Abstract
THESIS: Despite spending more on medical care than any other country in the world, the United States still boasts some of the worst patient outcomes of any developed nation. This disparity is especially true of how Americans give birth and die. These natural human transitions have become catastrophically expensive and leave patients and their families traumatized from unnecessary interventions. This article examines the costs and outcomes associated with the medicalization of birth and death and argues that alternatives exist that improve patient outcomes while lowering costs. Access to these alternatives will require changing current regulatory and reimbursement structures and providing trained support staff to help families navigate beginning- and end-of life decisions.
Similar content being viewed by others
Further Reading
Aldridge, M., & Kutner, J. 2014. Improving access to high quality hospice care: What is the optimal path? Health Aff Blog. September. http://healthaffairs.org/blog/2014/09/09/improving-access-to-high-quality-hospice-care-what-is-the-optimal-path/. Accessed 25 March 2016.
Andrews, M. 2014. Health law provides no guarantees of access to birthing centers. http://NPR.org. http://www.npr.org/sections/health-shots/2014/03/03/285299551/health-law-provides-no-guarantees-of-access-to-birthing-centers. Accessed 11 Jan 2016.
Angus, D. C., & Truog, R. D. 2016. Toward better ICU use at the end of life. JAMA, 315(3), 255.
Aragon, K., Covinsky, K., Miao, Y., Boscardin, W. J., Flint, L., & Smith, A. K. 2012. Use of the Medicare posthospitalization skilled nursing benefit in the last 6 months of life. Archives of Internal Medicine, 172(20), 1573.
Barnato, A. E., Mcclellan, M. B., Kagay, C. R., & Garber, A. M. 2004. Trends in inpatient treatment intensity among Medicare beneficiaries at the end of life. Health Services Research, 39(2), 363–376.
Bekelman, J. E., Halpern, S. D., Blankart, C. R., et al. 2016. Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA, 315(3), 272.
Bell, M. 2013. Why 5% of Patients create 50% of Health Care Costs. Forbes. http://www.forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/. Accessed 7 Jan 2016.
Bernacki, R. E., & Block, S. D. 2014. Communication about serious illness care goals: A Review and Synthesis of Best Practices. JAMA Internal Medicine, 174(12), 1994. doi:10.1001/jamainternmed.2014.5271.
Biasucci, G., Benenati, B., Morelli, L., Bessi, E., & Boehm, G. 2008. Cesarean delivery may affect the early biodiversity of intestinal bacteria. The Journal of Nutrition, 138(9), 1796S–1800S.
Caughey, A. B., Cahill, A. G., Guise, J.-M., & Rouse, D. J. 2014. Safe prevention of the primary cesarean delivery. Obstetrical & Gynecological Survey, 69(7), 381–383.
Connors, A. F. 1995. A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA, 274(20), 1591.
Conrad, P. 2007. The Medicalization of Society. Baltimore, MD: Johns Hopkins University Press.
Corry, M., Napoli, M., Pollack, R., Ness, D., Pearson, C., Norsigian, J. 2006. Letter to ACOG President, Douglas Laube, MD, MEd, concerning ACOG’s statement on out-of-hospital births. December. http://www.childbirthconnection.org/pdfs/ACOG-place-of-birth.pdf.
Declercq, E., Sakala, C., Corry, M., Applebaum, S., & Herrlich, A. 2013. Listening to Mothers III: Pregnancy and Birth. New York:Childbirth Connection http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_MajorSurveyFindings_PregnancyAndBirth.pdf. Accessed 7 Jan 2016.
Fisher, K. A., Rockwell, L. E., & Scott, M. 2008. In Defiance of Death: Exposing the Real Costs of End-of-Life Care. Westport:Praeger.
Fox, B., & Worts, D. 1999. Revisiting the critique of medicalized childbirth: A contribution to the sociology of birth. Gender and Society, 13(3), 326–346.
Gawande, A. 2014. Being Mortal: Medicine and What Matters in the End. New York:Picador.
Gawande, A. 2016. Quantity and quality of life: Duties of care in life-limiting illness. JAMA, 315(3), 267.
Goer, H. 2002. The assault on normal birth: The OB disinformation campaign. Midwifery Today, 63, 10–15.
Hearn, J., & Higginson, I. J. 1998. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317–332.
Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. 2012. Continuous support for women during childbirth. In The Cochrane Collaboration (Ed.), Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons, Ltd.
Hospice Care in America. 2012. National Hospice and Palliative Care Organization. http://www.nhpco.org/sites/default/files/public/Statistics_Research/2012_Facts_Figures.pdf. Accessed 14 Sept 2016.
Howell, E., Palmer, A., Benatar, S., Garret, B. 2014. Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center. Centers for Medicare & Medicare Services, Office of Information Products & Data Analytics.
Institute of Medicine. 2014. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, D.C.: National Academy Press, Institute of Medicine.
Johanson, R., Newburn, M., & Macfarlane, A. 2002. Has the medicalisation of childbirth gone too far? BMJ, 324(7342), 892–895.
Johnson KC. 2005. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 330(7505):1416–0.
Kamal, A. H., Currow, D. C., Ritchie, C. S., Bull, J., & Abernethy, A. P. 2013. Community-based palliative care: The natural evolution for palliative care delivery in the U.S. Journal of Pain and Symptom Management, 46(2), 254–264.
Klinger, C. A., Howell, D., Zakus, D., & Deber, R. B. 2014. Barriers and facilitators to care for the terminally ill: A cross-country case comparison study of Canada, England, Germany, and the United States. Palliative Medicine, 28(2), 111–120.
