The Health Care Dimension: Delivering Care for High-Risk Pregnant Women and Preterm Infants

Abstract

This chapter examines the medical care provided to high-risk pregnant women and to preterm newborns. In the U.S., this care often involves technologically focused interventions, including some that are of questionable effectiveness. The drivers of this maximalist approach to care are provider competition, an urge to action in response to cultural expectations that medical care can assure positive pregnancy outcomes, and commercial interest in increasing revenue by providing more goods and services. This chapter explores the consequences of this approach, in terms of system organization (over-capacity of NICUs and a fragmented maternal referral system), and high healthcare expenditures. Women’s experiences of high-risk pregnancies and families’ experiences once preterm infants are born are conditioned by shared cultural understandings and affected by the dynamics of the healthcare delivery system. The U.S. health care system, with its orientation toward healthcare as a business and the minimal decision-making role played by government entities, is quite different from the healthcare systems of Canada, Great Britain, and Western Europe. In these other settings, health care is publicly financed, and maternity care systems are more primary care focused and more systematically organized. This limits the overtreatment that sometimes occurs in the U.S. system, reduces practice variation, and orients care providers to pay more attention to the clinical value of treatments, but it can also mean that infants born prematurely have less immediate access to NICU care, relative to the U.S.