Steve Calvin M.D. on pregnancy care, health care reform, and innovation

What is the goal of pregnancy care?

Yesterday we met with the president of Minnesota Community Measurement ( to discuss what pregnancy care measurements would be most valuable as Minnesota leads the way in pregnancy care reform.  Cesarean section rates are obviously a major focus but it occurred to us that there is a more valuable measure that would help mothers choose care and to help providers and systems improve.  That measure would be the percentage of mothers who are able to accomplish a vaginal birth at term – maybe we could call it the “optimal pregnancy outcome” measure.   This goal seems self-evident but sometimes our real priorities get buried in the confusion of the current system.

It’s always better to be known for what you are for than for what you are against.  We should all be for safe, satisfying, and cost-effective pregnancy care.  And we all know that cesarean section birth for more than one in three mothers is a bad thing.  The recent focus on maternal and newborn risks of elective induction of labor as well as support for the option of vaginal birth after cesarean section will be helpful in slowing the growth in the cesarean section rate.   But our efforts to stop the behaviors that increase cesarean sections should be accompanied by active promotion of the things that will increase the chances for an optimal pregnancy outcome (OPO) of vaginal birth at term.   Read Henci Goer and Amy Romano’s book.

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