Health policy trends for early delivery in pregancy

I am grateful to have the opportunity to work with many women who are pregnant at Marinwood Community Acupuncture. It allows me to hear many stories about the approaches of different hospitals and Obstetricians throughout Marin County. My patients share information about the regularity of their check ups, whether or not they include ultrasounds or stress tests, and how often they are performed. I get to learn the differences of opinion between different medical approaches for conditions such as nausea and vomiting in pregnancy and each doctor’s prefered solutions, which range from just telling the patient to ‘tough it out’, to the administration of medications to remove the symptoms when they become severe. It is all a wonderful way for me to absorb more information about the process of a woman traveling from pregnancy through to delivery. It can be a source of great happiness for myself to work with a patient through the treatments which aid in fertility, to management of the onset of nausea, to efforts to control (or at least try to control) the troubles with low back pain and sleep, and finally to helping to bring on labor once the baby is at full term.

Through all of these talks I have noticed a shifting trend among patients of different ages concerning the frequency with which elective delivery by C-section are taking place. It seems to be a very prevalent story among those patients who have had one or two previous pregnancies in the last five years or more that a C-section delivery was performed because the women was ‘late’ in delivering naturally. Usually the pattern also included the promise that subsequent vaginal deliveries would be possible but in the end each of the following children were also delivered via Cesarean. I can see the complex emotions that my patients feel just by watching their faces, or listening to their tone of voice, as they talk about the desire they had for a natural birth and all the planning they had made for a home delivery. Things, for one reason or another, ‘just didn’t look right for a natural birth’ to the Obstetrician.

In those Women who are newly pregnant, with their first child, there seems to be less talk about a push for surgical deliveries. While I do still encounter a seemingly majority of patients who end up being induced with pharmaceuticals in the hospital I do not seem to hear of elective/scheduled C-sections. While thinking about the reason for the change between those women who delivered children in the past versus those I have worked with in the last two years I came across a very interesting article on health policy trends in the New York Times.

Times writer Tina Rosenberg, in her article Reducing Early Elective Deliveries, covers the trends over the last ten years in nationwide hospitals for early deliveries among pregnant women. She also does a really nice job of discussing how health practices that have been found to be unhelpful or dangerous for the outcome of the patient can continue to stay in practice in the large hospitals around the country. Thankfully, she also shows how just a few well read and well placed articles in major health journals can be the spark needed to start national health reform to reduce the incidences of these procedures and provide better patient outcomes. She does note sadly, that the real impetus for change in those states where the practice was most firmly entrenched was financial. It was the refusal of Medicaid to pay for the procedures of low income women that got the hospital to actually reduce the numbers and follow the national health policy trends. I found this article to be very education and I recommend that you take the time to read it as well.



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