to improve the quality of maternity care in the U.S.through introduction of new legislation

But...until this becomes a ubiquitous, national dialogue...until the gravity of these unacceptable statistics becomes a household conversation, the misconception of our nation's 'superior' maternity care system will prevail.

Let's be honest: many folks believe that the United States women's perinatal healthcare system is superior because we theoretically have access to SO MUCH. And yes, in comparison to most underdeveloped nations, U.S. women experience hugely superior perinatal care and overall safety. But this is a big country in which over 4 million women give birth each year. And so, the deficiencies that exist still have enormous (and often deleterious) effects.

We ARE a nation which boasts excess: our pharmacies are overflowing much medicine (compared to under served/underdeveloped nations) and yet a woman with no healthcare insurance may not be able to afford medicine she is deemed in need of; we have plenty of testing equipment: performing/interpreting ultrasounds, blood & urine chemistry in the provider's office is accomplished quickly and easily - and yet a woman lacking access to proper prenatal care misses out on that theoretically accessible testing; we have oodles of maternity care providers (women in many African and Asian countries continue to endure pregnancy, labor and birth with NO trained personnel - largely contributing to their astronomical maternal morbidity and mortality rates).

Highly developed medical systems like ours boast people, devices and medicines out the wazoo...how can we not be the best?

And yet, the truth is in the numbers. With all this knowledge, technology and availability of health-promoting goods, we continue to see a rise in maternal mortality, a deficiency in the access to adequate prenatal care for a HUGE segment of our maternal population and an ever-increasing rate of surgical delivery when the World Health Organization STILL prescribes a 'safe' c-section rate to be no more than 15% (with 5-10% considered optimal).

In my humble opinion, these are the people who need to care about and engage in discussions over the U.S. maternity care system:

All healthcare providers who come into contact with women of childbearing age:doctors of varying disciplines, nurses, medical assistants & technicians, ultrasound technicians. I once had a dermatologist try to prescribe me a topical chemotherapetuic agent for a skin rash...while I was pregnant. He didn't seem to be too terribly concerned about the potential effects of the absorbed medication on my unborn baby, nor my pregnant physiology (and yet, he likley would have - had I accepted the prescription and experienced a regretful side effect.)

State and federal legislators: Reviewing the report card referenced in the Clinician Reviews article, it seems that lack of health insurance and inadequate access to first trimester prenatal care is a country-wide problem (for all but members of the highest socio-economic group). This is a systemic issue that needs to be addressed at both the state and federal level. Have you contacted your local legislators to remind them of these important issues?

Laypeople: Pregnant women who are currently experiencing the maternity care system are NOT the only folks who should care about these issues. Women and their partners who anticipate a pregnancy in their near (or distant) future should be thinking about the status and quality of the maternity care system in which they will become consumers. Current and would-be grandparents should care about this due to its direct effect on the health and well-being of their adult (female) children and would-be grandchildren. Clergy who spiritually and emotionally support young families in times of need - especially when pregnancy presents special challenges. Neighbors who become aware of a nearby pregnant community member placed on (hottly debated) bed rest.

Get my drift?

Anyone who can confirm knowing a pregnant woman, a family with young children or a woman who will likely become pregnant in the near future should care about this issue. What are we, as maternity care providers, childbirth educators birth or postpartum doulas and laypeople doing to raise universal awareness about the true state of our nation's perinatal healthcare system?

Posted by: Kimmelin Hull, PA, LCCE

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