Whenever I'm on-call on a weekend, I'm always charmed by the birth class. A dozen couples are led on a tour of Labor and Delivery, the postpartum floor, and the nursery. I often see the couples in the cafeteria after the class is over, enjoying lunch and each other, sharing in the preparation for the birth of their child that may be a few weeks or months away. Seeing these couples always brings a smile to my face, but until recently I never considered that the classes might be more than a bonding experience.
Now I have another way to view these classes, courtesy of the management team at Isis Parenting:
Pregnancy is one of those medical events where cost-savings and quality care are (mostly) aligned. What's the number one way payers could reduce the cost of pregnancy? Convert cesareans into vaginal deliveries (hospitals get paid a lot more for a c-section than for a vaginal delivery). How else could costs be reduced? Make sure neither mom nor baby is readmitted to the hospital after discharge for a preventable complication. (Another way to reduce costs -- one that may not align with quality care -- is to reduce prenatal ultrasounds and fetal testing.)
The primary quality initiative in obstetrics right now is the push to avoid unnecessary deliveries before 39 weeks. When doctors don't induce labor before that point, or move to an early c-section, the consequence is -- you guessed it -- a tendency to let women labor on their own which increases the chance that a vaginal birth will result (and a cesarean will be avoided).
Key to all of this is patient education. Prepared and educated parents advocate for waiting until 39 weeks, and are better prepared to care for themselves and their newborn when they are discharged home.
In this light, that class on a Saturday afternoon isn't just a shared parenting activity, but is a strategic educational intervention designed to improve quality, reduce costs, and promote patient satisfaction.
In 2003, the largest birthing hospital in Boston outsourced its maternity classes to Isis Parenting. Their thinking was simple: running the classes was a headache. If Isis could do it off-site and make money (classes are mostly self-pay), it would be a win-win. Eight years later, Isis does the same thing for five hospitals in the Boston area, and plans to scale nationally.
The part I find most interesting is that Isis is in discussions with a large health insurance company, which is thinking about subsidizing classes for its covered pregnant ladies, taking over a cost traditionally borne by the patient herself. The insurance company is buying into the idea that classes improve quality and save money.
To be fair, I haven't seen any empirical data demonstrating that pregnancy classes save money and improve the quality of anything beyond the relationship between the expectant mom and her partner. It's one of the dirty little secrets of public health that investment in preventive care rarely saves money in the long run.
But anecdotally, childbirth educators hear from patients that childbirth education is the first step and a feeder into newborn care, breastfeeding and CPR classes. Isis' prenatal classes cover postpartum depression warning signs and encourage women to join a new moms group after the baby comes for additional education and support. "We fill the void left by the disintegration of the cohabitating extended family that traditionally supported new moms in earlier history," said Chris Just, Isis' director of prenatal education. Read one mom's life-saving story here.
But as our health system asks for higher value from the physicians and hospitals that are providing care, it makes sense that one way to encourage higher quality is to educate patients to demand it. And if better care is cheaper care, all the better.
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