Clinical Controversies

Conflict about home birth, VBAC, vaginal breech and twin birth, elective induction, and cesarean section without indication occurs in the context of the current maternity care delivery system that offers perverse financial incentives favoring overuse of cesarean surgery versus skill-based and time-intensive approaches to facilitating labor and birth. Gaps between evidence and practice, uncertainty about effects of inadequately assessed practices, and diminished access to many forms of care pit many women and their preferences against the maternity care available in their communities. Decreased use of some practices, often the result of liability concerns, is leading to loss of skills and unsupportive environments. Care for childbearing women and newborns should be provided within an integrated system that ensures respect and support for women’s informed choices while responding appropriately to unexpected needs.

Read more about PROBLEMS related to clinical controversies and system GOALS >>

Major Recommendations and Action Steps

  1. Align practice patterns and views of both maternity caregivers and consumers with best current evidence about controversial clinical scenarios and evidence-based maternity care generally.
  2. At the clinical microsystem and health care organization levels, implement policies and practices that foster safe physiologic childbirth and decrease excessive use of elective procedures and interventions.
  3. At the macro environmental level, institute legislative and policy initiatives, payment incentives, and liability protections to foster access to a full range of care options for labor and birth supported by evidence.

Learn more about the ACTION STEPS for implementing these recommendations. >>

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