Contested Care: The Limitations of Evidence-Based Maternity Care Reform

Abstract

Promoting evidence-based medicine is a leading strategy for improving quality of care and reducing costs in the U.S. health care system. Obstetrics is one health care specialization where the disjunction between standard practice and the latest in scientific evidence is particularly stark. Advocates have increasingly turned to evidence-driven strategies as a primary mode of support for their campaigns to shift away from a medicalized model of childbirth and improve both maternal and infant outcomes. Evidence-based advocacy influences norm setting in a variety of different legal and quasi-legal contexts; these range from formal legislative change, to amendment of the professional guidelines that establish standards of care for practicing obstetricians, to revision of the institutional policies that determine the quality of care women receive when giving birth in hospitals. In the highly contested terrain of childbirth, evidence-based medicine thus serves as an important frame for debates about control over medical decision-making, the limits of acceptable risk for women and their babies, and the very meaning of a positive birth outcome. This Article examines the state of maternity care in the United States, offering a critical analysis of reform efforts that employ evidence-based arguments as their main strategy to change the laws, policies, and practices that shape childbirth. The critique is grounded in feminist concerns about overreliance on professional experts and scientific knowledge, the limitations of study design and research methodologies, and the role of structural economic and legal conditions that impact decision-making about women’s bodies and health. The Article concludes that evidence-driven approaches to changing maternity care hold great potential for legal and policy reform but should be pursued alongside other arguments grounded in law and morality, lest the promotion of evidence-based maternity care limit attainment of the ultimate goal reformers share: better birth for women and babies.

Keywords: Health Care, Maternal Health, Social Movements, Evidence-Based Medicine