Maternity Care and Liability: Least Promising Policy Strategies for Improvement

BackgroundThe present liability system is not serving well childbearing women and newborns, maternity care clinicians, or those who pay for maternity care. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are unlikely to meet the proposed criteria and contribute to needed improvements. A companion paper considers more promising strategies.MethodsWe considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability, when available, and considered other studies when unavailable.FindingsFifteen strategies seem to have little potential to improve liability matters in maternity care. Despite support for capping non-economic damages, a series of studies has found a modest impact at best on maternity care. Maternity-specific studies also do not lend support to tort reforms collectively and several other specific tort reforms. Some tort alternative and liability insurance reform strategies have narrow aims and are not policy priorities.ConclusionsCaps on non-economic damages and other tort reforms have narrow aims and have been marginally effective at best in the context of maternity care. Several other possible reforms similarly are not promising. Continued focus on these strategies is unlikely to result in the high-performing liability system that maternity care stakeholders need.     

Maternity Care and Liability: Most Promising Policy Strategies for Improvement

BackgroundThe present liability system is not serving well childbearing women and newborns, maternity care clinicians, or maternity care payers. Examination of evidence about the impact of this system on maternity care led us to identify seven aims for a high-functioning liability system in this clinical context. Herein, we identify policy strategies that are most likely to meet these aims and contribute to needed improvements. A companion paper considers strategies that hold little promise.MethodsWe considered whether 25 strategies that have been used or proposed for improvement have met or could meet the seven aims. We used a best available evidence approach and drew on more recent empirical legal studies and health services research about maternity care and liability when available, and considered other studies when unavailable.FindingsTen strategies seem to have potential to improve liability matters in maternity care across multiple aims. The most promising strategy—implementing rigorous maternity care quality improvement (QI) programs—has led to better quality and outcomes of care, and impressive declines in liability claims, payouts, and premium levels.ConclusionsA number of promising strategies warrant demonstration and evaluation at the level of states, health systems, or other appropriate entities. Rigorous QI programs have a growing track record of contributing to diverse aims of a high-functioning liability system and seem to be a win–win–win prevention strategy for childbearing families, maternity care providers, and payers. Effective strategies are also needed to assist families when women and newborns are injured.     

当前《母婴保健法》实施中存在的问题及对策

《中华人民共和国母婴保健法》(以下称《母婴保健法》)实施以来 ,对依法保障母亲和婴儿健康 ,提高出生人口素质发挥了重大作用 ,但在实施过程中还存在着一些问题 ,阻碍着我国妇幼保健事业的发展 ,亟待加以解决。1　《母婴保健法》实施的效果《母婴保健法》的颁布实施体现了国家     

Virtual Prenatal and Postpartum Care Acceptability Among Maternity Care Providers

Maternal and Child Health Journal - The Covid-19 pandemic and statewide stay-at-home orders abruptly impacted clinic operations necessitating the incorporation of telehealth. Uptake of telehealth...     

各具特色的国外妇幼保健工作

本文通过对国际上几个主要国家的妇幼保健工作的介绍,使人们对不同特色的妇幼保健事业有所了解,他山之石,可以攻玉,希望能够对我国妇幼保健工作的发展提供借鉴。     

徐州市妇幼保健院

徐州市妇幼保健院始建于1957年,是一所集医疗、保健、预防、科研教学为一体的三级甲等妇幼保健院、徐州医学院附属徐州妇幼保健院、全国首批爱婴医院、全国内镜与微创专业技术妇科培训基地、江苏省妇科内镜诊疗技术培训基地、江苏省苏北片遗传医学诊断中心、江苏省新生儿疾病筛查中心徐州分中心、江苏省AAA级诚信服务医疗保险定点单位。     

Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana

BackgroundMaternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with risk of death during pregnancy and up to 1 year postpartum among women in Louisiana from 2016 to 2017.MethodsData provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all pregnancy-associated deaths verified by the Louisiana Department of Health (n = 112 from 2016 to 2017) and geocoded live births occurring in Louisiana during the same time period (n = 101,484), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory spatial analysis to identify significant associations between place of residence and risk of death.ResultsWe found that the risk of death during pregnancy and up to 1 year postpartum owing to any cause (pregnancy-associated mortality) and in particular death owing to obstetric causes (pregnancy-related mortality) was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access (adjusted risk ratio [aRR] for pregnancy-associated mortality, 1.91; 95% confidence interval [CI], 1.15–3.18; aRR for pregnancy-related mortality, 3.37; 95% CI, 1.71–6.65). A large racial inequity in risk persisted above and beyond differences in geographic access to maternity care (non-Hispanic Black vs. non-Hispanic White aRR for pregnancy-associated mortality, 2.22; 95% CI, 1.39–3.56; aRR for pregnancy-related mortality, 2.66; 95% CI, 1.16–6.12).ConclusionsEnsuring access to maternity care may be an important step toward maternal mortality prevention, but may alone be insufficient for achieving maternal health equity.     

Midwifery Care at a Freestanding Birth Center: A Safe and Effective Alternative to Conventional Maternity Care

Objective

To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.

Data Sources/Study Setting

Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions.

Study Design

Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care. We match on observable characteristics available on the birth certificate, and we use distance to the birth center as an instrument.

Data Collection/Extraction Methods

Birth certificate data from 2005 to 2008.

Principal Findings

Women who receive birth center care are less likely to have a C-section, more likely to carry to term, and are more likely to deliver on a weekend, suggesting less intervention overall. While less consistent, findings also suggest improved infant outcomes.

Conclusions

For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.     

青岛市长期医疗护理保险：制度效能、实施困境与政策优化

目的:分析青岛市长期医疗护理保险制度的实践现状,为我国长期医疗护理制度提供参考。方法:采用案例分析法对青岛市的长期医疗护理保险制度进行个案剖析,同时将青岛实践与部分发达国家经验进行对比分析。结果:青岛市首创性地实施了长期医疗护理保险制度,在制度效能与实施困境方面为我国养老风险的制度性化解提供了参考路径。结论:针对该制度的实施困境,应当从法制建设、筹资结构、储备社工资源、政策公平性等角度优化长期医疗护理保险制度。