Effective, Respectful Care for All Pregnant women: On Our Way, But Not Yet There

By Cynthia Pearson

Improving health care for pregnant women has been one of NWHN’s goals since the very beginning. We’ve made a lot of headway since 1975, when pregnant women were still subject to untested drugs, unsafe advice, and inhumane hospital routines. But we’re still far from where we’d like to be: with a health care system that welcomes all women; treats them respectfully; offers them information; and provides support and care that’s been proven to be safe and effective.

One reason why all pregnant women don’t get the best possible care is that the health care system has too many incentives for physicians and hospitals to provide services that have been proven to be either unnecessary or unsafe. It’s tough to change medical practice — think how long it took advocates to get physicians to stop routinely recommending hormone therapy to all older women. But it can be done, especially if consumers, clinicians, policy makers and payers all band together to insist upon change. A new report aims to do just that – make change. The report, Evidence-Based Maternity Care: What It Is and What It Can Achieve, offers a road map for improving women’s health by using practices that have been shown to be effective (such as using midwives and family practitioners to attend normal births) and by limiting practices that are overused and can be harmful (like continuous electronic fetal monitoring). The report was written by the Childbirth Connection and co-published with a policy think thank and a group of State health officials who are interested in improving care and reining in wasteful spending in the health care system. We’ll publish more in a future issue about this great example of advocates strategically linking their efforts with partners who can help push for change. (The report is available at www.childbirthconnection.org.)

Another reason why some pregnant women do not receive the best possible care is that they are judged and treated punitively by their health care providers. The National Advocates for Pregnant Women (NAPW) is tackling this problem head-on by defending pregnant women’s civil rights. NAPW handles cases in which women are denied the right to be treated with respect and offered app-ropriate services. The organization is best-known for defending pregnant women who have been tested for substance abuse without their consent and then turned over to the criminal system and denied medical care. A recent NAPW case involved a woman who rejected electronic fetal monitoring and asked that a nurse use a stethoscope instead. Despite the fact that evidence shows that electronic monitoring isn’t needed in routine childbirths, the hospital sent a psychiatrist to evaluate the woman for mental illness. (We are not making this up.) We’re so impressed with NAPW’s work that we recently honored founder Lynn Paltrow with one of the first Barbara Seaman Awards for Activism in Women’s Health. We’ll write more about the awards in an upcoming issue, but you can learn more now by visiting their website or our’s.