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Information on policies, protocols and rates of outcomes in the United States maternity care system—known as “transparency”—is widely unavailable to the general public. Without this information, women cannot make fully informed decisions about their health care, which can have adverse effects on their care during pregnancy and birth, according to Elan McAllister in the December issue of The Journal of Perinatal Education.

Women who are well informed about their choices have better birth outcomes, according to McAllister.

Without transparency, a woman is unable to make informed decisions regarding her care. According to McAllister, where and with whom a woman births directly affects her experience and chance of enduring certain obstetrical interventions, including induction, episiotomy and Caesarean surgery, all of which carry risks. Women who choose a facility or practitioner with a high rate of Caesarean surgery, for example, increase their risk of having a Caesarean birth.

Transparency also serves to hold medical facilities and practitioners more accountable for their policies and practices. Transparency requires medical facilities to disclose accurate rates of birth outcomes, commonly used medical procedures, and Caesarean surgeries. Transparency also requires practitioners to provide rates of procedures used (including episiotomies and Caesareans) as well as patient satisfaction reports. The belief is that when practitioners and facilities are held more accountable, the quality of care improves.

“Choosing the right facility and practitioner is one of the most important first steps toward a healthy pregnancy and birth,” said Lamaze International President Pam Spry. “The medical system is responsible to provide women with the ability to make an informed choice.”

Couples choosing a facility can use the questions provided with this article as a starting point.

New York requires hospitals and birth centers to provide the annual rates of obstetric procedures to patients in its Maternity Information Act. Choices in Childbirth, a grassroots nonprofit group in New York, is working to help activists pass similar legislation in other states.

The Birth Survey also is a tool for consumers, founded by the Coalition for Improving Maternity Services. Couples can provide feedback on their hospital or birth center experiences so others can make informed decisions.

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