Can moms always be sure they're getting the best maternity care?

Heather Larson

Despite being a wealthy, First World country, the United States has one of the highest infant death rates among comparable countries - an average of 6.7 infants die out of every 1,000 live births. In comparison, the infant death rate in Japan is 2.6 infants out of every 1,000 live births.

maternity-careJennifer Margulis set out to discover what was going wrong with maternity care in the U.S. While in her current post as Senior Fellow at the Schuster Institute for Investigative Journalism at Brandeis University she wrote "The Business of Baby: What Doctors Don't Tell You, What Corporations Try to Sell You and How to Put Your Pregnancy Before Their Bottom Line." In her book she gives examples of corporate profits and private interests trumping what is best for moms and babies. spoke with Margulis about her motivation for writing this book, why her message needs to get out and what action she hopes readers of the book will take.

Are moms in the U.S. always getting the best maternity care?

What prompted you to write this book?

We spend more money on health care than any other country yet we have one of the highest infant death rates in the industrialized world. Hospital protocol says newborns should have a Hepatitis B vaccine even though there's no medical need for it unless mom tests positive for Hepatitis B. The disease spreads through sexual contact, using dirty needles or transfusions of tainted blood. But the vaccine may cause irritability, fever, diarrhea or loss of appetite. I wanted to find out why we take this potentially harmful action and others.

Why do obstetricians and pediatricians allow the Hepatitis B vaccine?

Even though most doctors have the best possible intentions, they often go along with a broken and sometimes dangerous system. That's what they know and what they're taught in medical school. Until recently, most parents didn't question a doctor's authority, but now there are parents who don't believe the current vaccination schedule should be followed.

How do drug company hand-outs affect doctors' prescribing habits?

A well-known example is a 2005 study from the University of Montana. It found that physicians with access to free drug samples were less likely to prescribe cheaper generic drugs than those doctors who didn't have such access. They were also less likely to recommend over-the-counter medications that would have been appropriate alternatives to the expensive prescribed meds - thus paradoxically increasing total drug costs for patients who had started off with the free samples.

How did the United States get to a place where corporate profits and private interests trump what is best for a pregnant mother-to-be and her newborn?

Pharmaceutical companies spend $20 billion a year on doctor goodwill, which includes free medications for physicians and their families, catered dinners, plane fares to conferences and more. Medical professionals with the best intentions accept these benefits, and since many other doctors in America are doing the same, they think it's okay.

Most obstetricians recommend moms-to-be take prenatal vitamins. Do those cause any harm?

Most over-the-counter and prescription prenatal vitamins contain toxic ingredients like petroleum-based food dyes and titanium dioxide. Also, synthetic vitamins don't provide the nutritional insurance they advertise. The supplements may not break down in the body like they should, which means nutrients aren't being absorbed. Instead of prescribing vitamins, doctors should take the time to educate their pregnant patients on how to eat for optimal health.

Is it true that the more patients an obstetrician sees in a day, the more money he makes?

In general, yes. Doctors in private practice make more money if they see more people, while doctors in HMOs also get rewarded financially for rushing through as many patients as they can. It's not uncommon to wait in a waiting room for an hour because the doctor has overscheduled his appointments. The average prenatal visit lasts less than 15 minutes.

You also wrote in your book that doctors get paid extra for each individual test they order for a pregnant woman. Does that mean unnecessary tests for expectant moms?

Most doctors don't order tests just to increase their profits, but there's a tremendous financial incentive to do so. A practice charges almost twice as much for a prenatal visit that includes an ultrasound than one that doesn't. Pregnant women are not paying out-of-pocket for this routine testing so it is the insurance companies that are getting charged. I urge mothers-to-be to forgo ultrasound testing especially in the first trimester unless there is a real medical indication for it. Prolonged or ill-timed ultrasound exposure may be more harmful than your doctor says. An increasing body of research also suggests prenatal ultrasound exposure is one trigger for autism in susceptible children. Some women find testing deeply reassuring, but testing (can) create a tremendous amount of stress.

What actions do you hope readers of your book will take?

I want them to make safe evidence-based choices, refuse unnecessary testing and better understand that (sometimes) what doctors recommend to them in the name of good health is actually big business advertising.