Kozhimannil, K., & Hardeman, R. 2015. How Medicaid coverage for doula care could improve birth outcomes, reduce costs, and improve equity. Health Affairs. http://healthaffairs.org/blog/2015/07/01/how-medicaid-coverage-for-doula-care-could-improve-birth-outcomes-reduce-costs-and-improve-equity/. Accessed 14 Feb 2016.
Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O’Brien, M. 2013. Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 103(4), 113–121.
Laliberté, F., Lefebvre, P., Law, A., et al. 2014. Medicaid spending on contraceptive coverage and pregnancy-related care. Reproductive Health, 11(1), 20.
Lindheim, R. 1981. Birthing centers and hospices: Reclaiming birth and death. Berkeley:Center for Environmental Design Research.
MacDorman, M., Mathews, T. J., Declercq, E. 2012. Home births in the United States. http://www.cdc.gov/nchs/data/databriefs/db84.pdf. Accessed 7 Jan 2016.
Mattes, M. D., & Sloane, M. A. 2015. Reflections on Hope and Its Implications for End-of-Life Care. Journal of the American Geriatrics Society, 63(5), 993–996.
Midwest Bioethics Center 2002. Barriers to Hospice Care and Proposed Policy Solutions. Kansas City:Midwest Bioethics Center http://practicalbioethics.org/files/members/documents/SI_17.pdf.
Midwives Alliance of North America. 2016. Midwifery laws state-by-state. http://mana.org/about-midwives/state-by-state. Accessed 23 March 2016.
Miyashita, M., Morita, T., Sato, K., Hirai, K., Shima, Y., & Uchitomi, Y. 2008. Good death inventory: a measure for evaluating good death from the bereaved family member’s perspective. Journal of Pain and Symptom Management, 35(5), 486–498.
Odejide, O. O. 2016. A policy prescription for hospice care. JAMA, 315(3), 257.
Ornstein, K., Aldridge, M., Garrido, M., Gorges, R., Meier, D., & Kelley, A. 2015. Association between hospice use and depressive symptoms in surviving spouses. JAMA Internal Medicine, 175(7), 1138–1146.
Oster, E. 2013. Expecting Better: Why the Conventional Wisdom Is Wrong-- and What You Really Need to Know. New York, NY: Penguin Books.
Rooks, J. P., Weatherby, N. L., Ernst, E. K., Stapleton, S., Rosen, D., & Rosenfield, A. 1989. Outcomes of care in birth centers. The National Birth Center Study. The New England Journal of Medicine, 321(26), 1804–1811.
Rosenthal, E. 2013a. American way of birth, costliest in the world. The New York Times. http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html. Published June 30. Accessed 7 Jan 2016.
Rosenthal, E. 2013b. Getting insurance to pay for midwives. Well. http://well.blogs.nytimes.com/2013/07/03/getting-insurance-to-pay-for-midwives/. Accessed 11 Jan 2016.
Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. 2015. Midwife-led continuity models versus other models of care for childbearing women. In The Cochrane Collaboration (Ed.), Cochrane Database of Systematic Reviews. Chichester: John Wiley & Sons, Ltd.
Shah, N. A. 2015. NICE Delivery — The cross-atlantic divide over treatment intensity in childbirth. The New England Journal of Medicine, 372(23), 2181–2183.
Span, P. A. 2015. Quiet End to the “Death Panels” Debate. The New York Times. http://www.nytimes.com/2015/11/24/health/end-of-death-panels-myth-brings-new-end-of-life-challenges.html. Published November 20. Accessed 25 March 2016.
Stapleton, S. R., Osborne, C., & Illuzzi, J. 2013. Outcomes of care in birth centers: Demonstration of a durable model. Journal of Midwifery & Women's Health, 58(1), 3–14.
Taylor, D. H., Ostermann, J., Van Houtven, C. H., Tulsky, J. A., & Steinhauser, K. 2007. What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program? Social Science & Medicine, 65(7), 1466–1478.
Temel, J. S., Greer, J. A., Muzikansky, A., et al. 2010. Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733–742.
Teno, J. M., Mitchell, S. L., Kuo, S. K., et al. 2011. Decision-making and outcomes of feeding tube insertion: A five-state study: Decision-making and outcomes of feeding tube insertion. Journal of the American Geriatrics Society, 59(5), 881–886.
The Medicare Payment Advisory Commission. 2015. Report to the Congress: Medicare Payment Policy. 285–312. http://medpac.gov/documents/reports/chapter-12-hospice-services-%28march-2015-report%29.pdf?sfvrsn=0. Accessed 10 Jan 2016.
Truven Health Analytics. 2013. The cost of having a baby in the United States. January. http://www.chqpr.org/downloads/CostofHavingaBaby.pdf.
Van Teijlingen, E. R. 2004. Midwifery and the medicalization of childbirth: Comparative perspectives. New York:Nova Science Publishers, Inc..
Waldenström, U., & Nilsson, C.-A. 1993. Women’s satisfaction with birth center care: A Randomized, Controlled Study. Birth, 20(1), 3–13.
Wax, J. R., Lucas, F. L., Lamont, M., Pinette, M. G., Cartin, A., & Blackstone, J. 2010. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol, 203(3), 243.e1–243.e8.
Wertz, R. W., & Wertz, D. C. 1977. Lying-in: A History of Childbirth in America. New York:Free Press.
Whoriskey, P., & Keating, D. 2014. Dying and profits: The evolution of hospice. The Washington Post. https://www.washingtonpost.com/business/economy/2014/12/26/a7d90438-692f-11e4-b053-65cea7903f2e_story.html. Published December 26, 2014. Accessed 25 March 2016.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hall, L.K. Rehumanizing Birth and Death in America. Soc 54, 226–237 (2017). https://doi.org/10.1007/s12115-017-0129-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12115-017-0129-6