PREVENTING A RETURN TO TWILIGHT AND STRAITJACKETS: Using the Patient Protection and Affordable Care Act as a Starting Point for Evidence-Based Obstetric Reform in the United States

Cruz O'Malley, Alexius | June 19, 2013

The United States has the most medicalized approach to childbirth of any nation in the world. Women in the United States have a greater lifetime risk of dying due to pregnancy-related complications than women in forty other developed nations. Babies born in the United States have a higher risk of dying within the first months of life than babies born in the forty other countries. Poor outcomes combined with costly, procedure-intensive care have been labeled the “perinatal paradox: doing more and accomplishing less.” Inspired by her own pregnancy and childbirth experience, the Author explores this “perinatal paradox” and the state of obstetric care in the United States today; the social policy implications of this most-medicalized approach; and proposes best-evidence based reform using the Patient Protection and Affordable Care Act (PPACA) as a starting point. The present Article first explores the systematic issues plaguing obstetrics and the maternal experience in the United States, historically and today. Second, it discusses several causal theories including: the practice of defensive medicine, fee-for-service medical reimbursement systems, and for-profit insurance companies and hospitals. Third, it details the legislative history of the Patient Protection and Affordable Care Act (PPACA), identify several starting points the PPACA provides for evidence-based reform, and then proposes several enhancements to move obstetric care forward. Ultimately the Article promotes the use of best-evidence based care, integrative healthcare information technology systems, greater access to midwives and birth centers, combined with the advances made by PPACA, in an effort to significantly enhance obstetric care in the United States and save the lives of women and babies across the country.