Greetings, a non-academic colleague (childbirth activist) is putting
together a proposal for
childbirth professionals (obstetricians, anesthesiologists, midwives,
researchers, etc.) to
convene a symposium to examine current issues regarding pain management
in
labor.
She has asked me whether any studies exist which examine the
economic impact on hospitals, anesthesiologists, and
managed care/insurance companies in the situation of increasing use of
epidural anesthesia during labor? She's interested in such things as,
How do anesthesiologists bill for their services? How much of a
hospital's
maternity revenue is affected by the epidural rate? How has maternity
care
been
reorganized with the increasing epidural rate, ie., nursing roles,
relationships between
medical staff over administering and monitoring epidural meds. What
options
for
nursing care are provided by hospitals for women who do not want/recieve
epidurals?
All good social science type questions. I had few answers!
As a bit of background,
The use of epidural anesthesia during childbirth is rising dramatically
in
US hospitals. According to a press report from the American Society of
Anesthesiologists, "In larger hospitals, the use of regional anesthesia
tripled during the 15 years from 1981 to 1997. Sixty-six percent of
women in
the largest hospitals received regional analgesia in 1997 versus 55
percent
in 1992 and 22 percent in 1981. The percentage of women receiving
regional
analgesia in smaller hospitals nearly doubled in five years from 21
percent
in 1992 to 42 percent in 1997". (Hawkins, 1999, ASA).
The obstetrics literature and independent studies such as one
conducted recently by Rand researchers seems to indicate that increased
epidural rates have a significant impact on increased cesarean rates.
Interestingly, the anesthesiology literature finds no such impact and
contests
studies which do. A case where scientific results are embedded within
competing economic and professional interests, not to mention the impact
on women's actual and potential childbirth options and experiences.
I'm intrigued by the possible significance of this finding as reported
by
Hawkins, 1999 on behalf of the American Society of Anesthesiologists:
"At the same time, the responsibility for virtually all obstetric
anesthesia care now falls to anesthesiologists. In 1981, obstetricians
in
the larger hospitals provided 26 percent of labor epidurals and 3
percent of
c-section epidurals. In 1997, obstetricians provided virtually none of
the
anesthesia care for labor or c-section deliveries."
Could it be that as anesthesiologists, as opposed to obstetricians,
started
providing anesthesia care to obstetrics patients, the epidural rates
went up
accordingly?
For people looking for a research topic, this would be a very
interesting
one
to pursue, I think. My cursory examination of the health services and
medical
literature didn't turn up very much. I'm interested to hear from those
of
you
who might know of other studies in this area.
Thanks in advance for your help.
Christine Morton
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Christine Morton, PhD Candidate, UCLA Sociology Department
Mailing Address: 18003 NE 30th Street, Redmond WA 98052
Email: [log in to unmask] Web: www.christinemorton.com
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Reproductive Network --- www.repronetwork.org
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--
Dr Jane Sandall
Reader in Midwifery
Dept. Midwifery
City University
London, E1 2EA
Tel: 0171 505 5871
Fax: 0171 505 5866
[log in to unmask]
http://www.city.ac.uk/barts/midwiferyintro.htm
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